What are the danger signs requiring emergency medical care after a head injury or concussion?

After a head injury or concussion, it is essential to watch for danger signs that may indicate a medical emergency and require immediate care. These signs include a worsening headache, seizures or convulsions, extreme drowsiness or inability to wake up, weakness or numbness, difficulty with coordination, repeated vomiting, confusion, and slurred speech, in addition to loss of consciousness.

A concussion is a brain injury that occurs due to the rapid back-and-forth movement of the head and brain, which can cause chemical changes and damage to brain cells [1]. Although most people recover fully, some symptoms may worsen, or more dangerous signs may appear that necessitate urgent medical intervention.

When to seek emergency care immediately?

You must seek immediate emergency care if any of the following signs appear after a head injury, even if the injury seemed mild at first:

• Seizures or convulsions: Any involuntary movement or loss of consciousness associated with abnormal electrical activity in the brain [1].
• Extreme drowsiness or inability to wake up: If the person has great difficulty staying awake or does not respond to stimuli as usual [1].
• A headache that gets worse and does not go away: A persistent headache that increases in intensity and does not improve with rest or pain relievers [1].
• Weakness, numbness, or lack of coordination: The appearance of weakness on one side of the body, numbness in the limbs, or difficulty walking or performing motor tasks [1].
• Repeated vomiting or nausea: If the person vomits repeatedly after the injury [1].
• Confusion: Inability to think clearly, difficulty remembering events, or not knowing the place or time [1].
• Slurred speech: Difficulty speaking clearly or understanding speech [1].
• Loss of consciousness: Any period of loss of consciousness, even if it was brief [1].
• Changes in pupil size: If one pupil appears larger than the other [1].
• Bleeding or fluid draining from the nose or ears: This may indicate a skull fracture [1].

The importance of early medical evaluation

It is important to obtain a medical evaluation from a healthcare provider as soon as possible after any head injury, especially for children and adolescents [2]. Studies indicate that receiving treatment within the first seven days after a concussion can make a significant difference in recovery [3]. A doctor may perform a neurological exam to assess vision, balance, coordination, and reflexes, and may also request brain imaging tests such as a CT scan or MRI to rule out bleeding, swelling, or skull fractures [1].

Recovery and gradual return to activities

Rest is very necessary after a concussion to help the brain heal [1]. Initially, you may need to limit physical activities and activities that require high concentration, such as studying, working on a computer, or playing video games, as these activities may cause concussion symptoms to return or worsen [1].

Returning to normal activities, including studying and sports, should be gradual and in accordance with the guidance of a healthcare provider. Returning too early can worsen the injury and prolong the recovery period [3]. For more information on a safe return to study and sports after a concussion, you can visit Safe Return to Study and Sports After Concussion (Arabic).

When to monitor symptoms?

Concussion symptoms may not appear immediately; they may begin days or weeks after the injury [1]. Therefore, it is important to monitor the injured person closely for any changes in their condition. Symptoms that may appear later include headache, neck pain, nausea, ringing in the ears, dizziness, or fatigue, and the person may feel confused or not like themselves for days or weeks after the injury [1]. If any of these symptoms worsen, a healthcare provider should be consulted [1].

Medical references

• Concussion
• Concussion Basics
• 5 things parents should know about concussions