Concussion Care in Bellevue: Understanding Symptoms, Recovery & Treatment
Introduction
Every few years, the world’s top experts gather for the International Consensus on Concussion in Sport. Think of it as the 'best practices' playbook for concussion care. Their consensus statement is often considered the gold standard for how concussions should be assessed and managed.
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But here’s the challenge: despite this effort, there are more than 30 official definitions of concussion across medical and educational institutions worldwide.
At Summit Neuro in Bellevue, we believe what matters most isn’t the textbook definition—it’s your unique experience. Concussions affect every person differently, and the best treatment starts with listening to your story.
The Many Faces of Concussion: Phenotypes
Not all concussions look the same. In fact, specialists often describe them as “phenotypes”—different types of concussion presentations. Identifying which one (or ones) you have is key to targeted recovery.
• Oculomotor (Eye Movement Problems): Do your eyes move perfectly in sync? Or do you notice eye strain, blurred vision, or double vision?
• Headache: Concussions can trigger different headache types—tension, migraine-like, pressure-based. Getting the right diagnosis matters.
• Vestibular (Balance & Motion): This may be the most common and critical. The vestibular system helps your brain interpret gravity and motion.
• Autonomic: These are automatic body functions like heart rate, blood pressure, breathing, and digestion. After concussion, some people notice they can’t regulate these as smoothly.
• Cognitive (Thinking & Processing): Feeling foggy, slow, unfocused, or “not yourself” is common.
• Cervical (Neck Involvement): Whiplash or joint injuries in the neck can masquerade as concussion symptoms—or worsen them.
• Sleep: Trouble falling asleep, staying asleep, or waking rested often skyrockets after concussion.
• Emotional: Mood shifts are common—irritability, flat affect, or loss of motivation may show up unexpectedly.
Clinician’s Corner: Phenotypic Classification of Concussion
The latest consensus work suggests concussion is best approached via multi-domain phenotyping rather than a single label. This allows targeted rehabilitation protocols.
Phenotype Categories & Assessment Tools:
- Oculomotor: Smooth pursuit, saccade testing, VOG analysis
- Headache: ICHD-3 criteria subtyping; tension vs migraine overlap
- Vestibular: VOR testing, BPPV screening, dynamic posturography
- Autonomic: Tilt-table, COMPASS-31
- Cognitive: SCAT5, computerized neurocognitive testing
- Cervical: Joint position error, cervical kinesthetic testing
- Sleep: PSQI, actigraphy
- Emotional: PANAS-SF, BSI-18
PROM Recommendations:
- Baseline: BESS-8, MTQ-10
- Acute/Follow-Up: SCAT, GSQ-30, RPQ, HSP-46
- QoL: QoLS, QOLIBRI, EQ-5D-5L
- Autonomic: COMPASS-31
- Sleep: PSQI
Common Symptoms of Concussion
Concussion symptoms can vary widely—but here are some of the most common:
• Dizziness
• Headache
• Nausea
• Brain fog or 'slowed down' feeling
• Irritability or mood changes
• Trouble focusing or concentrating
• Fatigue and excessive sleepiness
• Sensitivity to light or sound
• Blurred, fuzzy, or double vision
• Balance or coordination problems
• Difficulty with speech or math
Key Insight: Dizziness, in particular, is one of the most reliable indicators of concussion severity.
Clinician’s Corner: Symptom Sensitivity
Dizziness is highly predictive of severity and duration of recovery (UPMC research).
Loss of consciousness (LOC) is now considered a poor marker of severity.
Fogginess is also strongly predictive of prolonged recovery.
Modifiers for Prolonged Recovery:
- Prior concussions
- Anxiety or mood disorder history
- Pre-existing headache syndromes
- Dysautonomia
- Motion sickness history
Clinical Pearl: Concussions are not visible on CT, MRI, or X-ray.
Why ER Evaluations Often Miss Things
If you’ve gone to the ER after a concussion, you probably had a CT scan. If it came back 'normal,' you might have been told you were fine.
Here’s the catch:
- CT and MRI can only rule out life-threatening emergencies (like a brain bleed).
- They cannot detect the subtle connection and circuit issues that cause concussion symptoms.
- That’s why many patients are discharged with 'normal' results but still feel terrible.
The ER’s job is to make sure you’re not in danger. Their role is not long-term recovery or rehab.
Clinician’s Corner: Limitations of ER Evaluations
Primary role: Identify emergent conditions (intracranial hemorrhage, skull fracture).
Common tool: CT (structural imaging).
Limitation: No imaging reliably detects functional deficits of concussion.
Concussion remains a clinical diagnosis without accepted biomarkers.
Advanced diagnostics (VOG, computerized testing, vestibular assessments) can quantify deficits.
Summit Neuro’s Approach
At Summit Neuro in Bellevue, we take a detective approach:
- We listen to your story.
- We test each system carefully (eyes, balance, cognition, neck, autonomics, sleep, mood).
- We use advanced, FDA-cleared technology to measure what’s going on beneath the surface.
- Then, we design a personalized plan to restore function and get you back to peak performance.
Our Promise: We won’t just tell you 'rest and wait.' We will help uncover the root causes of your symptoms—and give you tools to recover.
???? Book online today for a remote first interview and start your recovery journey.
Clinician’s Corner: Summit Neuro Clinical Workflow
1. Comprehensive Phenotypic Assessment (oculomotor, vestibular, cervical, autonomic, cognitive, emotional, sleep).
2. Validated PROM Integration (SCAT, GSQ-30, COMPASS-31, PSQI, QOLIBRI).
3. FDA-Cleared Technologies for objective measurement (VOG, computerized neurocognitive testing, balance platforms).
4. Individualized Rehabilitation Protocols aligned with consensus guidelines.
5. Home Care Strategies for continued neurorehabilitation.