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A trauma-induced alteration in mental status that may or may not involve loss of consciousness.
A concussion is a mild traumatic brain injury with associated abnormalities in brain function, rather than structural injury.
Concussion is a traumatic brain injury associated with rapid onset, usually transient neurologic dysfunction, induced by bio mechanical forces rather than structural injury.
Concussion is due to a direct or indirect blow to the head, neck, body, that results in rapid linear or rotational acceleration of the brain.
The resulting impulsive force mechanically injures nerve cells, triggers ionic fluxes of sodium and potassium and widespread depolarization.
These changes with altered cerebral blood flow create an energy demand mismatch and lead to inflammation, cytoskeletal damage, axonal dysfunction, and disrupted neurotransmission.
Disruption of neuronal communication, altered cerebral metabolism, and alteration in cerebral blood flow can impair networks involved in balance, vision, cognition, and mood with resultant symptoms of headache, dizziness, visual disturbance, cognitive, slowing, and emotional lability.
An estimated 1.1 million to 1.9 million pediatric concussions occur annually in the US.
An abnormality in the biochemical processes leading to functional impairment without any evidence of structural findings on standard neuroimaging.
For most children full recovery occurs with symptom resolution within four weeks following concussion, but 30% of children diagnosed with concussion experience persistent symptoms, lasting more than 28 days.
The effect and outcome of concussion are far worse in the developing brains of children as compared to that of adults.
Concussion in the pediatric age group significantly impacts school and sports-related performance, and it often leads to significant academic, social, and financial losses, and may even cause permanent damage and worsening of existing neuropsychological symptoms.
Repeated head injuries, particularly prolonged subconcussive injuries, may lead to a much more severe condition like the chronic traumatic encephalopathy.
The diagnosis of concussion is mostly clinical based on the presence of a constellation of symptoms following trauma to the head: headache, loss of consciousness, confusion, dizziness, and nausea and vomiting.
No single finding is sufficient to confirm or exclude concussion, the presence of mental fog, noise and light sensitivity, nausea, or ocular abnormalities are the most useful to identify a patient likely to have had a concussion.
The mechanisms of pediatric concussion vary by individuals age and activities.
Many concussed adolescence have an injury that arises during sports and recreation, with contact and  collision between participants accounting for a substantial proportion of cases.
In contrast, younger children more often have concussions during unstructured activities, such as free play or recess.
Other mechanisms for concussion include motor vehicle collisions, slips, falls, and assaults.
Absence of a headache makes a concussion less likely to be considered in the diagnosis of pediatric concussion.
There are many assessment tools that aid in the diagnosis of concussion, the subjective nature of these assessment tools limits their utility.
There are no imaging or laboratory test to diagnosis concussion.
Brain CT scans and MRIs are used to rule out more serious traumatic brain injury are of little value in diagnosing concussion.
Concussion responds to adequate physical, cognitive. and psychological rest.
The patient should be removed from active sports to avoid another concussion or any form of additional injury that may exacerbate the present concussion symptoms and prolong recovery time.
The child should not attend school and avoids any mentally exhausting activities such as homework, video games, and excessive screen time.
Rest is encouraged until resolution of symptoms and the removal of stressful activity that worsens the condition.
Analgesics or nonsteroidal anti-inflammatory drugs may be used for headaches.
Sleep hygiene usually helps patients, as they often complain of sleep disturbances in the form of delayed onset sleep or excessive daytime sleepiness.
For patients experiencing nausea or vomiting, ondansetron is an optimal treatment
Metoclopramide and promethazine should be avoided in children because of their adverse effects.
Some patients have prolonged symptoms that may progress to post-concussive syndrome.
Recent evidence suggests long-term effects on physical, behavioral, and neurocognitive development with meaningful consequences for learning, school performance and mental health.
Early clinical evaluation and management is associated with improved recovery, including shorter symptom duration and more rapid return to sport.