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Concussion in Hyderabad: The Brain Injury You Cannot See on a Scan — Why It Still Needs Assessment, Rest, and a Structured Return to Play
Same-day SCAT6 assessment, neuropsychological testing, and structured return-to-play protocol at KIMS Neuroscience, Secunderabad, Hyderabad.
Concussion is a traumatic brain injury caused by a biomechanical force to the head, face, neck, or body that produces a transient functional neurological disturbance without structural damage visible on standard CT or MRI. The brain is not bruised; there is no haemorrhage — but the neurons undergo a neurometabolic energy crisis: ionic disruption, glutamate surge, glucose demand rising while blood flow falls. Recovery takes days to weeks. During recovery, the brain is specifically vulnerable to Second Impact Syndrome (SIS) — a second head impact producing catastrophic and potentially fatal diffuse cerebral oedema. CT head is NOT routinely indicated; the Canadian CT Head Rules guide when CT is needed. Assessment: SCAT6 (2023). Return to play: clinical recovery first (asymptomatic at rest), then the 6-stage CISG graded return to sport protocol with a minimum of 24 hours per step and written medical clearance required at Stage 5; neuropsychological testing is a supplementary tool, not the clearance criterion. Complete cognitive isolation (dark rooms) is no longer recommended beyond 24–48 hours.
- Second Impact Syndrome — potentially fatal
- A second head impact during concussion recovery produces catastrophic diffuse cerebral oedema that is far more severe than the initial concussion and can be fatal. Return to play before full recovery is not just inadvisable — it is potentially lethal. SCAT6 and written medical clearance at Stage 5 protect against SIS.
- SCAT6 — concussion assessment (2023)
- 22-symptom scale (each 0–6 severity), SAC cognitive screening, Modified BESS balance test, tandem gait, cervical assessment, red flag screening, neurological examination. Administered at KIMS for all sports concussion. Compared to pre-season baseline where available.
- CT NOT routinely indicated for concussion
- CT will be normal in concussion by definition. CT is indicated by Canadian CT Head Rules: GCS <15 at 2 hours, suspected fracture, two or more vomiting episodes, age ≥65, amnesia ≥30 minutes before impact, or dangerous mechanism. NOT for headache alone after minor bump.
- CISG 2023: dark rooms are harmful
- Complete cognitive isolation beyond 24–48 hours is no longer recommended. Prolonged complete rest causes deconditioning, anxiety, social isolation, and sleep disruption — all of which compound concussion symptoms. Light aerobic exercise at sub-symptom threshold speeds recovery.
- 6-stage return-to-play protocol
- Clinical recovery first — asymptomatic at rest before the protocol begins. Stage 1: symptom-limited activity · Stage 2: light aerobic (no resistance training) · Stage 3: sport-specific · Stage 4: non-contact drills · Stage 5: full-contact practice with WRITTEN MEDICAL CLEARANCE · Stage 6: competition. Minimum 24 hours per step; any symptom recurrence: drop back one stage.
- Neuropsychological testing is supplementary
- SCAT6, ImPACT and Cogstate are useful adjuncts — especially against a pre-season baseline — but they do not determine return to play. Symptoms and clinical examination drive the protocol: a normal test score in a symptomatic athlete does NOT clear them to return to sport (CISG Berlin 2017, 2023 update).
- Cricket helmet standard BS 7928:2013
- Grille gaps of 35mm or less. Faceguard tested to 56 m/s ball impact. A loose or ill-fitting helmet provides far less protection than one correctly fitted. Half-helmets are a fraction as protective as full-face helmets. KIMS counsels every recovering cricketer on helmet choice and fit.
- Sub-concussive impacts also matter
- Sub-concussive impacts — head impacts below the concussion threshold that cause no overt symptoms — are not harmless. They accumulate over a career and contribute to long-term brain changes. This is why sport-wide head impact reduction policies are needed, not just concussion management.
| Fact | Details |
|---|---|
| Definition | Functional neurological disruption from biomechanical force · No structural damage on CT or MRI · Neurometabolic energy crisis: days to weeks to resolve |
| Second Impact Syndrome | Second head impact during recovery = catastrophic diffuse oedema · Potentially fatal · Prevention: return to play only after medical clearance via 6-stage protocol |
| SCAT6 (2023) | 22-symptom scale + SAC cognitive screening + BESS balance + tandem gait + red flag screening · Compared to pre-season baseline · Objective documentation regardless of player self-report |
| CT decision | Canadian CT Head Rules only · NOT for headache alone · NOT routinely for concussion · Indicated: GCS <15, suspected fracture, 2+ vomiting, age ≥65, amnesia ≥30 min, dangerous mechanism |
| CISG 2023 rest guidelines | 24–48 hours relative rest · NOT dark-room isolation beyond that · Graduated return to cognitive activity · Light aerobic exercise speeds recovery · BCTT identifies safe exercise level |
| Return-to-play | Clinical recovery first — asymptomatic at rest before starting · 6 stages, minimum 24 hours each · Written medical clearance at Stage 5 (full-contact practice) · Symptom recurrence: step back one stage |
| Neuropsychological testing | Supplementary tool, not the clearance criterion · Most useful against a pre-season baseline · Symptoms and clinical examination drive the protocol · A normal score in a symptomatic athlete does NOT permit return to sport |
| India sports context | Cricket concussion from fast bowling impacts significantly underreported · Kabaddi/wrestling/football also affected · Culture of "playing through" persists · KIMS provides same-day athlete assessment |
About This Condition
The Batsman Who “Felt Fine”
A 22-year-old club cricketer in Hyderabad is hit on the helmet by a fast delivery during a weekend match. He momentarily loses his balance and stumbles before regaining his feet. He shakes his head and signals to the dressing room that he is fine. His teammates and captain watch him bat for another 12 minutes before he is dismissed. He does not tell anyone that the world looked blurry for about 30 seconds after the impact, that he felt nauseated, and that he cannot remember the 3 overs before the impact.
He arrives at KIMS 6 hours later, sent by his parents, with a persistent headache, continued light sensitivity, and an inability to concentrate on his phone screen. The SCAT6 assessment at KIMS documents: symptom severity score of 42 (significant); ImPACT cognitive testing showing reduced processing speed and working memory compared to his pre-season baseline; and balance assessment showing increased postural sway. He has concussion.
The diagnosis matters because what he does next matters. If he returns to training tomorrow (as he planned), he is at risk of: prolonged recovery from cumulative sub-concussive stress; Second Impact Syndrome if he takes another head impact before recovering; and, over a career of repeated unrecognised concussions, an elevated risk of Traumatic Encephalopathy Syndrome. At KIMS, the return-to-play protocol is initiated: complete rest for 24 hours, then graduated return to activity over minimum 7–14 days, with reassessment at each stage.
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Speak directly with our concussion specialist team. Same-day appointments available for athletes. Monday to Saturday.
040-44885000Emergency line: 040-46324365Quick Facts about Concussion
The essential facts every athlete, parent, and clinician should know about concussion — what it is, why it matters, and when imaging is required.
What it is
Concussion is a traumatic brain injury caused by a direct blow to the head, face, or neck — or from an indirect force transmitted to the head from a blow to the body. It produces a transient functional disruption of neurological function without any structural brain damage visible on standard CT or routine MRI. The brain is not bruised, and there is no bleeding. But the neurons have been subjected to a mechanical and biochemical disruption that temporarily impairs their ability to function normally. The result: symptoms of headache, dizziness, fogginess, memory difficulty, slowed reaction time, and sensitivity to light and noise.
It is not just a bump on the head
Concussion is a genuine brain injury. The neurons stretch, ionic channels become temporarily disrupted, glutamate floods the synapse, and a neurometabolic cascade follows: glucose demand rises while blood flow falls, producing an energy crisis in the affected neurons that can take days to weeks to resolve. During this recovery period, the brain is vulnerable — a second head impact during recovery can produce Second Impact Syndrome (SIS), a catastrophic and potentially fatal diffuse cerebral oedema that is far more severe than the initial concussion.
How common
Concussion is the most common form of traumatic brain injury. In India, sports concussions are significantly underreported — athletes continue to play through concussion symptoms in cricket, kabaddi, wrestling, football, and hockey because the diagnosis is not made on the field and the culture of "playing through" is prevalent. At KIMS, the sports concussion programme provides same-day assessment for athletes, using the SCAT6 (Sport Concussion Assessment Tool, 6th edition) to objectively document symptoms, cognitive function, balance, and neurological status.
When CT is and is not needed
A CT head is NOT routinely required for concussion — it will be normal in concussion by definition, and unnecessary radiation exposure adds no value. The Canadian CT Head Rules guide CT decision-making at KIMS: CT is indicated if GCS below 15 at 2 hours after injury; suspected open or depressed skull fracture; any sign of basal skull fracture; two or more episodes of vomiting; age 65 years or older; amnesia for events before impact of 30 minutes or more; or a dangerous mechanism (pedestrian struck by vehicle, fall from more than 1 metre or 5 stairs, ejection from a motor vehicle).
Concussion Symptoms
Concussion produces a constellation of symptoms — physical, cognitive, vestibular, and emotional. Recognising them is the first step to safe recovery.
Headache — the most common and most persistent symptom
Post-traumatic headache is present in over 90% of concussion patients. It is typically a pressure-like or pulsating pain, worse with cognitive effort, screen time, and physical exertion. The headache of concussion is different from the 'thunderclap' headache of subarachnoid haemorrhage (which is sudden and severe from the first second) and from the progressive worsening headache of an expanding haematoma. If the headache is worsening significantly in the hours after injury — not fluctuating, but progressively building — this is a red flag for intracranial haemorrhage and warrants immediate CT at KIMS emergency.
Cognitive fog — the symptom that most affects function
Patients describe: feeling 'in a cloud' or 'not quite there'; difficulty finding words mid-sentence; slowed thinking speed; difficulty keeping track of conversations; and inability to concentrate on reading, screen-based work, or academic tasks. This cognitive fog reflects the neurometabolic energy crisis in the recovering neurons. It typically improves with rest and worsens with cognitive effort. During the acute recovery phase, cognitive rest — reducing the demands placed on the recovering brain — is as important as physical rest.
Vestibular symptoms — dizziness, imbalance, and visual disturbance
The vestibular system (which controls balance and eye-head coordination) is particularly vulnerable to concussion. Symptoms: dizziness with head movement; feeling off-balance when walking; visual motion sensitivity (nausea with scrolling on a phone or watching moving objects); and difficulty with eye tracking. Vestibular concussion symptoms often respond specifically to vestibular physiotherapy — exercises that recalibrate the relationship between head movement, eye movement, and balance — and this is a specific component of the KIMS PCS rehabilitation programme for cases where vestibular symptoms persist.
Emotional and sleep symptoms
Irritability, mood swings, anxiety, and low mood are common in the first 2–4 weeks after concussion. They reflect neurobiological changes (disruption of serotonergic and noradrenergic neurotransmission from the injury) as well as the psychological burden of being unwell and unable to return to normal activities. Sleep disturbance (difficulty falling asleep, waking frequently, unrefreshing sleep) compounds all other symptoms by preventing the brain's normal overnight recovery processes. At KIMS, sleep hygiene education and, where needed, melatonin supplementation are part of the acute concussion management plan.
Diagnosis at KIMS
Concussion Assessment at KIMS
Concussion is a clinical diagnosis — there is no single test that confirms it. KIMS uses a structured, multi-component assessment that combines symptom scoring, cognitive testing, balance assessment, and selective imaging.
SCAT6 (Sport Concussion Assessment Tool, 6th Edition)
The internationally validated clinical tool for sideline and clinical concussion assessment. Components: symptom scale (22 symptoms, each scored 0–6 for severity); Standardised Assessment of Concussion (SAC) cognitive screening; Modified Balance Error Scoring System (mBESS) for balance; tandem gait; cervical spine assessment; red flag screening; and observed neurological examination. At KIMS, the full SCAT6 is administered for all sports concussion presentations, and the results are documented and compared to pre-season baseline assessments where available.
Neuropsychological (cognitive) testing
Computerised neuropsychological testing (ImPACT, CogSport, or similar) provides objective documentation of cognitive impairment after concussion and tracks recovery. Domains tested: reaction time, visual processing speed, working memory, and impulse control. At KIMS, post-injury neuropsychological testing is compared to the patient's pre-season baseline (collected before the sports season) where available, or to normative age-matched data. Neuropsychological testing (SCAT6, ImPACT, Cogstate) is a useful supplementary tool, particularly for baseline comparison in organised sport, but it is not the sole criterion for return to play. Return to play decisions are based on clinical recovery — complete symptom resolution at rest — followed by the graded return to sport protocol: the athlete must be asymptomatic at rest before beginning the protocol, and must complete each step without recurrence of symptoms before progressing. A normal neuropsychological score in a symptomatic athlete does not clear that athlete to return to sport.
CT Head — only when indicated
CT head using the Canadian CT Head Rules: ordered at KIMS only when clinical criteria are met (see Quick-Facts). Not ordered routinely for concussion — the scan will be normal in concussion and adds radiation without information. If CT is normal and neurological examination is non-focal, the patient can be managed as concussion. If CT shows any abnormality, the condition is reclassified as moderate or severe TBI and managed accordingly.
Vestibular and ocular-motor assessment
A specific assessment of vestibular and oculomotor function (the VOMS — Vestibular/Ocular Motor Screening tool) is performed when dizziness, visual symptoms, or balance problems are prominent. This identifies vestibular concussion and guides whether vestibular physiotherapy is needed as part of the recovery programme.
Treatment
Return-to-Play Protocol at KIMS (CISG 2023 Guidelines)
The 6-stage return-to-play protocol — internationally recognised and used at KIMS — ensures athletes do not return to competition while their brain is still recovering.
Symptom-limited daily activity — avoid exertion; cognitive rest if needed
Objective: Asymptomatic at rest before the graded protocol begins
Minimum time in stage: 1–2 days after injury
Light aerobic exercise (walking, swimming, stationary cycling at 50–60% max HR) — no resistance training
Objective: No return of symptoms during or after exercise
Minimum time in stage: At least 24 hours symptom-free at rest
Sport-specific exercise (running, skating — no head impact activities)
Objective: No return of symptoms
Minimum time in stage: 24 hours symptom-free after Stage 2
Non-contact training drills (passing, footwork, technique) — resistance training may start
Objective: Normal neurological examination; no symptoms
Minimum time in stage: 24 hours symptom-free after Stage 3
Full-contact practice after medical clearance
Objective: Medical clearance from KIMS concussion specialist
Minimum time in stage: 24 hours symptom-free after Stage 4
Return to competition
Objective: Full medical clearance documented
Minimum time in stage: 24 hours symptom-free after Stage 5
Critical rule: If any symptoms return during or after any stage, the patient drops back to the previous symptom-free stage and waits a further 24 hours before reattempting. Stage 5 (full-contact practice) requires explicit written medical clearance from the KIMS concussion specialist.
Red Flags — When a Concussion Is Not “Just a Concussion”
Most concussions resolve with rest and a structured return-to-play protocol. But certain symptoms after a head injury indicate possible intracranial bleeding or severe brain injury — and require emergency assessment at KIMS 040-46324365 immediately.
Loss of consciousness more than 1 minute
Worsening headache after the first hour
Repeated vomiting
Seizure
Inability to recognise people or places
Weakness or numbness in any limb
Unequal pupils
GCS below 13
Related Conditions
Concussion belongs to the family of traumatic neurological conditions managed at KIMS:
FAQs
Frequently Asked Questions
A head impact on the cricket ground. A kabaddi player who did not come off after a collision. A cyclist who hit the road with their head. Concussion is a brain injury that needs assessment, not dismissal.
At KIMS Neuroscience, Secunderabad, Hyderabad, same-day concussion assessment using SCAT6 and neuropsychological testing, followed by a structured return-to-play protocol, protects athletes from the risks of premature return and cumulative brain injury. Call 040-44885000.
International enquiries: info@kimsneurosciences.com