Concussions are one of the most commonly misunderstood injuries in sports and daily life. Diagnosing a concussion is not as simple as performing a single test or scan; it requires a comprehensive evaluation by trained professionals using multiple diagnostic tools.

In this article, we’ll walk through the step-by-step process of how concussions are diagnosed, incorporating the latest clinical practices and emerging technologies.

The Concussion Diagnosis Process.

Proper concussion diagnosis involves a combination of clinical expertise, patient history, and diagnostic tools. Here are the key steps:

1. Clinical Evaluation and Neurological Exam

The first step in diagnosing a concussion is a thorough clinical evaluation, where a trained clinician conducts a detailed neurological exam. This involves taking a detailed medical history, assessing the injury mechanism, and performing a focused neurological exam.

The neurological exam often evaluates:

  • Cranial nerve function
  • Balance and coordination
  • Reflexes
  • Cognitive function (memory, focus, and mental clarity)

Learn More: Clinical Evaluation of Concussions

2. Baseline Testing for Athletes

For athletes with access to baseline testing, comparing pre- and post-injury results can help pinpoint deficits caused by a concussion. This step is especially valuable in sports like hockey or football, where repeated contact is inevitable.

Baseline testing may include:

  • Neurocognitive assessments
  • Balance tests
  • Visual-motor evaluations

Explore: What Is Baseline Testing?

3. Imaging When Necessary

Imaging, such as CT or MRI scans, is not typically required for diagnosing a concussion unless red flags (e.g., skull fractures or brain bleeds) are present. However, in some cases, advanced imaging techniques like SPECT or DTI may be used to detect subtle brain injuries or changes in function. However, currently, these imaging methods are more interesting than clinically useful. 

Related Reading: When to Use Advanced Imaging for Concussions

4. Symptom Assessment (PCSS)

Symptom evaluation is a cornerstone of concussion diagnosis. Clinicians often use the Post-Concussion Symptom Scale (PCSS) to assess the severity of symptoms, including:

  • Headache
  • Dizziness
  • Nausea
  • Fatigue
  • Cognitive and emotional changes

Learn More: What Is the PCSS?

5. Vestibular and Oculomotor Screening (VOMS)

The VOMS test evaluates vestibular (balance-related) and oculomotor (eye movement) systems, which are often impaired after a concussion. The test assesses:

  • Smooth eye movements
  • Visual tracking
  • Balance and motion sensitivity

Research highlights the importance of detecting vestibular and oculomotor impairments early, as these are familiar sources of prolonged symptoms (Büttner et al., 2021).

Deep Dive: What Is VOMS?

6. The Buffalo Concussion Treadmill Test

The Buffalo Concussion Treadmill Test (BCTT) is used to evaluate exercise tolerance and guide return-to-play decisions. This tool helps identify autonomic dysregulation—a key factor in post-concussion symptoms—and provides a safe way to reintroduce physical activity.

Evidence supports the BCTT’s role in predicting recovery timelines (Kumar et al., 2022).

Explore: Buffalo Treadmill Test

7. Emerging Diagnostic Tools

Advances in concussion research have introduced innovative diagnostic tools, including:

  • Biomarkers: Specific proteins in blood or plasma that may indicate brain injury (Tabor et al., 2024). More and more evidence is emerging on the use of GFAP and UCH-L1 for the acute assessment of concussion and determining the need for CT imaging. 
  • SCOAT6: Designed for use during the 3–30 day post-injury window, the Sport Concussion Office Assessment Tool 6 (SCOAT6) provides a structured framework for delayed concussion assessments. It incorporates key elements such as the Post-Concussion Symptom Scale (PCSS), a modified Vestibular Ocular Motor Screening (VOMS), and graded-exercise testing to create a comprehensive evaluation of concussion recovery (Patricios et al., 2023).

These tools represent significant advancements in concussion diagnostics and are part of the framework outlined in the 2023 Consensus Statement on Concussion in Sport (Patricios et al., 2023).

FAQs: Diagnosing a Concussion.

Q: Can a concussion be diagnosed with an MRI or CT scan?
 A: No, concussions do not show up on standard CT or MRI scans unless there is a more severe brain injury. Imaging is used to rule out complications.

Q: How soon should I see a doctor after a concussion?
 A: Ideally, you should see a concussion specialist within 48 hours of injury. Early assessment improves recovery outcomes.

Q: What if my symptoms don’t appear right away?
 A: Some concussion symptoms can take hours or even days to emerge. If in doubt, always err on the side of caution and seek an evaluation.

Main Takeaways.

Diagnosing a concussion is a multi-step process requiring clinical expertise, evidence-based tools, and sometimes advanced diagnostics. Here’s a quick recap:

  1. Start with a thorough clinical evaluation.
  2. Use baseline testing for athletes when available.
  3. Employ imaging only when necessary.
  4. Assess symptoms with tools like the PCSS.
  5. Perform vestibular and oculomotor screening (VOMS).
  6. Leverage the Buffalo Concussion Treadmill Test to guide recovery.
  7. Consider emerging tools like biomarkers and SCOAT6 for a comprehensive approach.

The more precise the diagnosis, the better the recovery trajectory.

References
  1. Büttner, F., Howell, D. R., Doherty, C., Blake, C., Ryan, J., & Delahunt, E. (2021). Clinical detection and recovery of vestibular and oculomotor impairments among amateur athletes following sport-related concussion: a prospective, matched-cohort study. The Journal of Head Trauma Rehabilitation, 36(2), 87–95. PubMed
  2. Patricios, J. S., Davis, G. A., Ahmed, O. H., Blauwet, C., Schneider, G. M., Purcell, L. K., … & Schneider, K. J. (2023). Introducing the sport concussion office assessment tool 6 (SCOAT6). British Journal of Sports Medicine, 57(11), 648–650. PubMed
  3. Kumar, A., Kara, S., van der Werf, B., & Fulcher, M. (2022). Can the Buffalo Concussion Treadmill Test be used as a prognostic indicator for patients with sport-related mild traumatic brain injury? Clinical Journal of Sport Medicine, 10–1097. PubMed
  4. Tabor, J. B., Penner, L. C., Galarneau, J. M., Josafatow, N., Cooper, J., Ghodsi, M., … & Emery, C. A. (2024). Plasma biomarkers of traumatic brain injury in adolescents with sport-related concussion. JAMA Network Open, 7(9), e2431959–e2431959. PubMed
  5. Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., … & Meeuwisse, W. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711. PubMed

Disclaimer: 

This blog was AI-generated and human-edited by Dr. Mark Heisig to ensure accuracy and relevance.