By: Lauren McRae

As COVID-19 continues to impact our daily lives, our Neurological Institute remains dedicated to serving our patients with all of your healthcare needs.

We know that our new normal looks different with COVID-19. With the new school year approaching and summer sports in full swing, it is imperative that concussions and head injuries be seen by a specialist as soon as possible to help prevent symptoms from worsening.

Telehealth appointments are available with our specialists can be taken from the comfort of your home via phone, tablet or computer. More advanced cases and urgent diagnostics must be seen in-person; and should be discussed with a physician to determine which appointment type is best for you.

Nicole D. Reams, MD, a fellowship-trained sports neurologist, offers some insight into what you should do if you have a concussion, plus how NorthShore is handling head injuries during the pandemic.

What are the signs of a concussion?
Dr. Reams: About 10% or less of individuals will have a loss of consciousness, meaning the vast majority do not. Most individuals will experience some or all of the following symptoms: headaches, sensitivity to lights and sounds, nausea, dizziness, imbalance, cognitive change (ie trouble concentrating, feeling confused or foggy), trouble sleeping, or sleeping too much, and feeling more irritable or emotional than normal. These symptoms typically occur rapidly after the injury, though in some cases can be delayed.

Are there different degrees of concussion?
Dr. Reams: We no longer grade concussions as this old system of trying to grade severity was inaccurate and didn’t have good prognostic value. Each individual can certainly experience this injury differently as far as the intensity of symptoms and duration of symptoms and this may be a reflection of the force of impact or mechanism of the injury or preexisting conditions that can contribute to recovery.

Due to COVID-19, many sports have been canceled/postponed. What types of concussions you are seeing during this time?
Dr. Reams: We are seeing almost entirely non-sports injuries with varying acuity. We see individuals who have suffered a fall, been in a car accident, or simply hit their head on an object in their home. We have also seen an uptick in individuals who have old/preexisting injuries and questions about symptoms they may be experiencing currently.

Are you finding that people are delaying visiting a specialist if they think they have a concussion due to COVID-19?
Dr. Reams: Luckily, I have not seen much of this. With the availability of telemedicine visits, and more recently with more in-person options based on the comfort of the patient and availability of the physician, we are still seeing concussion patients very quickly.

What advice would you offer someone who is delaying visiting a specialist that thinks they may have a concussion?
Dr. Reams: It is of utmost importance to be seen quickly following a potential head injury. Medical providers need to screen and examine the patient for a more severe injury, such as a bleed in the brain, that would require more testing, observation, and occasionally surgical intervention. 

Physicians also use this early opportunity to educate the patient about what to expect, what activities they need to reduce or avoid, how to transition back to school or work if applicable, as well as to screen for possible risk factors that may make the injury recovery more complicated or prolonged. If there is a significant delay (even just a few weeks) in seeing a physician trained in concussion, it can prolong and complicate recovery.

We certainly are sensitive to patients’ desire to stay home and limit exposures, which is why we have both telemedicine and in-person options available to meet these needs while providing the recommended early care.

What safety protocols are taking place in clinics to ensure safety if patients are visiting for a possible concussion?
Dr. Reams: For in-person visits, there are a limited number of physicians in our clinic space each day in order to ensure that there can be appropriate social distancing in our waiting rooms (many chairs have been taken out of this space to ensure safety). All patients entering one of our clinic facilities will be screened for COVID exposure and symptoms, will have to have their temperature taken, and will be provided with and mandated to wear a mask. 

The physician will also be wearing a mask and eye-protective gear to limit and exposure. As mentioned above, there is also the option to have the visits conducted by telehealth. These have been encouraged for the appropriate patient, though for new or complicated cases, an in-person visit may be suggested.

What is the timeframe someone should come in if they suspect they have a concussion or head injury?
Dr. Reams: Ideally, we would see a patient within 1 week of a potential injury. The sooner the better.

What happens if someone doesn’t get a concussion or head injury checked out immediately? Can it cause brain damage?
Dr. Reams: The primary concern would be that the head injury was not simply a concussion (a mild traumatic brain injury), but rather a more serious injury that involves bleeding in the brain and/or a skull fracture. Though this is rare, if this type of more serious injury is missed, it could be fatal.

The other risks of delayed presentation or no presentation to a physician following head injury is that the injury recovery may be more prolonged or complicated if early measures and treatment are not taken. We may also miss an opportunity to identify that the injury didn’t result in a concussion, but rather a condition that requires a different treatment path altogether (such as a neck whiplash injury).