eMedicine Specialties > Sports Medicine > Neurological

Concussion: Differential Diagnoses & Workup

Author: David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
Contributor Information and Disclosures

Updated: Aug 6, 2009

Differential Diagnoses

Repetitive Head Injury Syndrome

Other Problems to Be Considered

Epidural Hematoma (in the Emergency Medicine section) (See also the eMedicine article Epidural Hematoma [in the Radiology section].)

Intracranial Hemorrhage

Seizure disorders (See also the eMedicine article Seizures and Epilepsy: Overview and Classification.)

Subarachnoid Hemorrhage (in the Neurosurgery section) (See also the eMedicine article Subarachnoid Hemorrhage [in the Emergency Medicine section].)

Subdural Hematoma (in the Neurology section) (See also the eMedicine article Subdural Hematoma [in the Radiology section].)

Trauma-induced migraine

Trauma-induced headache

Workup

Imaging Studies

  • Computed tomography (CT) scanning
    • In an emergency department-based study, the percentage of abnormal CT scans in adult patients increased from 13% for patients with a perfect GCS score to 37% for those with a GCS score of 13.
    • In a different study that assessed 712 patients with LOC or amnesia and a perfect GCS, the rate of abnormal CT scans was 9%, with less than 1% requiring surgical intervention.33
    • Indications for ordering a CT scan include focal neurologic examination findings, signs or symptoms of increased intracranial pressure, GCS score less than 15, and seizures related to trauma. Some authors suggest that any athlete with loss LOC (grade 3 concussion) should have a CT scan obtained.34 This area is controversial. Athletes with a brief LOC are at no higher risk for long-term neurologic sequelae, and indications for imaging should not differ from those listed above.
    • CT scanning continues to be the imaging study of choice in evaluating an acute head injury. Better imaging of an acute hemorrhage, speed of the study, and improved ability to monitor the patient are the reasons for using CT scanning rather than magnetic resonance imaging (MRI).
  • MRI
    • MRI is the imaging study of choice for patients who have prolonged symptoms (> 7 d) or for a late change in an individual's neurologic signs or symptoms.
    • MRI offers a more detailed examination and possibly detects more subtle findings.
    • Delayed or slowly developing bleeds may be easier to detect on MRI.
  • Neuropsychologic testing
    • Detailed neuropsychologic testing is employed more often at the professional level and in research in athletes with MTBI.
    • When evaluating an athlete's performance on the neuropsychologic tests, it is best to compare results with the athlete's previous tests.
    • Both the National Hockey League (NHL) and National Football League (NFL), along with many college teams, are utilizing limited neuropsychologic testing to document the possible prolonged effects of presumed minor head injuries and to assist the clinician in determining possible retirement issues.
    • Neuropsychologic testing is indicated in cases of complex concussions.23  
  • Although positron emission tomography (PET) scanning and functional MRIs (fMRIs) may be used, their clinical application in most cases of MTBI is uncertain.5,13,35

More on Concussion

Overview: Concussion
Differential Diagnoses & Workup: Concussion
Treatment & Medication: Concussion
Follow-up: Concussion
References
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Further Reading

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Keywords

concussion, mild traumatic brain injury, MTBI, head injury, brain injury, traumatic neurologic dysfunction syndrome, second impact syndrome, postconcussion syndrome, post-concussion syndrome, postconcussive syndrome, post-concussive syndrome, repetitive head injury syndrome

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Contributor Information and Disclosures

Author

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD, FACSM, FAAFP, is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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