In the Emergency Room
Although many concussions go undiagnosed or pre sent to outpatient clinics, athletes commonly will present to the emergency department for evaluation if they lose consciousness or have a cervical neck injury. This evaluation focuses on similar points to those discussed in the preceding section, with the addition of a more comprehensive history and detailed neurological examination, including mental status, cognitive, gait, and balance evaluations.
Additionally, because some time will have passed between the concussive event and presentation to the emergency department, it is important to identify whether there has been improvement or deterioration in the athlete's clinical status since the time of injury. Often, the athlete will be unable to recall the event, and additional information should be sought from parents, coaches, and teammates who witnessed the injury.
The evaluation of the concussed athlete in the emergency department must also include the determination of the need for emergency neurological imaging, which should be used when concern for intracranial or structural lesions exists. The utility of neuroimaging in the emergency department resides in identifying the rare instance when a lesion requires urgent neurosurgical intervention, such as an epidural hemorrhage. Although newer imaging modalities have provided evidence that abnormalities exist even in mild SRCs, as discussed later in this review, the current data have yet to provide conclusive evidence to support the use of these new modalities in routine assessments outside of the research setting.
Neurosurg Focus. 2016;40(4):e5 © 2016 American Association of Neurological Surgeons