Symptoms & Diagnosis
How Are Concussions Diagnosed When the Scan Is “Normal”?
People expect brain injuries to show up like broken bones: point to the image, point to the problem. Concussions do not always cooperate. A concussion is a type of mild traumatic brain injury (mild TBI), and routine CT or MRI often looks normal even when symptoms are real and disruptive. The diagnosis is usually clinical—based on what happened, what changed afterward, and how the brain is functioning on exam. [1][2][3]
That can feel unsatisfying. It is also how modern medicine is designed to handle a condition that is often more about function than a visible structural lesion on standard imaging. [2][3]
Key Takeaways
• A normal CT or MRI does not rule out a concussion; routine imaging is often normal in mild TBI. [2][4]
• Clinicians diagnose concussion using history, symptom pattern over time, and neurologic/functional findings. [1][2][5]
• Imaging is most often used to rule out dangerous complications (like bleeding), not to “prove” a concussion. [3][6][7]
• Symptoms may evolve or worsen after the event; delayed onset is a known pattern. [8][9]
• Clear symptom-and-function tracking helps guide care, referrals, and recovery planning. [8][10]
What “Normal” Imaging Really Means
CT and MRI are excellent tools—but they answer specific questions. In the acute setting, CT is commonly used to evaluate for fractures and intracranial bleeding when clinically indicated after head trauma. [6][7] MRI may be used in selected situations to evaluate complications or alternative diagnoses, but it is not a magic “concussion detector.” [3][11]
A concussion is typically described as a disturbance in brain function after biomechanical force, and routine imaging can be normal because standard CT/MRI is not designed to capture many of the functional changes that drive post-concussion symptoms. [2][4][12]
The Core of Diagnosis: History + Pattern + Exam
Concussion diagnosis usually starts with the story. Clinicians look at the mechanism (a blow to the head, face, neck, or body with force transmitted to the head) and whether the symptom pattern fits what is known about concussion. [1][12]
Common features clinicians evaluate include:
• Immediate or early symptoms (headache, dizziness, confusion, nausea, visual disturbance, “foggy” feeling). [8]
• Symptom course over hours and days (improving, fluctuating, or worsening). [9][10]
• Neurologic screening and functional impact (attention, memory, balance, coordination, eye movements, symptom provocation). [3][10][13]
Put plainly: the question is rarely “Do we see it?” The question is “Does the pattern fit a concussion, and have we ruled out something emergent?” [3][7][10]
Common Tools Doctors Use (Beyond Scans)
Clinicians may use structured tools to quantify symptoms and function. These tools are not “gotchas.” They are ways to measure what you are experiencing and track change over time.
Symptom inventories and checklists
These capture symptoms across physical, cognitive, sleep, and emotional domains and help monitor recovery. [8][10]
Balance and gait screening
Balance problems are common after concussion, so clinicians may assess postural stability and coordination. [8][13]
Vestibular and vision-focused screening
When dizziness, nausea, visual motion sensitivity, or screen intolerance is prominent, clinicians may screen vestibular-ocular function and consider targeted therapy or referral. [12][13]
Cognitive screening and neuropsychological testing (when indicated)
If symptoms persist or the clinical picture is complex, cognitive screening and, sometimes, formal neuropsychological testing may help characterize deficits and guide treatment. [13]
Why Timing Matters: Symptoms Can Evolve
Many people assume concussion symptoms must be immediate. In reality, symptoms can emerge or become more obvious later—especially when someone returns to work, school, or screens and realizes their brain is not tolerating normal demands. The CDC explicitly notes that symptoms can change during recovery and may show up or shift over time. [9]
This is one reason follow-up matters. A one-time snapshot in the emergency department may rule out a dangerous bleed, but it may not capture how function changes over the next several days. [6][9][10]
When Imaging Is Used, and What It’s Trying to Prevent
Imaging is often about safety. If there are concerning features—such as worsening headache, repeated vomiting, significant neurologic changes, or other “danger signs”—clinicians may recommend urgent evaluation and imaging to rule out serious complications. [8][11]
Professional guidelines and decision pathways for head trauma emphasize imaging’s role in evaluating acute injury risk rather than confirming concussion as a diagnosis. [7]
The Kind of Documentation That Helps (Health First)
From a medical standpoint, the most useful “documentation” is specific, accurate reporting of symptoms and functional limits. This supports better care decisions, appropriate referrals, and safer return-to-activity planning. [8][10]
Helpful details include:
• What you felt, and when it started (same day vs next day; sudden vs gradual). [9]
• What tasks became harder (reading, screens, driving, multitasking, physical exertion, sleep). [8][9]
• What predictably worsens symptoms (noise, bright light, busy environments, exertion) and what tends to help (rest breaks, pacing). [8][10]
• Whether symptoms are improving, stable, or worsening over time. [9][10]
Accuracy beats drama. In concussion care, specifics are often the difference between “unclear” and “actionable.” [10][13]
Myth vs. Reality
Myth: “A normal CT/MRI means nothing happened.”
Reality: Routine imaging can be normal after concussion; the diagnosis is typically clinical. [2][4]
Myth: “If symptoms showed up later, it can’t be a concussion.”
Reality: Symptoms can evolve, and the CDC notes they may change during recovery. [9]
Myth: “Doctors are guessing.”
Reality: Clinicians use established symptom frameworks, neurologic exams, and functional assessment tools; imaging is reserved for specific safety questions. [8][10][13]
FAQ
Can you have a concussion without losing consciousness?
Yes. Concussion can occur with or without loss of consciousness. [2][11]Why do I feel “foggy” if my scan is normal?
Because concussion can disrupt brain function in ways routine imaging may not detect; symptoms are real even when CT/MRI is normal. [2][4][12]What are “danger signs” after a head injury?
Examples include symptoms that worsen over time, severe or worsening headache, repeated vomiting, or other concerning changes that warrant urgent evaluation. [8][11]What kind of doctor evaluates persistent concussion symptoms?
Care often starts with primary care or urgent care and may involve specialists such as neurology, sports medicine, or rehabilitation depending on symptoms and duration. [11][13]If symptoms last weeks or months, does that mean the injury wasn’t “mild”?
“Mild” often refers to early clinical severity, not how disruptive symptoms can be. Some people recover quickly; others experience prolonged symptoms and need follow-up care. [1][9][11]
Medical Disclaimer
This is general educational information, not medical advice. If you have worsening symptoms or danger signs after a head injury, seek urgent medical care. [8][11]
Legal Disclaimer
This is for general informational purposes only and is not legal advice; consult a licensed attorney for guidance about your specific situation.
Referral
If you want a referral to a qualified attorney in your area, contact your state or local bar association’s lawyer referral service.
Sources
[1] CDC — About Mild TBI and Concussion: https://www.cdc.gov/traumatic-brain-injury/about/index.html
[2] AANS — Concussion: https://www.aans.org/patients/conditions-treatments/concussion/
[3] Mayo Clinic — Concussion: Diagnosis and Treatment: https://www.mayoclinic.org/diseases-conditions/concussion/diagnosis-treatment/drc-20355600
[4] Tator CH. Concussions and their consequences (review; notes conventional CT/MRI often normal): https://pmc.ncbi.nlm.nih.gov/articles/PMC3735746/
[5] NINDS — Traumatic Brain Injury (TBI): https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
[6] Mayo Clinic — Traumatic brain injury: Diagnosis & treatment (CT evaluates bleeding/fracture/contusion): https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/diagnosis-treatment/drc-20378561
[7] American College of Radiology — Head Trauma (Appropriateness Criteria narrative): https://acsearch.acr.org/docs/69481/Narrative/
[8] CDC HEADS UP — Signs and Symptoms of Concussion: https://www.cdc.gov/heads-up/signs-symptoms/index.html
[9] CDC — Symptoms of Mild TBI and Concussion (symptoms can change during recovery): https://www.cdc.gov/traumatic-brain-injury/signs-symptoms/index.html
[10] CDC — Concussion Signs and Symptoms Checklist (danger signs / symptom tracking framework): https://www.cdc.gov/heads-up/media/pdfs/schools/TBI_schools_checklist_508-a.pdf
[11] Mayo Clinic — Persistent post-concussive symptoms (imaging for concerning symptoms; images can’t “see” persistent symptoms): https://www.mayoclinic.org/diseases-conditions/post-concussion-syndrome/diagnosis-treatment/drc-20353357
[12] CDC HEADS UP — Concussion Basics: https://www.cdc.gov/heads-up/about/index.html
[13] Mayo Clinic — Concussion testing and screening tools: https://www.mayoclinic.org/tests-procedures/concussion-testing/about/pac-20384683
Author: Chandler Crawford, esq.
