Concussions and their consequences: current diagnosis, management and prevention

oncussion is the most common type of mild traumatic brain injury and can have serious consequences. Not just confined to high-profile athletes, concussions are frequent in all age groups and in a variety of settings, such as the work environment, motor vehicle crashes, sports and recreation, and falls at home among older people. Concussion is defined by the International Consensus Conference on Concussion in Sports as "a complex pathophysiological process affecting the brain, induced by biomechanical forces." 1 Concussion is the preferred term be cause of its familiarity to the public. Since 2000, international expert panels have clari fied the definition and modified the management of concussion; these changes have affected recommendations for return to work, school and sport for those experiencing a concussion. he importance of accurate and timely recognition and management stems from the consequences of misdiagnosis or faulty management that can lead to major disability or death, in both the short and long term. Second-impact syndrome occurs when a concussed person, especially a younger person, returns to play before complete recovery and sustains a second brain injury. However, malignant brain swelling can occur even without a second injury. 3 Also, repeated concussions may cause delayed posttraumatic brain degeneration, leading to dementia and movement disorders similar to Alzheimer and Parkinson diseases. 4 Thus, it is important for practitioners to know the current principles of recognition and management of concussions, including the physical, cognitive and emotional effects and the guidelines for return to play, work or school.