As of now the evaluation of concussion patients relies heavily on the patient’s self-evaluation of various symptoms (Vagnozzi, et al., 2010). It is, however, possible that asymptomatic patients, including those who are never diagnosed with a concussion, will not have fully recovered from their injuries. The use of MRI technology that allows the measurement of the ratio of metabolites in the brain has shown that metabolic imbalances occur following a concussion and that the metabolite ratios within the brain do not correct themselves until long after the patient is asymptomatic (Vagnozzi, et al., 2010). This is also supported by concussive studies conducted on rats. Creed, et al. demonstrated that while symptoms such as edema and cognitive impairment were only noticeable within the first three days following the trauma, degeneration of the axons as well as impaired axonal conductance were apparent for up to 2 weeks (Creed, et al., 2011). Therefore, the resolution of traditional concussion symptoms does not mean that “cellular dysfunction” has also been resolved (Creed, et al., 2011).
An understanding of the physiological consequences of concussions may help to improve the ability of medical and training personnel to successfully diagnose mild traumatic brain injuries and protect patients from suffering further damage during the recovery period. The transition from symptomatic monitoring and treatment of concussions to a more quantitative biological approach will most likely result in longer periods of reduced activity than previously thought necessary.
As of now there are multiple grading systems for concussions, with different organizations and practices using different grading systems. Three prominent concussion grading guidelines are the 2 sets of Cantu guidelines, an older and a newer version, developed by Dr. Robert Cantu in conjunction with the American Academy of Neurology and guidelines developed by The Colorado Medical Society in 1991 that were more restrictive than the first set of Cantu Guidelines and are used by the NCAA. All three grading systems contain 3 different concussion severity levels, but differ in the severity of the symptoms that constitute each grade (eg. loss of consciousness or not, length of time for amnesia to subside, etc.) (American Association of Neurological Surgeons). There are many other guidelines that also exist (Clinical Psychology Associates of North Central Florida, P.A.), making the grading of concussions too variable
As of now, the treatment for mild traumatic brain injury/concussion is rest, with Tylenol taken as a pain reliever for headaches. Stronger, more potent narcotic based pain relievers seem to provide little relief for concussive headaches (American Association of Neurological Surgeons).