Archives 2015

Acute Concussion

Pathophysiology of Concussion



The current belief is that mild traumatic brain injury results from mechanical deformation of the neuronal membrane at the junction between the grey and white matter (the differing densities create different acceleration rates).  This acceleration “pulls” open the ion channels causing influx of Ca++ and outflow of K+ leading a relatively massive depolarizing “storm” in the brain.  This Ca++ inside the cell inhibits or destroys mitochondria and stops ATP production causing spreading neurological depression within the days post injury.


●Concussion is an energy crisis in the brain!


It is thought that the ATP is lowest around 3 days post injury and recovers to normal by day 30. 

Use of extra ATP in the acute stage may prolong symptoms and maintain vunerability.


Interesting note: It has been found that a concussion requires between 70 and 120 G’s of acceleration, while a mild cervical sprain requires only 4.5 G’s.  We expect most if not all concussions to have co-morbidities.


When Presented with an acute concussion:

  • Reassure!  → best way to decrease risk of post concussion syndrome
  • Educate
  • Neurological test(cranial nerve exam, cerebellum, long tract signs, etc)rule out serious.
  • Diagnostic testing and referral if indicated by exam, Canadian C/S rule or head CT rule.
  • Prompt referral to a therapist familiar with concussion managment for complete assessment and management through the return to learn and return to play steps.
  • Absolute rest- physical and cognitive- 4-5 days Max!