Concussion: symptoms

Concussion symptoms are quite typical, but there are post-coma disorders, a syndrome of delayed signs of head trauma, which should also be known and be attentive to the slightest atypical manifestations, so as not to miss a serious pathology.

This is a typical consequence of any injury that is applied to the head. Even the lightest blow can lead to brain damage, moreover, according to statistics, the consequences of TBT are the most common cause of deaths worldwide. Symptoms of concussion directly depend on the degree of severity, in clinical surgical practice fall into the following categories: 

• An easy degree of trauma and concussion; 
• Severe-severe degree of CCT and concussion; 
• Severe injury and tremors.

The most common are tremors of mild degree. In the total number of injuries, these conditions occupy about 80% of all cases. Threatening symptoms of concussion - severe forms of CCT: diffuse lesion, compression, bruises inside the skull, trauma accompanied by deformation of bone fragments, fracture of the base of the skull. The most promising in terms of recovery is an easy degree of trauma, when a person loses consciousness for several minutes, and more often the trauma generally does without losing consciousness. All life support functions remain normal, neurological symptoms are observed, but not threatening. Short-term changes in the conductivity of nerve impulses are compensated by rest and observance of bed rest. This type of concussion usually passes fairly quickly, the functions are restored within two to three weeks.

[1], [2], [3], [4], [5], [6], [7]

How to distinguish the symptoms of concussion with more severe head injuries?

The concussion (tremor) of mild severity is characterized by the main groups of symptoms: 

• Signs concerning the head. This atypical fatigue and drowsiness, some confusion. There may be headache or dizziness, often nausea. Loss of memory, as a rule, is not observed. There may be painful sensations in the movement of the eyes, stiff neck muscles, jumps in blood pressure, changes in the pulse. 
• Neurological signs expressed locally. This nystagmus (twitching, twitching of the eyes), visual blurring, fuzziness, staggering when walking, general muscle weakness.

Symptoms of concussion can be remote, they are called post-comsum. Post-smoking syndrome often occurs after weeks or months after an injury that a person can not pay due attention to.

ICD-10 describes this syndrome as a consequence of head trauma, usually after concussion.

Signs of postcommission are as follows: 

• A squeezing, constrictive headache, which is often confused with a typical HDN - a tension headache. Postkommunatsionnaya pain manifests itself 7-10 days after injury, less often in a month. 
• Dizziness, not associated with fatigue or other vegetative disorders. 
• Increasing fatigue, asthenia. 
• Irritability
• Gradual decrease in activity of cognitive functions - memory, attention. 
• Difficulty concentrating and problems with the implementation of simple tasks
• Feeling of inexplicable anxiety, increasing aggressiveness, often tearfulness. 
• Sleep disturbance, drowsiness during the day. 
• Manifestations of sensory disturbances - decreased vision, hearing, tinnitus. 
• Violations of sexual functions not associated with urologic or gynecological pathology.
• Decreased resistance to stress, emotional arousal or problems with alcohol.
• Often there is anxiety and depression.

Headaches and dizziness more than half of the cases persist for several months, but after a year they appear only in 1% (and in most of these cases the examination shows no anomalies).

Postkommunitsionnye frustration, usually manifested a month after the injury, but in 10-15% of all cases of symptoms of concussion that can not be seen immediately, can be seen even after six months.

Data on the relative role of organic and psychogenic factors in maintaining the above symptoms are quite contradictory. Thus, it was suggested that these symptoms simply reflect the desire to receive material compensation. In some large surveys, it was possible to establish a strong connection with the previous constitution, belonging to a particular social class, the nature of the accident and the lawsuit. In other review works and follow-up studies, there is a connection with early neurologic symptoms (diplopia, anosmia, duration of posttraumatic amnesia). Lishman notes that these symptoms begin on an organic basis and mostly go to naught, but they can also be supported by psychological factors. In a prospective study, the reasons for the persistence of symptoms were mixed (organic and social), and the desire to receive compensation was not among the factors.

Psychiatrists are often asked to prepare reports in connection with the requirements of material compensation after the traumas of the head. When preparing such reports for civil courts, the following questions should be highlighted:

• authenticity of symptoms;
• whether the trauma of the head contributed to the appearance of these symptoms;
• and if so, to what extent (ie, could these symptoms occur without trauma?);
• what is the prognosis?

The court recognizes that a more vulnerable person will suffer more from injury than a strong person.

It is generally accepted that increased irritability and aggression, which, in particular, are noted after a head injury, can lead to the commission of a crime. Management of such patients is difficult, and in such cases, it is usually necessary to combine a cognitive behavioral approach with appropriate pharmacotherapy. Therefore, opinions were expressed that special services are needed for persons suffering from head injuries, and especially for persons with neuropsychiatric consequences of these injuries. In 1992, the Ministry of Health, as a pilot project, created twelve such services for a period of five years. However, their future is not guaranteed at all, and the activities of these services will be analyzed in the most careful way. If we had more adequate services, fewer people would be in inappropriate conditions for them, including in prisons.

Psychiatric symptoms after a head injury

This topic is reviewed by Lishman and McClelland. After a severe concussion of the brain, long-term psychiatric consequences occur quite often, and they can cause many social and psychological problems. In some traumas, neurological symptoms may occur, which tend to decrease over time. Light injuries can be associated with dizziness, transient frustration or loss of consciousness in the absence of signs of gross neurological damage.

In severe brain concussion, during a period of unconsciousness, a period of confusion follows, which, depending on the severity of the trauma and physical condition of the subject (worse in older people, as well as those suffering from atherosclerosis and alcoholism), can last from a few seconds to several weeks. During the period of confusion, slowness or irritability and confusion, disruption of orientation, violation of interpretation, depression or "violent" behavior may occur, as well as hysterical, aggressive or paranoid signs with delirium and hallucinations. Memories can be fragmentary or absent altogether (post-traumatic amnesia). There may be manifestations of violence. In this state, crimes can be committed, and they can look, at least at first glance, highly motivated, as, for example, it happens with athletes who, after hitting the head, can finish the game and completely do not remember that, what happened after the impact.

Post-traumatic (anterograde) amnesia can be complete or fragmented. The duration of post-traumatic amnesia indicates the severity of the lesion and the prognosis. Post-traumatic amnesia, lasting more than one week, indicates an unfavorable prognosis with disability for up to one year.

Retrograde amnesia refers to what happens before the impact and is usually very brief (from a few seconds to several minutes): "I remember that I saw the hammer fall, but I do not remember the impact." In very serious brain injuries, retrograde amnesia can spread for several days or weeks. Over time, the "period of coverage" of retrograde amnesia can be reduced. Long-term retrograde amnesia with minor head injuries suggests exaggeration and deception.

The psychiatric symptoms after a head trauma can vary significantly and may be due in part to organic factors and the psychic constitution, in part to psychogenic factors, including factors related to the environment and legal problems. Symptoms may include the following:

1. Headaches, dizziness, fatigue, concentration disorders and irritability.
2. Neurotic symptoms (phobias, anxiety, depression) can sometimes appear after fairly light injuries (but also after severe). Perhaps they are related to other life problems and are not so much organic as psychogenic. Careful collection of anamnesis can reveal their presence even before the trauma.
3. Great affective psychosis.
4. Schizophrenic psychosis.
5. Intellectual disorders and memory disorders (reflect the severity of the injury).
6. A wide range of personality changes, usually after severe head injuries, including the syndrome of the frontal division, the syndrome of the temporal department and the basal syndrome.
7. Disorder of sexual function.
8. Epileptic manifestations.

The prognosis will be worse for patients of an older age (perhaps because of the decline in the aging brain, as well as the concomitant diseases). The prognosis worsens the traits of inadequacy and neurosis, as well as the emotional manifestations associated with the incident (for example, fear). The patient's recovery is also affected by the domestic and production problems that he faces after the injury.

How is the disease diagnosed?

The clinical picture of coma is often quite typical, its characteristic signs are loss of consciousness, usually short-term (80-5% of all cases), impaired consciousness, nausea, sometimes to vomiting. Loss of consciousness, which lasts more than half an hour, prescribes additional examinations to exclude a more serious, life-threatening degree of trauma.

Symptoms of concussion can be manifested in the form of symptoms such as vertigo syndrome (dizziness), headache, muscle weakness, sweating as a vegetative reaction to trauma and sensory disturbances (sight, hearing).

Clinical manifestations of concussion are oculomotor dysfunctions: 

• Spontaneous eye movements (nystagmus); 
• The eyes can not be directed left, right, or up and down (paresthesia); 
• Sensations of pain with open eyes, Gurevich-Mann syndrome; 
• Symptom Sedan - the patient can not honor the test, written in small print with a relatively normal vision; 
• Convergence of the axes of vision - traumatic short-term strabismus; 
• Anisocoria can occur - different pupil diameters.

Facial concussion symptoms: 

• Loss of sensitivity or increase in sensitivity in different areas of the face; 
• Change of nasolabial folds (smoothing); 
• Change the position of the lips and tongue.

Clinical signs of reflex: 

• Violation of tendon reflexes; 
• Violation of skin reflexes; 
• Anisoreflexia is the asymmetry of the reflexes of the right and left parts of the body; 
• Muscle weakness (neurological test according to Panchenko and Barre); 
• Violation of the palmar-chin reflex as an indicator of damage to the subcortical area (Marinescu-Radovici reflex) - normally the chin muscle should automatically contract in response to irritation of a special area of the palm.

Threatening lives are the following signs that you need to know in order to take appropriate measures in time: 

• Bruises under the eyes in the form of glasses - the syndrome of "glasses", this is a sign of a fracture of the base of the skull; 
• Loss of consciousness for more than half an hour; 
• Convulsive syndrome; 
• Slowing heart rate; 
• Stopping breathing; 
• Nausea, turning into indomitable vomiting; 
• Dizziness lasting more than three days.

Concussion symptoms shows quite clearly, the main thing in this state is timely medical help. If you take all the necessary measures, the concussion is successfully treated and, after a few weeks, less often in months, the brain regains its functions, and the person returns to normal activity.