Evaluation of Concussion Symptoms

Dr. Lowell Greib MSc ND CISSN

Concussion, by definition, is a traumatic brain injury that is induced by biomechanical forces to the head that, ultimately, result in aberrant functioning of the brain.  These forces can be the  result of a direct blow or indirect transmission of force. When the forces are transferred to an athlete’s head, a complex cascade of events occur in and around the brain (these were outlined in ‘The Complexities of Concussive Injury’).  One could deduce that because the brain is a highly intricate and specialized organ, each individuals brain will respond to forces differently. As such, it is expected to have variable symptoms from athlete to athlete or even concussion to concussion. 

The Concussion in Sport Group (CISG) is considered a global authority on sport-related concussion. The CISG is  tasked to build principles that can be followed by the medical community, as well as develop the conceptual understanding of sport-related concussion.  The most recent consensus document was published in 2017 after the 5th International Conference on Concussion in Sport1. One of the key outcomes of the consensus statement was a revision in the Sport Concussion Assessment Tool (5th Edition)2 or SCAT 5 for short.  The SCAT 5 is a standardized tool for evaluating concussions.  Within the SCAT 5 is a list of symptoms that should be reviewed with each athlete and graded on severity.  The following is a list of the 22 symptoms:

  1. Headache
  2. ‘Pressure in head’
  3. Neck pain
  4. Nausea or vomiting
  5. Dizziness
  6. Blurred vision
  7. Balance problems
  8. Sensitivity to light
  9. Sensitivity to noise
  10. Feeling slowed down
  11. Feeling like ‘in a fog’
  12. ‘Don’t feel right’
  13. Difficulty concentrating
  14. Difficulty remembering
  15. Fatigue or low energy
  16. Confusion
  17. Drowsiness
  18. More emotional
  19. Irritability
  20. Sadness
  21. Nervous or anxious
  22. Trouble falling asleep

All of these symptoms, in totality, allow a medical practitioner to monitor the progression of athlete care, as symptoms should resolve over time.  Symptom evaluation is just one component of a comprehensive medical assessment which should be completed with each suspected concussion.  All aspects of comprehensive evaluation allow for appropriate management of the concussed athlete and, ultimately, leads to the resolution of symptoms.

1  McCrory P et al. BJSM 2017;0:1-10.

2  Davis GA et al. BJSM 2017:0:1-8

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