Athletes often return to competition too soon following concussions. Repeated concussions that occur without full recovery from one to the next can result in potentially fatal brain swelling, called second-impact syndrome. Repeated concussions over time can also result in permanently impaired thought processes and slowed reaction times.

A major misconception is that a concussion only occurs when an athlete is knocked out. However, the hallmarks of concussion are confusion and amnesia, usually without a preceding loss of consciousness. The signs and symptoms of concussion may be immediate or may gradually evolve over several minutes after the head trauma (See Concussion Signs & Symptoms).

Due to the possibility for serious medical complications, any athlete who loses consciousness or has persistent confusion should be evaluated in an emergency department. Those athletes whose symptoms seem to have resolved may be observed at home by a parent, but the athlete should be awakened from sleep every two hours and should avoid strenuous activity for at least 24 hours (See Emergency Symptoms).

Athletes may experience physical, emotional or cognitive symptoms that gradually taper in severity over hours, days, weeks, or even months after a concussion. These post-concussion symptoms can include:

✓ Headache

✓ Dizziness

✓ Problems sleeping

✓ Imbalance/incoordination

✓ Fatigue

✓ Sensitivity to light or noise

✓ Difficulty remembering or concentrating

✓ Difficulty thinking clearly

✓ Word-finding difficulty

✓ Irritability/moodiness/impulsiveness

✓ Feeling depressed or anxious

Any athlete having post-concussion symptoms should be evaluated and followed by a physician until all the symptoms resolve.

Anyone who continues to have symptoms of a concussion should not be allowed to return to play until all the symptoms have cleared. Sideline evaluations may be performed on players who are briefly symptomatic but not knocked out following a concussion to determine if they are safe to return to play. In 1997, the American Academy of Neurology (AAN) published recommendations regarding sideline evaluation and guidelines for return to play in contact sports following a concussion. The AAN guideline scores a concussion based on severity from grade 1 (least severe) to grade 3 (most severe). Specific sideline management recommendations are given based on the concussion grade. Recommendations on return to play are also given based on the frequency of concussions. These AAN guidelines have been available for use by professional sports organizations and school athletic departments since 1997.

David Kushner, M.D.

David Kushner, M.D., is associate professor of rehabilitation medicine and neurology at the University of Miami School of Medicine, Miami, FL. Neurology Now:Volume 3(5)September/October 2007p 22-23,27-32