Concussions are a lot more common than we think in the civilian world and are often missed in history gathering. A benign looking sport, such as cheerleading has a high rate of concussion, (we would not suspect and ask), while in football we expect concussions. Typically, the neurologic symptoms resolve; however, the psychiatric symptoms, such as depression and anxiety may persist long past the physical recovery.
- I would suggest we ask routinely on all initial evaluations about concussion and seizure history. Patients often may relate to the question: “Have you ever had your bell rung?” We need to ask the question of a patient in a way that they are on the same page. Concussion history, with or without loss of consciousness informs us regarding the severity factor.
- The suicide rates were elevated for all age groups, the highest being in the 16-20 year age group.
- The history of concussion should be included in every suicide/ lethality assessment.
- We should think about concussion as a “software malfunction” as there may not be any physical abnormality that is detectable on brain imaging.
- Pseudobulbar affect (PBA) should be excluded as emotional symptoms can overlap with PBA symptoms. PBA also occurs as a result of repeated concussions.