What is "Not a Concussion?"

Not all head injuries are concussions. However, they can have concussion like symptoms. Symptoms mimicking concussion can appear through injury or infection. The most common are Benign Positional Vertigo, Secondary Endolymphatic Hydrops, Meniere's Disease, Ruptured eardrum and Labrynthitis and Vestibular Neuritis.

First let's review concussions. A concussion is an injury that affects brain function. It usually occurs when someone is hit on the head, but can occur when the head or body is jarred. Loss of consciousness does not have to occur. Initial symptoms of a concussion include: headache or head pressure, confusion, amnesia, dizziness, ringing in the ears (tinnitus), nausea or vomiting, slurred speech and fatigue.

The first condition I'll look at is Benign Positional Vertigo. This is due to an inner ear disturbance. In your inner ear, there are fluid filled tubes (the semi circular canals). The canals are sensitive to movement of the fluid which occurs when you move. The movement of the fluid lets your brain interpret your body's position and maintain balance. This condition develops when a piece of bone like calcium breaks free and floats in the semicircular canal. This sends the brain mixed signals. This condition may run in families, be caused by head injury or by labrynthitis. Symptoms include: nausea, vomiting, a spinning sensation, hearing loss, a loss of balance and vision problems (a feeling that things are jumping or moving). It is diagnosed using the Dix-Hallpike manuever. Other tests that may be done include: EEG, ENG, Head CT, Head MRI, hearing test, Magnetic Resonance angioplasty of the head, and caloric stimulation (warming and cooling the inner ear with water to test eye movements). It is treated by Epley's maneuver which moves the piece of calcium that is floating in the inner ear. Occasionally, medications such as antihistamines, anticholinergics, and sedatives may be prescribed to stop the spinning sensation. Benign Positional Vertigo usually improves with time.

Endolymphatic Hydrops comes in 2 varieties. First we will cover secondary endolymphatic hydrops. Primary endolymphatic hydrops is Meniere's disease which will be discussed later. Secondary endolymphatic hydrops appears to occur in response to an underlying condition such as head trauma or ear surgery, other inner ear disorders, allergies or systemic disorders. In a normal inner ear, endolymph (fluid in the a compartment in the inner ear), is maintained at a constant volume with specific concentrations of electrolytes. This allows the cells of the inner ear to function normally. In endolymphatic hydrops, the controls that affect the fluid system balance are lost or damaged. This can cause the volume and concentration of endolymph to change in response to changes in the body's fluid and electrolyte balance. Secondary endolymphatic hydrops occurs in attacks. Symptoms include pressure or fullness in the ear, tinnitus, hearing loss, dizziness and imbalance. Diagnosis is based on the physician's observations and on the symptom history. In secondary endolymphatic hydrops, one of the goals in to treat the underlying condition, and then the hydrops begins to improve. Meniere's disease is primary endolymphatic hydrops.

Meniere's disease may occur when the pressure in the inner ear gets too high. It may be related to head injury, middle or inner ear infection, alllergies, alcohol use, family history, fatigue, recent viral illness, respiratory infection, smoking, stress, or use of certain medications. Symptoms include drop in hearing, pressure in the ear, ringing or roaring in the ear, vertigo, severe nausea, vomiting and sweating, headaches, uncontrollable eye movements. Symptoms worsen with sudden movement. Hearing loss may occur. It is diagnosed by brain and nervous system exams, hearing tests and audiograms, caloric stimulation, ECOG, ENG or VNG, and head MRI. Treatment includes diuretics and a low sodium diet. Vestibular Neuritis and Labrynthitis are in infections of the inner ear or the nerves connecting the inner ear to the brain. The infection interrupts the transmission of sensory information to the brain. This causes vertigo, dizziness, and difficulties with balance, vision and hearing. Inner ear infections are usually viral. The inner ear consists of the labyrinth. This serves for hearing and balance. The hearing function involves the cochlea and the balance function involves the vestibular organs. Signals travel to the brain via the vestibulo-cochlear nerve. This nerve has two branches; once branch transmits messages from the hearing organ while the other transmits messages from the balance organs. The brain then interprets these signals. When one side is infected, the brain gets mixed signals. Neuritis affects the branch associated with balance. This results in dizziness but no change in hearing. Labryrinthitis affects both branches of the nerve and results in dizziness and changes in hearing.

The final condition we will look at is a ruptured eardrum. It is usually caused by ear infections, but damage to the eardrum can also occur from very loud noises close to the ear, rapid change in ear pressure (as occurs when flying, scuba diving, or driving in the mountains), foreign objects in the ear, or injury to the ear. Ear pain may suddenly decrease right after the rupture. Symptoms after an eardrum rupture include ear drainage, ear noise/buzzing, earache, hearing loss, weakness of the face or dizziness. A doctor will examine the ear. If the eardrum is ruptured, they will see a hole in the eardrum or even the bones of the middle ear. They can also test to see how much hearing has been lost. Sometimes a patch may be placed over the ear to speed healing. If healing does not occur on it's own, surgery may be done. It usually heals within 2 months. Long term vertigo and dizziness can occur.

SO these are conditions that could be happening when they say "it's not a concussion."