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Central nervous system
Concussion is an injury to the brain that usually occurs following a blow or jolt to the head. A mild concussion occurs where the person is just dazed but does not lose consciousness, or loses consciousness for a very short time. A severe concussion may cause a more prolonged loss of consciousness with a delayed return to normal. A classification system used to assess a person's level of consciousness and brain function is the Glasgow Coma Scale or GCS; a scale from 3 to 15 where the lower the score the lower the level of consciousness.

If a person does suffer a blow to the head it is important to look out for any possible signs of concussion and to take the necessary action or precautions described below.
Anyone can suffer a concussion. Common causes include a head injury from a car accident, a fall, a sport's injury or an assault. Elderly people often fall because of difficulties with walking or their balance. Sometimes these accidents are caused by the elderly person's medication making them confused, slow to react or unsteady on their feet. People who take part in physical and contact sports are most at risk of a head injury.

The blow or jolt to the head temporarily prevents the nerve cells in the brain from functioning properly. Mild concussion itself is not dangerous, but blows to the head that cause severe concussion can lead to secondary injuries to the brain that may occur hours or even days after the initial traumatic event.

Secondary injuries are a complex set of reactions triggered by bleeding and inflammation within the skull that leads to swelling that puts pressure on the brain. Secondary injuries can dramatically make the original injury worse. They are a leading cause of brain damage and may be fatal.
Symptoms of concussion may include headache, dizziness, loss of consciousness, confusion, blurred vision, nausea, vomiting, loss of memory, loss of concentration, changes in mood and poor balance.

Post-concussion syndrome may occur, with symptoms appearing weeks or months after the initial injury. Symptoms of post-concussion syndrome include persistent headache, dizziness, memory problems, disturbed vision, emotional feelings and depression.
Treatment depends on the severity of the trauma. A mild concussion without any complications is not dangerous and does not need treatment - just some rest and time to recover. A mild headache following the knock to the head can be treated with simple pain killers, but if the headache is severe the person should seek medical advice.

A severe concussion where there has been a loss of consciousness for more than a few minutes requires medical attention. The treatment given will depend on the nature of the trauma and the area of the brain that has been affected.
When to see your pharmacist
Your pharmacist will be able to provide you with painkillers such as paracetamol or ibuprofen to relieve a mild headache, but you must tell your pharmacist if your headache is severe, has got worse or has stayed for a long time after your head injury. Your headache could be a sign of a more severe injury in which case your pharmacist will recommend that you see your doctor.
When to see your doctor
You should see a doctor if you have suffered a blow to the head and have been unconscious for more than a couple of minutes. You should also see a doctor if you vomit, become sleepy or confused after regaining consciousness. Similarly, see a doctor if you have a severe headache, if you cannot remember what happened or cannot remember personal details such as your name or address, you have a fit or if your condition worsens after an initial improvement.

You should also contact your doctor if you are taking warfarin for other medical conditions. Warfarin reduces the ability of the blood to clot so there is an increased risk of bleeding in the head after a fall or injury.

If you have been unconscious or if the concussion is severe and your doctor is concerned about the extent of your injury you will normally be sent to a hospital for observation, otherwise, you may be monitored at home for 12-24 hours.
After a concussion
If you or a member of your family has had a head injury and mild concussion it is important that you rest. Avoid physical activity for about a week or so, do not watch too much television or spend long periods working on a computer or reading so your injury has time to recover.

To avoid similar accidents in the future, try to anticipate the risk and take the necessary precautions. For those who take part in contact sports or physical activity where the head is exposed, wear protective headwear. If you look after an elderly person who is at risk of falling, make their environment as safe as possible. Check for trip hazards such as poor-fitting slippers and trailing wires, nothing is left on the stairs and all rugs and mats are secure.

Reviewed on 14 November 2010