Signs and Symptoms
Signs are outwardly apparent to those making an observation or conducting an assessment, while symptoms are findings the athlete will describe he/she is feeling.  Athletes with potential head injury must be serially monitored at regualar intervals acutely for signs and symptoms that may be delayed or do not appear for hours or several days post-injury.
Acute Hallmark Signs & Symptoms of a Concussion
  • Traumatic or repeated blows/hits or impulsive force transmitted to head
  • Headache
  • Confusion/Disorientation
  • Dizziness/Unsteady Gait
  • Visual disturbances
Signs & Symptoms of a Concussion
  • Prior History of head injury (risk factor)
  • Loss of Consciousness
  • Amnesia (loss of memory)
  • Confusion or disorientation
  • Difficulty concentrating or remembering
  • Headache  (persistent, crescendo)
  • Nausea/Vomiting
  • Unbalanced/Dizziness
    • Coordination Disturbance
    • Unsteady Gait
  • Fatigue
  • Answers questions slowly
  • Asks same questions repeatedly
  • Feeling mentally “foggy” or "Slowed down"
  • Sensitivity to Light
  • Sensitivity to Noise
  • Visual disturbances
    • Blurred Vison
    • Uncoordinated Eye movement; Double Vision
    • Altered Pupillary Reflexes
  • Sleep disturbances
    • Sleeping less or more than normal
    • Drowsiness
    • Difficulty falling/staying asleep
  • Emotional changes
    • Irritability
    • More emotional/Sadness
    • Nervousness


Loss of Consciousness (LOC)
  • Concussions can occur without LOC
  • Only 9% of concussions involve LOC.
  • The length of LOC needs to be timed as it is useful in concussion diagnisis
  • Observation of LOC at the time of concussion must be viewed as reflecting a potentially worrisome traumatic brain injury.
  • LOC followed by additional acute neurological status abnormalities, i.e. seizures, posturing movements, may indicate intracranial pathology.
  • Lack of LOC during a sports-related conucssion should not be considered indicative of a concussion of lesser severity.


Amnesia (Loss of Memory)
Retrograde Amnesia
  • Loss of memory of events immediately preceding injury.
  • Typically affects short-term memory centers 
    • Can be determined via questions relating to prior daily events, time, location, score, time & content of pre-game meal, play assignment.
Anterograde Amnesia
  • Lack of memory for events after injury, including questioning post-injury, assistance exiting field, final win/loss, showering/dressing after game, or departing event/ride home.
  • Often last to resolve of all post-traumatic symptoms.
  • Calculation of total amnestic time is important in concussion diagnosis.
Post-Traumatic Amnesia (PTA)
  • Only 24% of concussions involve posttraumatic amnesia.
  • Those who experience immediate amnesia have more persistent symptoms than the small minority who briefly lose consciousness (<1 minute).
  • Presence of post-traumatic amnesia, at time of injury, indicates a more involved injury and demands immediate cessation of athletic activity that day, and likelyhood of a more prolonged recovery period.


Graded Symptom Scale - 27-item            (print this form)

Concussion Symptom Inventory (CSI)    (print this form) 


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