Quick Answer
A concussion is a brain injury caused by a blow or jolt, diagnosed from symptoms and examination rather than by imaging. CNS provides adult follow-up in Las Vegas and Henderson where symptoms persist, with documented assessment. Acute head injury with red-flag signs is an emergency, not an appointment.
Key Takeaways
- A normal CT scan does not mean nothing happened. Imaging looks for bleeding and fractures, which are different from a concussion. The diagnosis is clinical, and being told a scan was normal frequently leaves patients believing their symptoms are unexplained.
- Loss of consciousness is not required. Most concussions occur without it, and its absence is one of the commonest reasons an injury goes unrecognised and unmanaged.
- Most people recover within weeks. Where symptoms persist beyond that, the reasons are usually identifiable and treatable individually rather than being an untreatable consequence of the injury.
- The persistent symptoms are treated separately, not as one thing. Headache, dizziness, sleep disruption, mood change and cognitive difficulty each have their own management, and treating them individually is what produces improvement.
- This is an adult service. CNS sees patients 18 and older, so it does not provide paediatric assessment or youth sports return-to-play clearance, and says so rather than accepting bookings it cannot serve.
01 — OverviewWhen a head injury is an emergency
As with the stroke page, the urgent information comes first, because a head injury can be more serious than a concussion and the difference matters within hours. This page sits within the wider neurological conditions library at Clinical Neurology Specialists, and its subject is adult follow-up rather than acute assessment.
Red flags after a head injury
Worsening or severe headache. Repeated vomiting. Increasing drowsiness or difficulty waking someone. Confusion that is getting worse rather than better. A seizure. Weakness, numbness or difficulty speaking. Unequal pupils. Clear fluid from the nose or ear. Any of these means emergency assessment rather than waiting, because they raise the possibility of bleeding inside the skull, which is a different and more dangerous problem than a concussion.
Who needs a scan and who does not
Imaging after head injury is used to look for bleeding, swelling or fracture, not to diagnose concussion. Emergency departments use established criteria to decide, weighing age, mechanism, anticoagulant use, symptoms and examination findings. Someone taking blood thinners, someone over a certain age, and anyone with red-flag signs is more likely to need one. A normal result is genuinely reassuring about bleeding and says nothing at all about whether a concussion occurred.
Why the distinction is worth spelling out
Patients frequently leave an emergency department having been told their scan was normal, and reasonably conclude that means nothing is wrong. When symptoms continue for weeks they then have no explanation and often no follow-up. The Centers for Disease Control and Prevention maintains the definitional framework that separates these two questions, and a great deal of unnecessary distress comes from conflating them.
A concussion is a traumatic brain injury caused by a blow, jolt or sudden acceleration of the head that temporarily disrupts brain function, diagnosed from symptoms and examination rather than from any scan, and occurring most often without loss of consciousness.
02What a concussion actually is, and why it is missed
The injury is functional rather than structural, which is precisely why it does not appear on standard imaging and why the diagnosis rests on symptoms and examination.
Not only a direct blow
Any force transmitted to the head, including a blow to the body causing rapid head movement. A whiplash mechanism in a road collision can produce a concussion with no impact to the head at all.
Usually not lost
Most concussions occur without loss of consciousness. Feeling dazed, confused or slowed for a period, or being unable to recall the moments around the event, counts.
Sometimes delayed
Symptoms may appear hours later rather than immediately, which is another reason an injury is dismissed at the time and only recognised in retrospect.
The symptom groups
Physical: headache, dizziness, nausea, light and noise sensitivity, blurred vision, fatigue. Cognitive: slowed thinking, difficulty concentrating, memory difficulty, feeling foggy. Emotional: irritability, low mood, anxiety, feeling unlike yourself. Sleep: sleeping more, sleeping less, or sleeping badly. Most patients have symptoms across several groups, and the mix varies considerably between people.
| Question | CT or MRI | Clinical assessment |
|---|---|---|
| Is there bleeding inside the skull | Yes | Raises suspicion only |
| Is there a skull fracture | Yes | No |
| Did a concussion occur | No | Yes, this is how it is diagnosed |
| Which symptoms are driving persistence | No | Yes |
| Is a vestibular problem contributing | No | Yes, with balance testing |
| Performed at CNS | Coordinated externally | Here, at both offices |
Why it is under-recognised
No loss of consciousness, a normal scan, symptoms that are invisible to others, and a mechanism that seemed minor at the time. Add the tendency to attribute fatigue and irritability to stress rather than to an injury weeks earlier, and a substantial proportion of concussions are never identified as such. The National Institute of Neurological Disorders and Stroke catalogues traumatic brain injury across its severity range for that reason.
Why the mechanism is worth describing precisely
Patients tend to summarise the event, and the detail is where the useful information sits. A rear-end collision at low speed with the head turned produces a different pattern from a frontal impact with the head straight, and a fall backwards onto a hard floor differs from a blow from the side. Whether a seatbelt was worn, whether an airbag deployed, whether the head struck anything, and whether the neck was also injured all shape what to look for. Reconstructing that months later is considerably harder than recording it early.
Repeat injury, and why it matters
Sustaining a further head injury before recovering from the first is associated with a longer and more difficult recovery. That is the clinical basis for graded return to activity rather than an abundance of caution, and it applies to adults in physical work and recreational sport as much as to organised athletics.
Told your scan was normal but still not right weeks later?
A normal scan rules out bleeding. It says nothing about whether a concussion happened.
03Recovery, and what happens when it stalls
Most adults recover within weeks. Where recovery stalls, the reasons are generally identifiable, which is the substance of what a follow-up assessment offers.
The usual course
Symptoms are typically worst in the first days and improve steadily. Complete rest for a prolonged period is no longer recommended; a brief initial period of reduced activity followed by graded return to cognitive and physical activity, staying below the threshold that markedly worsens symptoms, produces better outcomes than extended rest. That represents a change from older advice and patients frequently arrive with the older version.
Why symptoms persist in a minority
Rarely because of ongoing brain injury. More often because of identifiable and treatable contributors: a headache disorder triggered or worsened by the injury, a vestibular problem producing dizziness, disrupted sleep, low mood or anxiety, neck injury sustained in the same event, visual convergence difficulty, and deconditioning from prolonged inactivity. Each of those responds to specific treatment, which is why the persistent group is worth assessing carefully rather than being told to wait.
What the assessment involves
A detailed history of the event and the symptom course. Neurological examination. Assessment of balance and eye movement. Consideration of the neck. Screening for sleep and mood contributions. Where dizziness is prominent, objective balance testing is available in-office, described on the VNG balance testing guide. Where seizures are suspected, electroencephalography is performed here, on the EEG guide. Imaging is coordinated externally where indicated.
Treating the components separately
This is the practical point. Post-traumatic headache is treated as a headache disorder, with the approaches on the headache and migraine page. Vestibular symptoms are treated with rehabilitation, on the dizziness page. Sleep and mood are treated directly. Addressing four contributors individually produces improvement where treating a single label called post-concussion syndrome does not.
04Documentation, and where this overlaps with a claim
A substantial proportion of adult concussions in this valley arise from road collisions and workplace incidents, which means the assessment frequently has a second audience.
Why documentation quality matters here
Where an injury forms part of an insurance claim or legal matter, the clinical record becomes evidence. A record stating that a patient reported feeling foggy is considerably less useful than one documenting the mechanism, the symptom course with dates, examination findings, what was measured and what was excluded. The same standard that makes a report clinically useful makes it defensible, which is why the practice applies one standard rather than two.
What the practice provides on that side
Documented neurological assessment, objective testing where indicated, and reports written to withstand review. That service line is described on the personal injury and medico-legal page, and expert-witness work specifically on the expert witness page. Findings are reported as found, including normal ones, which is what makes the rest of a report credible.
The honest limitation
Concussion is diagnosed from symptoms a patient reports, and no test proves it objectively. That is a genuine evidential difficulty rather than something to talk around, and the correct response is documenting the mechanism, the timeline and the objective findings that are available, while being explicit about what rests on the patient’s account. A report claiming more certainty than the condition allows is easily dismantled.
What a useful record contains
The mechanism described specifically rather than as an accident. Whether consciousness was lost and for how long, or whether it was not. Whether events around the injury can be recalled. The symptoms present initially and how they have changed, with dates. What examination found, including normal findings, since a documented normal examination is itself information. What testing was performed and what it showed. And the functional consequences: work missed, tasks that have become difficult, activities stopped. That last group is what a reader outside medicine understands most readily and it is the group most often omitted.
Timing, which matters for both purposes
Assessment closer to the injury produces a better record and better treatment, because the symptom course is documented as it happens rather than reconstructed months later. For a claim, contemporaneous documentation is worth substantially more than a retrospective account. For treatment, earlier intervention on the contributing factors shortens recovery.
05What this practice does not provide
Stated plainly, because concussion is an area where patients frequently arrive at the wrong service and lose time doing it.
Adults only
CNS sees patients aged 18 and older. A child or adolescent with a head injury needs paediatric assessment, and our scheduling team will say so on the call rather than after a visit. That also means no youth sports return-to-play clearance, which is a common enquiry and one this practice cannot serve.
Not acute care
This is outpatient follow-up. An acute head injury, particularly with any red-flag sign, belongs at an emergency department. The practice does not provide emergency assessment or inpatient care, and reaching the right place quickly matters more than reaching this one.
Not a rehabilitation service
Vestibular, cognitive and physical rehabilitation are delivered by therapists rather than here, and are coordinated. Neurology contributes the assessment, the diagnosis of which contributors are present, and the medical management, and then refers into rehabilitation with that specified rather than leaving a therapist to work it out.
Not a promise of recovery
No timeline and no outcome is promised. Most adults recover within weeks and a minority take considerably longer, and predicting which is not reliably possible at the outset. What is offered is assessment of what is actually driving persistent symptoms, treatment of each identified contributor, and documentation to a standard that holds up. Guidance on practice patterns comes from the American Academy of Neurology.
06Concussion follow-up across Southern Nevada
Both CNS offices provide adult concussion follow-up and both carry the balance and EEG testing that assessment sometimes needs, so appointments happen at whichever address is the shorter drive.
Concussion Henderson NV and Green Valley
Patients seeking concussion Henderson NV follow-up attend the West Horizon Ridge Parkway office, just off the 215 Beltway. Concussion Green Valley Henderson residents almost always find that address closest, and the local guide is concussion care in Henderson.
Concussion Las Vegas and Summerlin
Concussion Las Vegas and concussion Summerlin patients generally attend West Flamingo Road, which the 215 and Summerlin Parkway feed toward. Consultation, balance testing and EEG are all available there.
Concussion Southern Nevada: light, noise and a city that supplies both
Concussion Southern Nevada patients face an environmental factor worth naming. Light and noise sensitivity are among the commonest persistent symptoms, and this is a valley of intense sunlight, bright interiors and a hospitality economy built on noise and stimulation. A patient working on a casino floor or driving in desert glare is being exposed to precisely what worsens their symptoms, all day. That is not a reason to abandon work, and it does make specific adjustments, timing and eye protection genuinely therapeutic rather than incidental advice.
Getting seen, and what to bring
Bring the date and mechanism of the injury, any emergency department records including the imaging report, a symptom timeline, your medication list, and if a claim is involved, whatever documentation exists. Records can be requested through medical records. Coverage and any prior authorisation are verified before your appointment, with detail on the insurance page, and where a workplace or road incident is involved, that pathway is handled by the medico-legal service line.
Concussion and Head Injury Guides
7 in-depth guidesThis hub covers adult concussion and traumatic brain injury follow-up at CNS. The guides below cover care at each office, the documentation pathway where a claim is involved, and the individual symptoms that persistent cases are made of. Acute head injury with red-flag signs is an emergency rather than a subject for any of these guides.
Start Here — Cornerstone Guides
Concussion care in Henderson
Adult follow-up off the 215 Beltway, with balance testing on site.
Read the guide → DocumentationExpert witness and documentation
Where an injury forms part of a claim and the record becomes evidence.
Read more → SymptomPost-traumatic headache
Treated as a headache disorder rather than as an untreatable consequence.
Read more →Browse by Category
Where to be seen
The symptoms that persist
Objective testing
Where a claim is involved
The Complete Index — every guide in this hub
Five board-certified physicians
Leo Germin, M.D., FAANEM, founder and medical director, triple board-certified in Neurology and Vascular Neurology through the ABPN and Neuromuscular Medicine through the ABEM, with subspecialty certification in Neurosonology and Neuroimaging. Anup Panduranga, M.D., fellowship-trained in epilepsy. Eric Gutglueck, M.D., neuromuscular medicine and neuromuscular ultrasound. Jessica A. Knirk, M.D., general adult neurology with Botox for chronic migraine. William Lujan, M.D., broad general adult neurology.
Four advanced practice providers
Fara Tan, APRN, MSCN, a Multiple Sclerosis Certified Nurse through the Multiple Sclerosis Nurses International Certification Board. Lindsey Evans, PA-C, general neurology and electromyography. Terra Fonseca, PA-C, a surgical and vascular background applied to general adult neurology. Alissa Nakamura, PA-C, board-certified through the NCCPA, with three years in pain management that transfer directly to nerve-injury and neuropathy questions.
Spread, not headcount
A referral that lands somewhere without neuromuscular or epilepsy depth often becomes a second referral, and each handoff adds weeks. Here an ambiguous nerve study can be reviewed by a neuromuscular specialist and an ambiguous EEG by a fellowship-trained epileptologist without the patient leaving the practice. Full biographies are on the providers page.
The Bottom Line
A normal scan rules out bleeding, not concussion. Where symptoms persist beyond a few weeks, the cause is usually a set of identifiable contributors rather than untreatable brain injury, and treating each one separately is what produces improvement.
Frequently Asked Questions
My CT scan was normal. Does that mean I did not have a concussion?
No. Imaging after head injury looks for bleeding, swelling or fracture, which are different problems. A concussion is a functional injury diagnosed from symptoms and examination, and it does not appear on a standard scan. A normal result is reassuring about bleeding and says nothing about concussion.
Do you have to lose consciousness to have a concussion?
No, and most concussions occur without it. Feeling dazed, confused or slowed for a period, or being unable to recall the moments around the event, counts. The absence of lost consciousness is one of the commonest reasons an injury goes unrecognised.
When is a head injury an emergency?
Worsening or severe headache, repeated vomiting, increasing drowsiness or difficulty waking someone, worsening confusion, a seizure, weakness or difficulty speaking, unequal pupils, or clear fluid from the nose or ear. Those raise the possibility of bleeding inside the skull and need emergency assessment.
Should I rest completely until symptoms go away?
No. Prolonged complete rest is no longer recommended. A brief initial period of reduced activity followed by graded return to cognitive and physical activity, staying below the threshold that markedly worsens symptoms, produces better outcomes. Many patients arrive with the older advice.
Why do my symptoms persist months later?
Rarely because of ongoing brain injury. More often because of identifiable contributors: a headache disorder triggered by the injury, a vestibular problem, disrupted sleep, low mood or anxiety, a neck injury from the same event, or visual difficulty. Each responds to specific treatment.
Does CNS see children or provide sports clearance?
No. CNS sees patients aged 18 and older, so paediatric assessment and youth sports return-to-play clearance are outside its scope. Our scheduling team will say so on the call rather than after a visit.
My injury is part of an insurance claim. Does that change the assessment?
Not the clinical assessment, but the documentation standard matters more. Mechanism, symptom course with dates, examination findings and what was measured and excluded all belong in the record. Assessment closer to the injury produces a substantially better record than a retrospective account.
Does CNS provide rehabilitation?
No. Vestibular, cognitive and physical rehabilitation are delivered by therapists and coordinated. Neurology contributes the assessment, identifies which contributors are present, provides medical management, and refers into rehabilitation with those specified.
How this page was sourced
Practice facts here come from Clinical Neurology Specialists directly: that adult follow-up is provided at both offices, that balance testing and electroencephalography are performed in-house while imaging and rehabilitation are coordinated, and that the practice sees patients 18 and older only. Definitional and clinical context is sourced to the organisations below.
This page concerns adult outpatient follow-up and is not a guide to emergency assessment; red-flag guidance is included because it is the most useful information on the page. No recovery timeline, prevalence figure or proportion of persistent cases is quoted, because those vary by population and definition. No outcome is promised. Scope is adults 18 and older.
References
- Centers for Disease Control and Prevention — definitions, surveillance and public guidance on traumatic brain injury.
- National Institute of Neurological Disorders and Stroke — the reference catalogue of nervous-system disorders.
- American Academy of Neurology — clinical practice guidance and specialist supply.
This page is for general education about adult neurological care and is not medical advice, a diagnosis, or a treatment recommendation. It does not create a physician-patient relationship. Adults 18 and older. For an active stroke, a first-time or prolonged seizure, sudden severe headache, sudden weakness, sudden vision loss, or a head injury with loss of consciousness, call 911 or go to the nearest emergency department. Speak with a qualified clinician about your own circumstances.