What is the diagnosis of concussion


concussion (Commotio cerebri): the slightest form of skull-brain injury that occurs mostly as a result of a fall. The typical complaints such as confusion, memory gaps and sometimes brief loss of consciousness are signs of temporarily impaired brain function without any detectable damage to the brain. The commonly used term concussion corresponds to that slight traumatic brain injury (Grade I traumatic brain injury, TBI I).

Treatment consists primarily of physical and mental rest, with the person affected being observed for 24 hours. The doctor relieves the often accompanying nausea and / or headache with medication.

Leading complaints

  • Confusion immediately after a head injury
  • May be unconscious for less than 1 hour
  • Memory gap (amnesia) for the period from the accident up to a maximum of eight hours thereafter
  • Mild to moderate headache, dizziness, nausea and vomiting, sensitivity to noise and / or light.

When to the doctor

Call a doctor immediately if

  • an injured person is unconscious or "not quite there" for a few minutes
  • the injured person vomits more than once
  • the condition worsens after initially free or poor of symptoms, e.g. B. increasing headache or confusion occur
  • There are signs of moderate / severe brain injury.

The illness

From a medical point of view, a concussion is a traumatic brain injury, also known as a traumatic brain injury (TBI). This TBI is divided into 3 degrees of severity using the Glasgow Coma Scale, with the concussion corresponding to TBI Grade 1. A brief loss of consciousness used to be a diagnostic criterion. Today we know that there can be a concussion even if you are unconscious. On the contrary, impaired consciousness or loss of consciousness are rather rare with a concussion. On the other hand, dizziness and states of confusion are frequent, as are gaps in memory for the time until the concussion. There are no neurological failures in the case of a concussion, and the CT of the brain is also normal.

An injury to the head without any brain dysfunction or injury to the brain is referred to as a bruised skull by the doctor.

Diagnostic assurance

Patients with a concussion are usually fine again when the emergency doctor arrives at the scene of the accident. However, to rule out more serious injuries, they are taken to hospital anyway.

The doctor uses the Glasgow Coma Scale to assess the severity of the traumatic brain injury at the scene of the accident. The score can also be calculated by laypeople using the three criteria of movement, speaking and opening eyes. To this end, the point values ​​of the three criteria are added.


    • Follows prompts: 6 points
    • Responds specifically to pain stimuli: 5 points
    • Reacts indiscriminately to pain stimuli: 4 points
    • Abnormal bending of arms and legs in response to pain stimuli: 3 points
    • Abnormal stretching of arms and legs in response to pain stimuli: 2 points
    • No reaction: 1 point


    • Oriented: 5 points
    • Disoriented: 4 points
    • Inappropriate, inappropriate comments: 3 points
    • Incomprehensible sounds: 2 points
    • No comment: 1 point

Open eyes

  • Spontaneous: 4 points
  • In response: 3 points
  • On painful stimulus: 2 points
  • No reaction: 1 point.

A conscious patient always has 15 points. If a person with a traumatic brain injury scores more than 12 points in the assessment, it is a concussion (TBI grade I). If he reaches 9–12 points, he has one moderate traumatic brain injury (Traumatic brain injury grade II), for values ​​below one severe traumatic brain injury or a grade III traumatic brain injury. The decisive factor is the worst value in the first 48 hours after the injury.

At the hospital, doctors will have the skull x-rayed to rule out injuries. The need for a CT scan of the brain depends on the condition of the injured person. In the case of a younger injured person with full points on the Glasgow Coma Scale at the scene of the accident and no signs of a fractured skull, the doctors usually refrain from a CT. It is important that there was no impairment of consciousness, amnesia or neurological disorder, even temporarily. The risk that such a patient will develop cerebral hemorrhage in the following hours is so low that most doctors do not consider hospital monitoring to be necessary, provided certain criteria are met, for example relatives in the following 12– Check regularly 24 hours after the injured person and that the person concerned can eat and drink normally without vomiting.

If the examination reveals only the slightest indication of far-reaching consequences, if the accident victim vomits several times or is older, a CT is performed. A CT is also necessary if the patient is taking medication to reduce blood clotting or has bleeding disorders, because in these cases a slight contusion of the skull can lead to cerebral hemorrhage. Depending on the symptoms, other doctors are also called in, e. B. an ophthalmologist for visual disturbances.

If the cause of the accident is unclear, the doctors try to uncover the cause of the accident with further examinations. So behind a fall with subsequent concussion z. B. also stuck cardiac arrhythmias or hypoglycaemia. To clarify this, the doctors arrange z. B. an EKG or determine the blood sugar.

Differential diagnoses. If a concussion is suspected, a traumatic brain injury of the 2nd or 3rd degree must always be ruled out.


In the case of a concussion, no special treatment is possible - nor is it necessary. Usually it is enough if the injured person spares himself a few days. Doctors prescribe short-term medication for headaches, dizziness or nausea, e. B. for headaches paracetamol (e.g. ben-u-ron®).

If there are new or worsened symptoms after 1–5 days, a doctor should be consulted. Rarely does a subdural hematoma develop.


A concussion usually goes away after a few days without any consequences.

Post-commotional syndrome

About 15% of people with a concussion develop post-commotional syndrome, which can last for weeks, months, and sometimes even years. Depending on the severity, those affected suffer from concentration disorders, headaches, sleep problems and emotional overreactions. The cause of these symptoms is unknown, but the likelihood of developing post-commotional syndrome increases with each concussion.

Your pharmacy recommends

If you have difficulty concentrating, mood swings, or other symptoms after your concussion, the following measures can help:

  • Avoid alcohol and drugs. They delay the healing process.
  • Treat dizziness. If you experience dizziness, tell your doctor. You may need balance treatment. Also, avoid situations in which dizziness can be dangerous, do not climb ladders and hold on to the railing when climbing stairs.
  • Focus purposefully. If you have trouble concentrating, it helps to stand up separate To concentrate things, avoid multi-tasking. B. on the coexistence of reading, watching TV, writing e-mails. Have a sticky note and a pen ready to jot down your ideas, use lists, plans and a diary.
  • Reduce stress. Bring peace into your life, make sure you get enough sleep. Drink less caffeinated drinks and eat a balanced diet. Learn mind-body therapies such as autogenic training or progressive muscle relaxation according to Jacobsen.
  • Getting in motion. Light exercise is good even after a concussion. Discuss with your doctor how you can exercise yourself.
  • Don't make life decisions. Mood swings can weaken your rational decision-making skills. Do not make any important decisions (move, change of job, separation) until you are really well again.


Head protection.

Always use a certified helmet when cycling. This of course also applies to other accident-prone sports such as horse riding, inline skating, skiing and skateboarding. A helmet also protects against head injuries on e-scooters.


Observe all necessary occupational safety measures, use suitable equipment when working at great heights, wear a hard hat on construction sites.

Seat belt.

Always use a seat belt and child seats for your child when driving. This will reduce the risk of banging your head in the event of sudden braking or an accident.

Be careful with water sports.

Never jump into shallow or unfamiliar waters, especially head first.

Further information

Information on concussions in sport can be found on the homepage of the association Kopf hoch e. V. at www.kopf-hoch.net/gehirnerschütterung/ and on the website of the Hannelore Kohl Foundation at www.schuetzdeinenkopf.de/LSHT_info_ Betroffene_eltern_trainer/LSHT_info_ Betroffene_eltern_trainer_leitfaden_erwachsene/


Dr. med. Nicole Menche in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 14:12

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.