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Concussion: Symptoms, Pathophysiology, Recovery & Post‑Concussion Syndrome

Concussion = mild traumatic brain injury (mTBI) induced by biomechanical forces. No structural lesion on standard CT/MRI.

Pathophysiology

  • Ionic flux (K⁺ efflux, Ca²⁺ influx) → spreading depression‑like depolarization.
  • Metabolic crisis: ↑ glucose demand + ↓ cerebral blood flow → energy mismatch.
  • Axonal stretch injury (diffuse axonal injury, mild).
  • Neuroinflammation, microglial activation.

Acute Symptoms (4 Domains)

PhysicalCognitiveEmotionalSleep
Headache, nausea, dizziness, balance, visual, photophobia, phonophobiaFogginess, slowed processing, concentration, memoryIrritability, sadness, anxiety, labilityDrowsiness, insomnia, hypersomnia

Recovery Trajectory

  • Adults: 7–14 days typical.
  • Adolescents/children: longer (2–4 weeks).
  • Risk factors for prolonged: prior concussion, migraine, ADHD, anxiety, female sex, high initial symptom burden.

Post‑Concussion Syndrome (PCS)

Symptoms >4 weeks (adults) / >1 month (kids). Multifactorial: persistent neuroinflammation, autonomic dysregulation, cervical/vestibular/ocular dysfunction, psychological overlay.

Management

  1. Relative rest 24–48h (cognitive/physical), then sub‑symptom threshold activity.
  2. Targeted rehab: vestibular, ocular, cervical, exertion (Buffalo protocol).
  3. CBT for mood/sleep.
  4. Medications for specific symptoms (topiramate for headache, melatonin for sleep).
  5. Multidisciplinary clinic if >4 weeks.

Return‑to‑Learn/Play

Graduated stepwise protocols (Berlin Consensus). Medical clearance required.

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