If you have had a head injury and you have not recovered completely, it is important to see a specialist who has experience in managing all aspects of head injured patients.

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It is vitally important to make sure that you have not had a bleed into the brain as this may require urgent treatment even if you are walking. It may get worse very quickly and the best time to operate is before this happens. As a rough rule, for every hour you spend with a neurological problem, it will take you another week to recover fully.

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You do not have to loose consciousness (pass out) to have suffered a signigicant head injury.

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Even if surgery is not required, specialist scans will help us recommend the best rehabilitation.

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If it becomes apparent that you are going to take a long time to recover we can support you during this time.

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Definition 

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Concussion is variably defined by different specialists, but there are key elements:

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• It is a complex pathophysiological process affecting the brain

• It is caused by mechanical forces

• It has characteristic clinical and cognitive symptoms

• There is a typical onset and resolution of symptoms

• Loss of consciousness is not a prerequisite for concussion.

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The problem with making a diagnosis is that there are no pathognomonic symptoms or signs, and no diagnostic imaging test.

Diagnosis needs to be based on assessment of symptoms, cognitive function and focused neurological assessment of balance.

Such assessment needs to factor in pre-existing symptoms, and is often most useful when done serially (several times) to detect changes, particularly given that symptoms may present in a delayed fashion.

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Symptoms

• Headaches

• Nausea or vomiting

• Dizziness or balance problems

• Tinnitus (ringing in the ears)

• Blurred vision

• Increased sensitivity to light or noise

• Feeling slow or tired: having no energy

• Concentration or memory problems

• Confusion

• Drowsiness or trouble sleeping

• Feeling very emotional or sad

• Irritability

• Feeling nervous or anxious  

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Diagnostic tools

There are a number of tools now available to act as a guide to diagnosing concussion. These do not provide absolute thresholds for diagnosis, nor have they all been validated. However, they provide a checklist of symptoms and signs to look for, and a valuable framework for documenting recovery following a concussion.

The Sports Concussion Assessment Tool (in its third version – SCAT3) is one such tool endorsed by FIFA, the IRB and the IOC. 

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Investigation of a concussed patient

Most patients who suffer a head injury that is bad enough to result in concussion will have had a CT scan. This may show nothing or it may show bruising (contusions). If it does show bruising this usually disappears within a week.

If you still have symptoms after a few weeks then an MRI scan is useful. MRI scans are much more sensitive and can pick up damage to the white matter tracts (the nerves that connect different parts of the brain). This is useful in

Magnetic resonance (MR) imaging can detect minor structural changes in concussion. Nonetheless, its role is currently in those cases where symptoms persist, as it is a useful prognostic tool.

 

New MR imaging techniques are advancing our understanding of concussion through advanced structural and functional analysis of the injured brain, and this in turn, may have therapeutic implications. This is particularly the case with higher magnetic field strengths such as 3 Tesla MRI scanners.

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While these symptoms will usually resolve with time they can be both distressing and disabling while they are present.

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Problems at work

A common problem is trying to go back to work too soon.

If you do a physical job then this will not help your brain to recover.

If you do a desk based job then the mental effort will not help your recovery and you will probably not perform at your best.

If possible, a staged return to work is often advisable. For example going back for 2 hours to start with and building up slowly.

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Problems at home

Slight personality disturbances may mean that you are, quite literally, not the same person that you were when you got married.

Irritability at things that would not usually make you irritated can make you difficult to live with. Understanding, or at least being aware that this can happen is the first step to coping with it.

 

Problems with money

Being worried about money is the last thing that you need when you are recovering from a head injury. For a start it will not help with your recovery.

Some people have savings, sick pay from work and family who can help them.

If you do not have any income then spiraling debts will cause more problems and may ultimately affect your recovery.