As you may have read in my last blog entry, concussions can be difficult to diagnose.

One method is to ask about symptoms.  Concussions can cause:

• headaches, particularly after mental or physical exertion
• dizziness and loss of balance
• nausea
• loss of memory
• “fogginess”, or the feeling that you’re just not quite right;
• fatigue and changes in sleep pattern
• even depression. 

Symptoms that are worrisome for more serious brain trauma such as bleeding in the brain might include: a change in vision or hearing; numbness or tingling in one side of the face or body; loss of strength in one side of the face or body; seizure; or prolonged loss of consciousness.  If these more serious symptoms occur, an assessment in hospital and brain imaging like CT or MRI might be appropriate.

Using symptoms to diagnose a concussion therefore relies on athletes being truthful in reporting those symptoms.  Since reporting symptoms usually means being pulled from a game, many athletes under-report their symptoms.

Another method would be to use a standardized set of questions to determine if the injury has had any effects.  An on-field assessment tool, like the standardized Sport Cognitive Assessment Tool, or SCAT, is useful because it can be administered by someone with little training, and has been shown to be reliable in detecting a concussion.   The tool is widely available on the Internet.

Another would be to use an online tool such as ImPACT.  This is a computer-based test, with a series of tasks that are meant to challenge the athlete more than the usual on-field testing.  Scoring in categories like verbal memory, visual memory, visual processing and reaction time give us much more information on the athlete’s cognitive abilities.  This is obviously not useful in a game situation, but is useful when trying to determine when the athlete would be ready to return to play.

The best scenario is one in which baseline testing is done using ImPACT on all athletes before playing, so that in the event of a concussion, we know what sort of scores the athlete is capable of.  This makes it much easier to determine when we can return the athlete to competition.

Finally, the “gold standard” of testing is full neurocognitive testing.  This consists of a battery of tests conducted by a neuropsychologist, usually taking up to a full day to complete.  This is often not called for, but in athletes with symptoms that go on for a long time, or in cases where the cognitive problems are interfering significantly with daily life, school, or work, then this can be a useful additional testing measure.

Diagnosing a concussion quickly, and taking appropriate steps to restrict activity, can be the difference between a return to normal life, or a lifelong loss of brain power.