PREVENTION, ASSESSMENT, PROGNOSIS, AND TREATMENT OF CONCUSSION SYNDROME

INTRODUCTION

Concussion is caused by the transmission of impulsive forces to the brain, leading to biochemical and metabolic disturbances to the brain tissues. Concussion is commonly sports-related, but can also occur in falls and motor vehicle accidents. It is regarded as a form of mild traumatic brain injury (TBI), which is defined as a “trauma-induced disruption in neurologic function with loss of consciousness for <30 minutes, Glasgow Coma Scale of 13-15, or post-traumatic amnesia for <24 hours” (1). ‘Post-concussion syndrome’ is defined as symptoms persisting longer than 3 months, causing multiple areas of dysfunction (e.g. visual, vestibular, cognitive etc). This narrative review aimed to summarise the literature on the prevention, assessment, prognosis and treatment of concussion.

PREVENTION

Primary prevention of concussion involves educating the athlete on restricting/reducing exposure to high-risk activities, use of protective mouth guards and/or head gear (although the evidence for this is less conclusive), and rule changes in sports (e.g. increasing body-checking age in youth ice hockey).

Secondary prevention of concussion occurs after the head injury has already occurred. The authors recommend patients to be clinically recovered from the initial concussion before being exposed to activities with a risk of another concussion. The dangers of a second concussion soon after a first cannot be underestimated. ‘Second impact syndrome’ is referred to as death or disability occurring from a second concussion soon after the first one, which was reported to occur in adolescent boys due to dysregulation of blood flow to the brain (2). The period between the first and second concussion is also known as the “vulnerable window”. The athlete needs to be educated to restrict and reduce participation in high risk activities, and athletes should be assessed for complete clinical recovery before return to sport.

ASSESSMENT

At present, there is no clinical imaging method to diagnose concussion, and imaging is predominantly used to exclude moderate to severe TBIs. Intracranial or cervical injury should be ruled out immediately after a head injury. Patients who have lost consciousness

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