Concussion

What is a concussion?

A concussion is a type of brain injury caused by a sudden knock or blunt force trauma to the head. Concussions can be serious, but many mild concussions heal on their own, with symptoms lasting days to weeks.

Brain imaging is usually normal, even when a concussion is present. Moderate and severe concussions due to a car accident or other serious brain injury may cause more trauma to the brain, such as bleeding, which may be visible on a brain scan.

For symptoms that are not resolving quickly, it is important to seek medical evaluation. Post-concussion syndrome is the term used to describe continuation of concussion symptoms past three months. People with post-concussion syndrome can have significant disability and can often benefit from treatment with a concussion specialist. The health care professionals at AHN have vast experience in treating, evaluating, and supporting those who have experienced a concussion.

AHN Neurologic Critical Care Division (including Neuro ICU)

AHN offers comprehensive care for the full spectrum of brain injuries. The AHN Concussion Center is a multidisciplinary program designed to treat all types of brain injuries that may occur from car accidents, work-related falls, or sports injuries. Working in a multidisciplinary manner means our experts coordinate care between specialties to help you experience seamless, continual care.

For the most complex concussion cases, our leading neurologists and neurosurgeons within the AHN Neurologic Critical Care Division provide exceptional surgical expertise and thoughtful follow-up care. Using a team approach, we help you manage post-concussion symptoms, so you can safely get back to your personal or professional pursuits.

Neurologic Critical Care at AHN is a highly specialized unit specifically dedicated to treating patients with life-threatening neurological conditions, including severe traumatic brain injuries (TBIs) and complex concussion complications. It is an environment built around 24/7, multidisciplinary, intensive care, designed to provide the highest level of support and intervention for critically ill neurological patients. AHN's Neurologic Critical Care offers:

• 24/7 expert care: We provide continuous monitoring by a dedicated team. This includes fellowship-trained Neurointensivists, who are neurologists specially trained and certified in critical care. This specialized expertise allows for immediate and informed decision-making. Our unit is also staffed by a dedicated team of critical care nurses, respiratory therapists, pharmacists, and other specialists, all with expertise in neurological critical care.
• Advanced monitoring & technology: Our Neuro ICU is equipped with state-of-the-art technology to provide the most precise monitoring available. This includes devices for continuous EEG (electroencephalogram) to detect seizure activity, intracranial pressure monitoring to assess swelling in the brain, cerebral oximetry to measure brain oxygen levels, and transcranial Doppler for evaluating blood flow. We also provide advanced ventilator management and organ support as needed.
• Multidisciplinary approach: Effective care for complex neurological conditions requires seamless teamwork. Our Neurologic Critical Care unit fosters close collaboration with a wide array of specialists, including neurosurgeons, stroke specialists, neuroradiologists, neurohospitalists, and rehabilitation specialists. This integrated team works together from the moment of admission through recovery and rehabilitation, ensuring comprehensive and coordinated care tailored to each patient's unique needs.
• Rapid intervention for time-sensitive conditions: In neurological emergencies, every second counts. Our unit provides immediate access to advanced diagnostic imaging (like MRI and CT scans) and life-saving interventions, ensuring that acute neurological crises are addressed swiftly and effectively to minimize potential damage.
• Commitment to best outcomes: At AHN, we’re committed is to prioritizing patient recovery and minimizing long-term issues. We do this by using evidence-based protocols and the latest research in neurological critical care, so that our treatment strategies are always at the forefront of medical advancement.

Quick guide to concussions

Concussion symptoms and signs

Concussion screening and diagnosis

Types and stages of concussions

Concussion treatment

Concussion FAQs

Contact us

Concussion symptoms and signs

If you or someone you know has recently suffered a blow to the head, it’s important to watch for the following symptoms within the first 24 hours:

• Headache
• Changes in vision (blurriness or seeing double)
• Trouble keeping your balance
• Difficulty concentrating
• Nausea
• Memory loss
• Ringing in the ears 

These common symptoms of a concussion may appear immediately or develop over the next few hours or even days. If you experience these symptoms, it’s usually best to see your medical provider for an evaluation. Concussions usually heal on their own through rest and avoiding reinjury. Concussions may also be confused with a more life-threatening traumatic brain injury. If a sudden blow to the head results in convulsions, seizures, loss of consciousness, extreme nausea, slurred speech, or weakness or numbness, seek medical help immediately.

Causes and risk factors

A concussion is a type of traumatic brain injury that results from a sudden movement of the brain within the skull. While often associated with a direct blow to the head, concussions can also occur from rapid acceleration and deceleration forces to the body, causing the brain to jolt or twist. Understanding the various ways a concussion can occur and who might be more susceptible is crucial for prevention and early recognition. Concussion causes often include:

• Falls: This is the leading cause across all age groups, particularly in young children (e.g., falling from playground equipment, down stairs) and older adults (e.g., slips, trips).
• Sports and recreational activities:
  • Contact sports: Football, hockey, rugby, soccer, lacrosse, basketball, and wrestling, where collisions, falls, and rapid movements can result in concussions.
  • Action sports: Activities such as skateboarding, snowboarding, skiing, and cycling are particularly dangerous, especially if helmets aren’t worn.
  • Equestrian activities: Horse riding carries a risk due to falls from a height, being thrown from a horse, or being kicked by a horse. The combination of speed and height increases the potential for serious head injuries.
  • Motor vehicle accidents (MVAs): Car crashes, motorcycle accidents, bicycle accidents — even with helmets — the forces can be enough to cause serious head injuries.
• Assaults/violence: Any act involving physical violence directed at the head or body can result in a concussion. This includes fights, domestic violence, child abuse (e.g., shaken baby syndrome).
• Being struck by an object: Head trauma can occur when a person is hit by a falling object, sports equipment (like a baseball or hockey puck), or any other projectile.
• Military combat: Service members are at risk of concussions from various sources both in training and active deployment. Risks include blast injuries, falls, and direct impacts.

Some individuals are more prone to concussions to due to various risk factors:

• Participation in high-risk activities (contact sports, high-speed, or fall-prone activities): This is a primary driver of concussions across many demographics and directly relates to the mechanism of injury.
• Previous concussion history: This is a crucial factor, as it significantly increases the risk of future concussions and can lead to more severe, prolonged symptoms.
• Age (young children, adolescents, older adults): Age is a powerful determinant, affecting both susceptibility to injury and recovery patterns across critical developmental stages.
• Neurological or psychiatric history: This is vital for understanding prolonged symptoms and recovery, as pre-existing conditions can significantly complicate a concussion's course.
• Gender: While still under study, the observed differences in reporting and symptomology in female athletes are significant enough to warrant inclusion as a key risk factor for both individuals and organizations tracking concussions.

When to seek emergency care

While many concussions can be managed with rest and follow-up with a doctor, certain symptoms indicate a more serious brain injury that requires immediate medical attention. If you notice any of these symptoms in yourself or someone else after a head injury, immediately go to the nearest emergency department or call 911:

• Loss of consciousness lasting more than 30 seconds
• Seizures or convulsions
• Worsening headache (severe or not improving)
• Repeated vomiting or increasing nausea
• Slurred speech or difficulty speaking
• Numbness or weakness in any body part
• Increased confusion, restlessness, or agitation
• Pupils of unequal size
• Difficulty recognizing people or places
• Significant drowsiness or inability to be awakened• Clear fluid draining from the nose or ears

Concussion screening and diagnosis

Having a concussion can be an unsettling experience, and knowing what to expect during the diagnosis process can help. At AHN, we understand the importance of accurately identifying a concussion and providing the right guidance from the very beginning. Our approach is designed to be comprehensive, expert, and timely, and we are dedicated to providing a clear diagnosis and initiating effective management as early as possible, which is crucial for a smoother recovery. Our screening and diagnosing follows crucial steps.

Step 1: Initial assessment

When you or your loved one comes to AHN with a suspected concussion, the first step is a thorough initial assessment. This typically takes place in an emergency department, urgent care, or a specialized concussion clinic, depending on the severity of symptoms and mechanism of injury. Our healthcare professionals will gather important information and conduct a focused examination to understand your situation. This often includes:

• Detailed history of the injury: You’ll be asked about how the injury happened, including the forces involved, any loss of consciousness, and what you remember leading up to and immediately after the event. This helps us understand the mechanism and potential severity.
• Symptom evaluation: We ask about any symptoms you're experiencing, such as headache, dizziness, nausea, confusion, sensitivity to light or sound, and changes in mood or sleep patterns. We use standardized tools to ensure a thorough and consistent evaluation of your symptoms.
• Neurological exam: This involves checking your balance, coordination, reflexes, eye movements, and cognitive function to identify any immediate signs of neurological impairment.

Step 2: Specialized testing (as needed)

Based on the initial assessment, your healthcare provider may recommend additional specialized tests. These tests help us gain a deeper understanding of how the concussion is affecting brain function and can guide a personalized recovery plan. These are not always required but are vital when further investigation is needed.

• Cognitive testing: These are specialized brain tests, like ImPACT®, are used to check your memory, how fast you think, and your reaction time to see how a concussion might be affecting you.
• Balance assessment: We use specific tests to objectively measure your balance, helping us understand if your concussion is affecting your stability and coordination.
• Ocular-motor assessment: This involves checking your eye movements to see if they are working smoothly and together, as concussions can sometimes affect how your eyes move.
• Vestibular screening: This checks for dizziness, spinning sensations, and balance problems that might come from your inner ear, which can be affected by a concussion.

Step 3: Imaging (when necessary)

It's important to understand that a concussion is a functional injury, meaning it affects how the brain works, rather than causing a visible structural change. Therefore, CT scans or MRIs are typically used to rule out more serious, life-threatening injuries, such as bleeding in the brain (hemorrhage), brain swelling, skull fractures, or other structural damage, rather than to diagnose the concussion itself. If your doctor suspects one of these more severe conditions based on your symptoms or the nature of your injury, imaging will likely be performed immediately. For uncomplicated concussions, imaging is often not required.

Step 4: Diagnosis and education

Once all necessary assessments and tests are completed, an understandable diagnosis will be given. This includes:

• Clear communication of the diagnosis: We will explain what a concussion is, how it has affected you, and answer any questions you may have. We aim to empower you with knowledge about your condition.
• Initial education on concussion management: You will receive detailed instructions on how to manage your symptoms, including guidelines for physical and cognitive rest, sleep hygiene, and how to gradually return to your normal activities. This education will also cover warning signs to watch for and when to seek further medical attention.
• Personalized recovery plan: We will work with you to develop a tailored plan for your recovery, which may include follow-up appointments, referrals to specialists (such as physical therapists, occupational therapists, or neuropsychologists), and guidance on school or work accommodations. Our goal is to support you every step of the way towards a full recovery.

Types and stages of concussion

It's crucial to understand that every concussion is a brain injury and should always be taken seriously. While we often hear about concussions in sports, they can happen to anyone, at any time, and their impact can vary significantly from person to person. At AHN, we recognize that there isn't a one-size-fits-all description for concussions because every injury is unique, and symptoms can evolve over time.

The symptoms experienced from a concussion can range in their intensity and impact on daily life. There aren't universally accepted grades or stages that dictate how a concussion will progress, because each individual's brain responds differently to injury. Instead, we focus on understanding the spectrum of symptoms, their severity, and the implications for your personalized care plan.

Physical concussions

Examples of physical concussion symptoms include headache, nausea, vomiting, dizziness, balance problems, visual disturbances (such as blurry vision or sensitivity to light), sensitivity to noise, and fatigue. What to watch for regarding the severity of these symptoms includes:

• Less severe concussion symptoms: Occasional mild headache, intermittent light sensitivity.
• More severe concussion symptoms: Constant, throbbing headache; persistent nausea/vomiting; severe dizziness or vertigo; debilitating light/noise sensitivity; profound fatigue limiting all activity.

Cognitive concussions

Examples of cognitive concussion symptoms include feeling "foggy," difficulty concentrating, memory problems, slowed thinking or processing, and difficulty with schoolwork or work tasks. What to watch for regarding the severity of these symptoms includes:

• Less severe concussion symptoms: Mild difficulty focusing occasionally, feeling foggy or not quite yourself.
• More severe concussion symptoms: Significant difficulty understanding conversations; inability to read or focus on screens; severe memory gaps; extreme mental fatigue from basic tasks.

Emotional/mood concussions

Examples of emotional or mood concussion symptoms include irritability, anxiety, sadness, mood swings, and feeling more emotional than usual. What to watch for regarding the severity of these symptoms includes:

• Less severe concussion symptoms: Mild irritability, feeling a bit down.
• More severe concussion symptoms: Persistent and overwhelming anxiety; severe depression; uncontrolled emotional outbursts.

Sleep-related concussions

Examples of sleep-related concussion symptoms include drowsiness, sleeping more or less than usual, and difficulty falling or staying asleep. What to watch for regarding the severity of these symptoms includes:

• Less severe concussion symptoms: Slight changes in sleep patterns.
• More severe concussion symptoms: Extreme insomnia or hypersomnia; sleep disturbances significantly impacting daytime function.

Concussion treatment

At AHN, board-certified physicians with expertise in concussions will be a part of your treatment team. Your care is tailored to your personalized needs and delivered with care and attention. Treatment plans may include:

• Medication: Medication can reduce or relieve certain symptoms, such as headaches or dizziness. Your care will be individualized to maximize improvement and minimize side effects of treatment.
• Occupational therapy: Knowledgeable occupational therapists help you extend your abilities, so you can move more easily and relearn how to perform routine tasks.
• Speech therapy: Skilled speech pathologists can help you address speech difficulties like slurred speech and word-finding problems.
• Vestibular therapy: Physical therapists use focused techniques to relieve problems such as dizziness, vision problems, and difficulty balancing.
• Cognitive therapy: Speech therapists and psychologists each address different aspects of memory, concentration, and mood issues commonly seen after a head injury so you can regain balance in your life.
• Surgery: Our nationally recognized trauma care team, including skilled neurosurgeons, treats patients with critical conditions in Allegheny General Hospital’s Level 1 Trauma Center. We provide lifesaving surgical procedures, 24/7 monitoring, and advanced rehabilitation services to help people recover from severe brain injuries.

Please note: AHN Orthopaedic supports the Pittsburgh Pirates and Pittsburgh Riverhounds, but sports-related concussions are often treated by that team.

We do not support sideline needs for either of these teams.

Concussion FAQs

Understanding the basics of a concussion can be the key to recognizing symptoms before they cause major problems. Your AHN Care Team is here to help you get the care and treatment you need. 

How long does a concussion last?

The duration of a concussion varies significantly from person to person. While many people start to feel better within a few days to a couple of weeks, full recovery can take longer. For some, especially children, adolescents, or those with a history of previous concussions, symptoms might persist for several weeks or even months. This is often referred to as post-concussion syndrome. The most important thing is to follow your healthcare provider's recovery plan, which will include periods of rest and a gradual return to activities, to ensure a complete and safe recovery.

How to know if you have a concussion?

You cannot definitively diagnose a concussion yourself, as its symptoms can be subtle and vary widely. The only way to truly know if you have a concussion is to be evaluated by a healthcare professional experienced in concussion management. If you experience a blow to the head or body that causes your head to move violently, and you notice any of the following symptoms, you should seek medical attention:

• Headache or a feeling of pressure in the head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light or noise
• Feeling sluggish, hazy, foggy, or groggy
• Confusion, difficulty concentrating, or memory problems
• Feeling "down" or more emotional than usual
• Sleep disturbances (sleeping more or less than usual, or difficulty falling asleep)

These symptoms can appear immediately or develop hours to days after the injury. Never try to tough it out or guess if you have a concussion. Prompt medical evaluation is key.

What does a concussion feel like?

A concussion can feel different for everyone, and symptoms can range from subtle to severe. You might experience a mix of physical, cognitive, emotional, and sleep-related issues. For instance:

• Physically: You might feel a headache (which can be mild or severe), dizziness, nausea, or lightheadedness. You might also be unusually sensitive to bright lights or loud noises.
• Cognitively: It might feel like your brain is foggy or slow. You could have trouble concentrating, remembering things, or thinking clearly. Tasks that were once easy might now feel overwhelming.
• Emotionally: You might notice you're more irritable, anxious, or sad than usual, or experience mood swings.
• Sleep-wise: You may find yourself sleeping more than usual, struggling to fall asleep, or feeling tired even after a full night's rest.

Some people describe feeling off, not themselves, or like they are in a daze. It's important to remember that these feelings are real and are due to the brain injury. Openly communicating all your symptoms to your healthcare provider will help them guide you through your recovery.

Contact us

Call 412-359-8850 to schedule an appointment as a new patient, or request an appointment to learn more about AHN neuroscience services.