What is a Concussion?

A concussion is a mild brain injury that can affect normal brain function. It may happen due to direct impact to the head or from sudden jerking movements of the head. A concussion can result in an altered mental state or the individual becoming unconscious.

Symptoms of Concussion

The general symptoms of concussion are:

Headache
Nausea
Dizziness
Drowsiness
Tiredness
Sleep disturbances
Vision problems
Concentration difficulties
Depressive mood
Nervousness and anxious
Memory loss
Temporary unconsciousness (for about a minute)
Sensitivity to bright light and noise
Loss of balance

Symptoms that require immediate medical intervention include:

Severe headache
Seizures
Blood discharge from the ears
Being unconscious for more than a minute
Difficulty waking from sleep

Causes of a Concussion

Some of the common causes for concussions are:

Motor vehicle accident
Falls, bicycle accidents
A contact sport injury
Head hit by an object
Violently shaking the head

Diagnosis of a Concussion

To determine the impact of the injury, your doctor may ask questions about the incident, perform a thorough physical examination, neurological examination, cognition tests, and imaging studies.

Neurological examination includes testing of

Eye movement
Reflexes
Hearing
Vision
Strength
Balance

Cognitive testing includes testing of

Memory
Concentration
Learning ability
Thinking ability
Processing of information

Diagnostic Studies

Quantitative EEG and Cortical Mapping of Injuries

Patients with persistent symptoms may be shown to have severe abnormalities using quantitative electroencephalography techniques as conventional MRIs do not show these problems. Pathology demonstration offers valuable therapeutic direction and impartial proof for treatment planning or legal contexts. Board-certified TBI neurologists are at the Concussion TBI Neurodiagnostic Laboratory. With the use of our advanced procedures, we are able to link test findings with symptoms and discover brain lesions that are not visible on traditional MRIs. The brain cortex's abnormal regions and connections between various brain regions are identified and clearly illustrated. We ONLY collaborate with neurologists who have received board certification in TBI, and we compare the test results' objective findings to the patient's complaints (subjective symptoms of TBI).

Cognitive Evaluation with Validity Indicators

Advanced neuropsychological evaluation, including validity indicators that can rule out symptom exaggeration or malingering. The latest computer-based neuropsychological assessments include sophisticated algorithms which can help identify symptom amplification or malingering. Comparable outcomes can be obtained by experienced neuropsychologists using the traditional “pen and paper” testing method. These techniques provide additional evidence to support the organic nature of the symptoms.

Videonystagmography

Videonystagmography (VNG) is a method used to detect abnormal eye movements, which are common in persistent post-concussion syndrome. These irregular eye movements can lead to issues like unsteady walking, balance problems, disorientation, coordination difficulties, and other impairments that affect daily life. Through advanced computer-assisted analysis, VNG can accurately identify these abnormalities. Notably, the results cannot be influenced by the patient or the examiner, guarding against intentional exaggeration of symptoms or deception.

Dynamic Posturography

The method of posturography is used to measure postural control in an upright posture under static or dynamic situations. Ten different test protocols are performed including a Sensory Organization Test (SOT), Limits of Stability Test (LOS), a Motor Control Test (MCT) and an Adaptation Test (ADT). A special computer software integrates all this and produces detailed graphics which can then be compared with normal ranges. The pattern of results can not be voluntarily modified due to the complex interactions among sensory, motor, and central processes. In brain injuries, abnormal results are often present.

Dynamic Posturography

This technique is employed to evaluate postural stability while standing in various upright positions, either static or dynamic. This assessment involves conducting different test protocols, such as the Sensory Organization Test (SOT), Limits of Stability Test (LOS), Motor Control Test (MCT), and Adaptation Test (ADT). Through specialized computer software, all collected data are synthesized to generate comprehensive graphics, allowing comparison against established norms. Importantly, the outcomes cannot be deliberately altered as they reflect intricate interactions among sensory, motor, and central processes. Consequently, abnormal findings frequently indicate underlying brain injuries.

Evoked Potentials

The brain's immediate response to specific visual, cognitive, or physical stimuli is assessed through event-related potentials (ERPs), commonly referred to as evoked potentials (EP). Essentially, when a sensory input is received, it travels through various neural pathways to reach the brain, where cells in different regions generate electrical activity. This electrical activity is captured by electrodes as an electrical wave, with its size (amplitude) and the time it takes to form and be detected (latency) being quantifiable. Injuries can lead to delays in the brain's response time to stimuli and a decrease in the size of the electrical wave (reduced amplitude).

The ability to focus on stimuli and encode information for memory storage and retrieval are key aspects of memory function. Two ERP components, P300a and P300b, are often utilized to assess these memory-related functions. In conditions associated with memory impairment, such as Alzheimer's disease or traumatic brain injuries (TBIs), extensive research has focused on the P300b component. Individuals with Alzheimer's disease typically exhibit lower P300b amplitudes and prolonged P300b latency compared to age-matched individuals without the condition. Studies have indicated that measurements of P300b amplitude and latency can predict the progression of mild cognitive impairment. Moreover, P300b measurements demonstrate greater sensitivity in detecting early stages of memory decline compared to conventional tests like the Mini-Mental State Examination (MMSE) and other neuropsychological assessments.

Assessments for Autonomic Nervous System Function and Dysregulation

In management of Post-Concussion Syndrome (PCS), dizziness emerges as a significant challenge. This disorienting sensation doesn't just signify a symptom; it serves as an indicator of deeper disturbances within the body's internal regulatory mechanisms. Many PCS sufferers contend with a condition known as autonomic dysregulation. Essentially, autonomic dysregulation disrupts the body's capacity to manage involuntary functions such as heart rate, blood pressure, and breathing. When these automatic bodily processes malfunction, it can lead to dizziness (for instance, an inability of the heart and blood vessels to adjust rapidly upon standing, resulting in insufficient blood flow to the brain).

While autonomic dysregulation may appear elusive, it is within the realm of scientific inquiry. Objective tests exist to detect its presence. Within the realm of neurophysiology, specific evaluations like the Quantitative Sudomotor Axon Reflex Test (QSART) and Heart Rate Variability (HRV) analysis, among others, are employed. These sophisticated assessments gauge the autonomic nervous system's response to stimuli such as changes in posture or stress, revealing whether it effectively regulates bodily functions like blood pressure and heart rate. These crucial tests not only aid in diagnosing autonomic dysregulation in PCS patients but also pave the way for targeted treatment strategies.

Some of the tests used to identify autonomic nervous system dysfunction include:

Assessment of Sudomotor Function
Heart Rate Variability Analysis (HRV)
Cardiac Autonomic Reflex Tests:Valsalva Ratio
E/I Ratio
K30/15 Ratio
Evaluation of Systolic and Diastolic Pressure Response to Standing

Advanced Imaging Studies

We collaborate with various facilities to integrate advanced imaging studies (such as DTI, SPECT, DWI, among others) to enhance and strengthen clinical correlations with our cognitive, oculomotor, quantitative EEG (qEEG), and posturography data. All data, including findings from neurological examinations, are analyzed by a board-certified neurologist specializing in cognitive neurology and traumatic brain injury (TBI). They compile a comprehensive and easily comprehensible report. Importantly, we exclusively partner with experienced and independent neuroradiologists, ensuring transparency and credibility in the data analysis process.

Treatment and Recovery

Your doctor may instruct you to have plenty of rest and avoid vigorous physical activities or mental activities that require a lot of concentration, memorization, and thinking.
Your doctor can prescribe the necessary medications to recover from a concussion.
Rehabilitations therapy such as balance training, visual exercises, speech therapy, and physical exercises may be recommended.
In some cases, if there is skull or brain damage, surgery may be performed, but most concussions do not require surgery.

Prevention

The preventive measures to prevent concussions include

Follow safety measures such as wearing seatbelts while driving
Use protective gear such as helmets and padding when playing sports
Exercise regularly, but avoid overexertion