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Concussion (Mild TBI): Symptoms, Recovery & Long-Term Risks

A concussion is a mild traumatic brain injury (mTBI) induced by biomechanical forces (direct impact or impulsive force transmitted to head) causing transient neurological dysfunction — without structural injury on standard neuroimaging.

Symptom Domains (SCAT6 / Clinical)

  • Physical: Headache (most common), dizziness, nausea/vomiting, photophobia, phonophobia, balance problems, fatigue, visual disturbances.
  • Cognitive: "Fog," slowed processing, concentration difficulty, memory impairment, confusion.
  • Emotional: Irritability, anxiety, sadness, lability.
  • Sleep: Drowsiness, insomnia, hypersomnia, altered architecture.

Red Flags — Emergency Evaluation

  • Loss of consciousness >1 min
  • Repeated vomiting
  • Seizure
  • Worsening headache
  • Focal neurologic deficits
  • Increasing confusion/agitation
  • Amnesia >24h (retrograde/anterograde)
  • Age <2 or >65, anticoagulation, bleeding disorder

Management

  1. Immediate removal from play/activity. "When in doubt, sit them out."
  2. Brief rest (24–48h) → sub-symptom threshold aerobic exercise (Buffalo protocol) — accelerates recovery vs. strict rest.
  3. Screen use moderation (not total avoidance).
  4. Symptom-limited return-to-learn/work/sport protocols (graded, stepwise).
  5. Multidisciplinary for persistent symptoms: vestibular therapy, vision therapy, cervical spine treatment, CBT, neuropsychology.

Recovery Timeline

  • Adults: 7–14 days typical; 10–30% >4 weeks (persistent post-concussive symptoms / PPCS).
  • Adolescents/children: longer (2–4 weeks typical).
  • Risk factors for prolonged recovery: prior concussions, migraine, ADHD, anxiety/depression, female sex, high initial symptom burden.

Long-Term Concerns

  • CTE (chronic traumatic encephalopathy): Associated with repetitive head impacts (not single concussion) — contact sport athletes, military.
  • Post-concussion syndrome / PPCS: Persistent symptoms >3 months — treatable with targeted rehab.
  • Second impact syndrome (rare, fatal): Second concussion before full metabolic recovery → malignant cerebral edema. Adolescents/young adults.

Concussion is a functional injury — treatable, recoverable with proper management. Early recognition and graded return are key.

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