Do I need an MRI post-concussion? Let’s dive into all your imaging questions.
One of the biggest questions when someone hits their head is do I have a concussion, and should I get any imaging?
In this blog today, we are going to talk about how a concussion is diagnosed, what may be included in the concussion diagnosis exam, if imaging is required, and what that imaging may reveal about your head injury.
How is a concussion diagnosed?
A concussion is diagnosed via what is considered a “clinical diagnosis” meaning there is not any imaging or blood tests that can be done to confirm whether someone has had a concussion or not. A clinical diagnosis utilizes signs and symptoms from the individual, a mechanism of injury, a vestibular exam, a balance assessment, and sometimes a cognitive exam to diagnose a concussion. A skilled clinician will assess all of these pieces to diagnose whether a concussion has happened or not. In other words, concussion diagnoses are very dependent on who is assessing the individual and the amount of training they have on concussions.
If you remember last fall when Tua Tagovailoa was hit during a game, and he was diagnosed with a back injury as opposed to a concussion. Then a few days later was hit again and collapsed on the field. This is a perfect example of a misdiagnosed concussion. However, when you read above what is involved in a diagnosis, and how largely subjective it is based on who is doing the exam, you can see why so many individuals are not properly diagnosed.
Should I get an MRI or CT scan after a concussion? And what will it show?
The short answer is no, it will not show anything if you have a mild traumatic brain injury—otherwise known as a concussion. Imaging following a mild head injury is utilized to reveal if there is a skull fracture or brain bleed, not for diagnosis of the concussion itself.
Clinicians utilize an algorithm to decide whether to order imaging or not. The following demographics and red flag symptoms will point a clinician towards ordering a CT scan—
If the individual is 65+
Vomited 2+ times
Cannot remember 30 mins before the incident
Had a dangerous mechanism of injury (car accident, major fall, etc.)
Suspected to have a skull fracture or moderate to severe traumatic brain injury (TBI)
Worsening/severe headache, inability to move neck, battle sign (bruising over mastoid process), slurred speech, numbness/weakness in extremities, decreased coordination, deteriorating conscious state/loss of consciousness, combative behavior, seizure/convulsion.
If none of these are apparent, they will likely forgo imaging. So instead of rushing to the ER for imaging, the best step following a head injury is to speak with a skilled healthcare professional who understands concussions. This might be an athletic trainer, school nurse, physical therapist, primary care physician, or urgent care physician.
If you’re worried you/the individual has worsening symptoms or any of the above red flags then an ER visit is certainly warranted.
Have questions or concerns about next steps? Reach out to me today!
Happy Healing,
Dr. Kira, PT, DPT
The content on this site is for informational or educational purposes only and does not substitute professional medical advice or consultations with healthcare professionals.