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Question: If you have been diagnosed with a level 3 concussion what does that really mean? Is one week long enough to stay away from sports if they have no signs of problems? No additional headache and had no motor or cognitive problems the night the player was injured.

Answer: Grading concussions is fraught with difficulties because different scales are used and the 'grade' of concussion in most instances has little bearing on how the person recovers. Many scales describe Grade 3 as any loss of consciousness. Amnesia and persistent symptoms are more important, based on recent studies. Without a doubt, an athlete with any 'grade' of concussion should not return to play until ALL symptoms are resolved, including headache, dizziness, nausea, concentration problems, emotional problems and fatigue. The athlete must remain symptom-free at the level of exertion necessitated by the sport he or she in playing. In most instances, clearance by a knowledgeable health care provider is recommended, to be absolutely sure the athlete is symptom-free and has a normal examination. Premature return to play increases the risk for more concussions and can, very rarely, even lead to death. The younger the athlete, the more cautious one must be. In short, if your athlete is free of symptoms (both at rest and with exertion, has a normal examination and has not had other recent concussions, he or she can return to play. But remember that evidence suggests that the impact of repeat concussions is significant, so prevention of further concussions is very important.

Answered on 01-01-1995 by Todd Maugans, MD, pediatric neurosurgeon, Dayton Children's

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