Diagnosing a concussion can be tricky. Although any degree of head trauma can cause one, the most common concussions—those that result from mild head injuries—do not involve identifiable bleeding or bruising in the brain.

    This means an imaging technology such as magnetic resonance imaging (MRI) or computed tomography (CT) that can diagnose a severe traumatic brain injury (TBI), isn't a viable way to diagnose a concussion.

    Since brain scans can identify bruising or bleeding in the brain, but not the cellular damage thought to cause concussion symptoms, doctors must rely on a careful assessment of symptoms and neuropsychological function.

    Sometimes this is done on-site, immediately after an injury, when an athlete experiences a blow or jolt to the head and a decision must be made quickly about whether he or she can safely get back into the game.

    © Verywell, 2018

    Concussion Testing

    The symptoms of a concussion can vary greatly. Sometimes it's quite obvious that someone may have one. But just as often the symptoms are vague and subtle.

    A person may simply feel "off" or as if they're not "getting" things. In any case, getting a definitive diagnosis of a concussion typically requires looking at several factors.

    Because there's no simple test for diagnosing a concussion, several steps are involved. The Weill Cornell Brain and Spine Center, for example, narrow it down to these: 

    Interview testing for various types of amnesia:These include the documentation of the presence and extent of any retrograde amnesia, which refers to a lack of memory about what happened just before a brain injury occurred, loss of consciousness, and post-traumatic amnesia. Post-traumatic amnesia refers to loss of memory for events after the trauma and is especially important because it will tell a doctor the most information about a patient's prognosis.

    Determination of the severity of symptoms and how extensive they are:Often this is part of an on-site assessment of an athlete who's been injured on the field and uses a standardized scale. The most common of these, the Sideline Concussion Assessment Tool, or SCAT-2, looks at symptoms, attention, memory, recent events in the game or event, and checks for problems with balance and coordination.

    Examination of neurological symptoms: This may involve tests of strength, sensation, reflexes, coordination, and other neurological functions.

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    Pre-Concussion Testing

    Besides diagnosing an initial concussion at the time of an injury, it's important for people who are going to participate in an activity—especially student athletes who want to participate in a high-impact team sport such as football—to undergo pre-concussion testing. In fact, this usually is a requirement of high schools, colleges, and highly competitive travel teams. 

    The main reason an athlete needs pre-concussion testing is if they subsequently have a suspected concussion, their functioning and injury effect can be compared to the athlete's baseline, allowing for better management decisions.

    This means that performance on a post-concussion test is not necessarily "good" or "bad" on its own, but must be based on whether or not there is a significant decline in comparison to the baseline that was set prior to the head injury.

    If a student athlete has a slower response or lower accuracy on a post-concussion test after a head injury, then the lower score could be a sign of a concussion. Along with a neurological examination and overall symptoms such as sleepiness, pain, or trouble concentrating, the results of a post-concussion test can be used to help determine whether the athlete has suffered a concussion.

    Pre-concussion testing generally includes a set of neuropsychological exams developed to assess and score a young athlete on skills that involve several aspects of his or her brain function. Pre-concussion tests include tasks that evaluate problem-solving, response time, speed, vision, and coordination.

    There's no gold standard pre-concussion screening tool required by an authoritative medical or sports association. There are a variety of ways to establish a pre-concussion score, though, including an in-person clinical evaluation or a pre-set questionnaire. There also are a number of available skills tests on the market that can be used to establish a baseline score for a player before the season begins.

    Pre-concussion tests may be scored by a computer or by a medical professional, depending on the type of examination and on the rules of the league or the school. 

    The baseline results are recorded and saved so that if an athlete suffers from a suspected concussion, he or she can take a repeat test for comparison.

    An example of the computer-scored test was developed by researchers at the University of Pittsburgh's Sports Medicine Center and is called  Immediate Post-Concussion Assessment and Cognitive Testing system, or ImPACT . This test measures an athlete's memory, reaction time, and processing speed in order to help determine when they can safely return to sports after a head injury. The ImPACT program is currently used at many high schools and colleges as well as by the National Football League (NFL) and National Hockey League (NHL).

    Frequently Asked Questions

    • Can I self-diagnose a concussion?

      Only a doctor can definitively diagnose a concussion. That said, certain symptoms may develop after a blow to the head that point to a concussion, including a headache, nausea and/or vomiting, dizziness, feeling hazy or groggy, and sensitivity to light or noise.

    • How can I tell if my child has a concussion?

      Some people lose consciousness after sustaining a concussion, often for a very brief time, but this doesn't always happen. Signs to look for in your child (or anyone else) that indicate they may have a concussion include:

      • Inability to remember things that happened either before a hit or fall or afterwards
      • Seeming dazed or stunned
      • Tending to forget things they're asked to do
      • Moving clumsily
      • Taking a long time to respond to or answer questions
      • Having changes in mood, behavior, or personality
    • Is a concussion the same as a TBI?

      A concussion is regarded as less severe as a TBI (traumatic brain injury); in fact, the term "mild TBI" often is used synonymously with concussion. Even so, concussions are serious injuries, especially when a person has more than one. They are not life-threatening but can have long-lasting effects and so should be diagnosed by a doctor and treated.

    • How many concussions are diagnosed each year?

      According to the Brain Injury Research Institute, each year, between 1.6 and 3.8 million people sustain a concussion related to a sport or recreational activity. It's unknown how many people experience concussions not related to a sport or physical activity, as it's believed many of these are never diagnosed.

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    Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

    1. Sharp DJ, Jenkins PO. Concussion is confusing us all . Pract Neurol. 2015;15(3):172–186. doi:10.1136/practneurol-2015-001087

    2. Mutch CA, Talbott JF, Gean A. Imaging evaluation of acute traumatic brain injury . Neurosurg Clin N Am. 2016;27(4):409–439. doi:10.1016/j.nec.2016.05.011

    3. Kutcher JS, Giza CC. Sports concussion diagnosis and management . Continuum (Minneap Minn). 2014;20(6 Sports Neurology):1552–1569. doi:10.1212/01.CON.0000458974.78766.58

    4. Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Graham R, Rivara FP, Ford MA, et al., editors. Sports-Related Concussions in Youth: Improving the Science, Changing the Culture . Washington (DC): National Academies Press (US); 3, Concussion Recognition, Diagnosis, and Acute Management. Available from: https://www.ncbi.nlm.nih.gov/books/NBK185340/

    5. Weill Cornell Brain and Spine Center. " Diagnosing and Treating Concussion ."

    6. Krol AL, Mrazik M, Naidu D, Brooks BL, Iverson GL. Assessment of symptoms in a concussion management programme: method influences outcome . Brain Inj; 25(13-14):1300-5.

    7. Thomas RE, Alves J, Vaska MM, Magalhães R. SCAT2 and SCAT3 scores at baseline and after sports-related mild brain injury/concussion: qualitative synthesis with weighted means . BMJ Open Sport Exerc Med. 2016;2(1):e000095. Published 2016 Oct 19. doi:10.1136/bmjsem-2015-000095

    8. Polinder S, Cnossen MC, Real RGL, et al. A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury . Front Neurol. 2018;9:1113. Published 2018 Dec 19. doi:10.3389/fneur.2018.01113

    9. Cottle JE, Hall EE, Patel K, et al. Concussion baseline testing: preexisting factors, symptoms, and neurocognitive performance . J Athl Train. 2017;52(2):77-81. doi:10.4085/1062-6050-51.12.21

    10. Putukian M. Clinical Evaluation of the Concussed Athlete: A View From the Sideline . J Athl Train. 2017;52(3):236–244. doi:10.4085/1062-6050-52.1.08

    11. McKeithan L, Hibshman N, Yengo-Kahn AM, et al. Sport-related concussion: evaluation, treatment, and future directions . Med Sci (Basel). 2019;7(3):44. doi:10.3390/medsci7030044

    12. Olson RL, Brush CJ, Ehmann PJ, et al. A history of sport-related concussion is associated with sustained deficits in conflict and error monitoring . Int J Psychophysiol. 2018;132(Pt A):145–154. doi:10.1016/j.ijpsycho.2018.01.006

    13. Cleveland Clinic. Concussion signs and symptoms .

    14. Centers for Disease Control and Prevention. Mild TBI and concussion .

    15. Brain Injury Research Institute. What is a concussion?

    16. Wellspan Health. Non-sports related concussions often go undiagnosed .

    Additional Reading

    • Weill Cornell Brain and Spine Center. " Diagnosing and Treating Concussion ."

    • Hall E, Cottle J, Ketcham C, Patel K, and Barnes KP . " Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance , J Athl Train. Jan 10, 2017. DOI: 10.4085/1062-6050-51.12.21
    • Thomas, RE, Alves, J, Vaska, MM, and Magalhaes, R. " SCAT2 and SCAT3 Scores at Baseline and After Sports-related Mild Brain Injury/Concussion: Qualitative Synthesis With Weighted Means. "  BMJ Open Sport & Exer Med. 2016;2:e000095. DOI:  10.1136/bmjsem-2015-000095 . 
    How does a doctor check for concussion?
    Your doctor may order imaging tests — such as MRI or CT scans — to make sure there's no bruising or bleeding in your brain. To confirm a concussion diagnosis, your doctor will use the data from your: Exam and interview. ImPACT or other cognitive tests. more
    How does a doctor check your prostate?
    Digital rectal exam (DRE) During a DRE, your healthcare provider inserts a lubricated, gloved finger (digit) into your rectum. This way, they can feel your prostate to see if there are any lumps or bumps on the back portion of the gland (where many cancers start). more
    Can a doctor check for concussion?
    Signs and symptoms of a concussion may not appear until hours or days after the injury. Tests your doctor may perform or recommend include a neurological examination, cognitive testing and imaging tests. more
    How do doctors check for concussion?
    A cranial computerized tomography (CT) scan is the standard test in adults to assess the brain right after injury. A CT scan uses a series of X-rays to obtain cross-sectional images of your skull and brain. more
    How does a doctor check for prostatitis?
    You'll need to have a urine test so the doctor can check for bacteria and other signs of infection. You might also need a blood test. You might have a digital rectal examination to see if your prostate is inflamed and painful, and the doctor may examine your stomach area (abdomen) and penis. more
    How does a doctor check your pancreas?
    Pancreatic ultrasound During an endoscopic ultrasound of the pancreas, your doctor inserts a thin, flexible tube (endoscope) down your throat and into your stomach. An ultrasound device at the end of the tube emits sound waves that generate images of your digestive tract and nearby organs and tissues. more
    How does a doctor check your stomach?
    During an endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat and into your esophagus. The tiny camera lets your doctor examine your esophagus, stomach and the beginning of your small intestine (duodenum). more
    Can a doctor check for concussion?
    Signs and symptoms of a concussion may not appear until hours or days after the injury. Tests your doctor may perform or recommend include a neurological examination, cognitive testing and imaging tests. more
    How do doctor's check your stomach?
    During an endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat and into your esophagus. The tiny camera lets your doctor examine your esophagus, stomach and the beginning of your small intestine (duodenum). more
    How does a doctor check for dementia?
    The following procedures also may be used to diagnose dementia: Cognitive and neurological tests. These tests are used to assess thinking and physical functioning. These include assessments of memory, problem solving, language skills, and math skills, as well as balance, sensory response, and reflexes. more
    Does the doctor check down there?
    Your doctor will ask you questions about your medical history and lifestyle during this exam. They'll also check your height, weight, and pulse; and examine your entire body, including your genitals, for growths or abnormalities by lightly feeling the genital, groin, and anal areas. more

    Source: www.verywellhealth.com

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