Diagnosis, Testing, and Medical Assessment After a Concussion

How clinicians in the West Metro Portland area evaluate concussion

After a head injury, many people want one clear answer.

They want a test that says “yes” or “no.”…a scan that shows the injury…or a number that tells them how bad it is and how long recovery will take.

Unfortunately concussions do not work that way.

This can feel frustrating, scary, or confusing; especially for parents, athletes, and working adults in Washington County who are trying to make the right decisions.

This article explains how concussions are diagnosed and assessed in real life. It explains why there is no single test, what doctors and clinicians look for, and how testing is used to guide care, not to give perfect answers.

Concussion Is a Clinical Diagnosis

A concussion is diagnosed by listening, observing, and examining.

There is:

• No blood test that proves a concussion

• No scan that shows a concussion

• No score that tells the full story

Instead, clinicians diagnose concussion based on:

• What happened during the injury

• What symptoms started after the injury

• How the person is functioning now

• What the exam shows

The diagnosis decision is made by a trained professional using judgment, patterns, and experience, not just one single test result.

Why This Can Feel Unsatisfying

Many injuries are easy to see.

A broken bone shows up on an X-ray.
A cut can be seen on the skin.
An infection shows up in blood work.

A concussion affects how the brain works, not how it looks.

That makes it harder to explain and harder to accept. But it does not make it less real.

What Clinicians Ask About First

The first part of a concussion evaluation is the story.

Clinicians ask questions like:

• How did the injury happen?

• Was there a fall, hit, or sudden stop?

• Did the head move quickly?

• Did symptoms start right away or later?

• What symptoms are present now?

The details matter.

A fall at home, a soccer collision, a bike crash, or a car accident can all cause concussion. The force does not have to seem dramatic.

Why Symptoms Matter More Than Scans

Symptoms are the main signal of concussion.

Clinicians look for patterns such as:

• Headache after injury

• Dizziness or balance trouble

• Trouble thinking or focusing

• Vision problems

• Sensitivity to light or noise

• Changes in mood or sleep

The presence of these symptoms after a head or body injury points toward concussion, even when scans are normal.

When Imaging Is Used

Brain scans are not used to diagnose concussion.

They are used to rule out more serious injuries.

CT Scans

CT scans are used when clinicians worry about:

• Bleeding in the brain

• Skull fracture

• Worsening neurologic function

CT scans are fast and helpful in emergency settings. They are not designed to show concussion.

MRI Scans

MRI scans look at brain structure in more detail. They may be used in special cases but are still usually normal after concussion.

MRI is not a recovery test. It does not show when the brain is healed.

Why Avoiding Unnecessary Imaging Matters

Imaging has limits and risks.

CT scans expose people to radiation.
Normal scans can give false reassurance.

Someone may think:
“The scan is normal, so I should feel normal.”

This can lead to pushing too hard and worsening symptoms.

Clinical guidelines stress that imaging should be used carefully and only when needed.

Common Assessment Tools Used After Concussion

Because there is no single test, clinicians use many small tools to understand how the brain is working.

Each tool looks at a different part of function.

Symptom Inventories

Symptom inventories are simple question lists.

They ask:

• What symptoms are present?

• How strong are they?

• How have they changed?

These lists help:

• Track progress over time

• Spot patterns

• Guide activity decisions

They are not pass-fail tests. They are tracking tools.

Cognitive Screening

Cognitive screening looks at thinking skills.

These tests are short and simple.

They may look at:

• Memory

• Attention

• Speed of thinking

Someone might be asked to:

• Remember words

• Repeat numbers

• Solve simple problems

These tests help show if thinking feels slower or harder than usual.

They do not measure intelligence.
They do not define recovery on their own.

Balance Testing

Balance testing checks how well the body stays steady.

After concussion, balance systems may not work smoothly.

Clinicians may test:

• Standing still

• Standing on one foot

• Walking in a straight line

Poor balance does not mean permanent damage. It means the system is under stress.

Vestibular and Oculomotor Assessment

These words sound big, but the ideas are simple.

Vestibular System

This system helps with balance and motion.

Tests may look at:

• Dizziness

• Head movement tolerance

• Stability while moving

Oculomotor System

This system controls eye movement.

Tests may look at:

• Tracking objects

• Focusing

• Eye coordination

Problems here can cause:

• Headache

• Dizziness

• Eye strain

• Nausea

These systems are often involved in concussion and are treatable when identified.

Cervical Spine Assessment

The neck matters more than many people realize.

Head and neck move together during injury.

Neck problems can cause:

• Headache

• Dizziness

• Balance trouble

• Vision discomfort

Clinicians often check:

• Neck movement

• Neck pain

• Muscle tension

Neck involvement does not mean the brain injury is worse. It means another system is adding to symptoms.

Why No Single Test Is Enough

Each test looks at one piece.

A concussion affects many pieces at once.

That is why clinicians combine:

• Symptom reports

• Physical exam

• Thinking checks

• Balance checks

• Eye movement checks

Together, these give a clearer picture.

Variability Across Care Settings

Concussion care looks different depending on where someone is seen.

This is normal.

Urgent Care and Emergency Departments

These settings focus on:

• Safety

• Ruling out serious injury

• Identifying red flags

They may not do detailed testing. Their job is to make sure the person is safe to go home.

Primary Care

Primary care clinicians manage:

• Follow-up

• Monitoring

• Guidance over time

They help coordinate care and watch for improvement or problems.

Sports Medicine and Rehabilitation

These specialists often do:

• More detailed testing

• Targeted exams

• Activity planning

They focus on recovery and return to function.

Different Tools, Same Principles

Even though tools vary, the core ideas are the same:

• Listen to symptoms

• Look for patterns

• Watch how the person functions

• Adjust care based on response

Limitations of Concussion Testing

Testing is helpful, but it has limits.

Normal Testing Does Not Mean Full Recovery

Someone may test “normal” but still feel bad.

This does not mean symptoms are fake.

It means tests are snapshots, not full stories.

Abnormal Testing Does Not Predict Exact Recovery Time

Testing cannot say:
“You will be better in two weeks.”

Recovery is individual.

Results Must Be Interpreted in Context

Tests are guides, not verdicts.

Clinicians look at:

• Daily function

• Symptom response

• Progress over time

Why Follow-Up Matters

Concussion care does not end after one visit.

Follow-up helps:

• Adjust activity

• Catch lingering problems

• Refer when needed

Recovery is a process, not a moment.

Questions to Ask Your Clinician

What factors might slow my recovery?

You might hear them say the following: people with more symptoms at the start, prior concussions, migraine history, sleep problems, anxiety or depression, or neck or balance involvement may take longer to recover, but no single factor can predict recovery for sure.

Which symptoms should guide activity progression?

Clinical practice guidelines would suggests an answer like: how symptoms respond during and after activity, especially headaches, dizziness, eye strain, and mental fatigue, should guide how fast activities are increased or scaled back.

When should referral be considered?

Based on the current evidence, your clinician might say the following: referral to specialists such as sports medicine, neurology, or rehabilitation is appropriate when symptoms last longer than expected, limit daily life, or suggest specific problems like balance or neck involvement.

Frequently Asked Questions

Is baseline testing required?

No. Baseline testing can help in some cases, but it is not required to diagnose or manage concussion.

Do neuropsychological tests diagnose concussion?

No. They support assessment, but they do not diagnose concussion by themselves.

Can symptoms persist with normal tests?

Yes. Symptoms can last even when tests look normal.

Why This Matters for Washington County Residents

People in this region are active.

Kids play sports.
Adults commute and work.
Families bike and hike.
Older adults experience falls.

Understanding how concussion is diagnosed helps people:

• Trust the process

• Ask better questions

• Avoid pushing too fast

Concussion care is about patterns and progress, not perfect tests.

How This Article Fits in the Series

This article explains how concussion is evaluated and why testing works the way it does.

The next article focuses on:

• Recovery

• Activity progression

• Return to school, work, and sports

• Long-term considerations

Together, these articles form a clear and practical guide for families and individuals in Washington County and the West Metro Portland area.