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Concussion is a transient disturbance of neurological function induced by head injury and resulting in no persistent abnormal neurological signs. There may or may not be brief loss of consciousness.

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Table C5 Classification of concussion

Grade

Clinical features

Mild (grade 1)

  • stunned or dazed

  • sensorium clears in <60 secs

  • no post-traumatic amnesia

  • ± loss of consciousness

Moderate (grade 2)

  • stunned or dazed

  • sensorium cloudy >60 secs

  • headache

  • amnesia <60 mins

  • ± loss of consciousness

Severe (grade 3)

  • sensorium cloudy >60 secs

  • amnesia >60 mins

  • irritable

  • persistent headache

  • unsteady gait

  • ± loss of consciousness

Management is supportive and observation. The patient should lie down and rest for a few hours. Paracetamol may be used for headache.

Post-concussion syndrome Occasionally a person who has an episode of concussion has persistence of headaches and dizziness for a number of weeks. Poor memory and concentration and sluggish decision making indicate impaired mental capacity. Patients with this problem should be investigated with neuropsychological testing and CT scanning or MRI of the brain.

Chronic traumatic encephalopathy is a long-term effect of concussion.

Resources: Pocket concussion recognition tool or Sports Concussion Assessment Tool (SCATs)

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