Do Mild Concussions Require MRI Scans? Expert Advice for Parents

Is an MRI necessary for a mild concussion?

Hello Doctor, my son had an accident while skiing in Japan before the Lunar New Year.
He did not collide with any hard objects, but he experienced a mild concussion.
At the time of the incident (around 10:00 PM, as it was night skiing), he exhibited short-term memory loss and was transported to the hospital by ambulance.
That night, he underwent a CT scan, which showed no signs of internal bleeding.
However, his memory had not yet returned.
The following morning, after a night's sleep, he woke up and his memory had almost fully recovered.
The doctor conducted another examination and found no issues, allowing him to be discharged.
After returning home, it was New Year's Eve, and the hospital did not have regular outpatient services, so no further examinations were conducted.
It has now been almost three weeks since the incident, and he has shown no physical abnormalities.
Recently, a friend learned about the situation and suggested that he should undergo another MRI.
However, the MRI is out-of-pocket and quite expensive, so I would like to ask the doctor if, given my son's current condition, an MRI is necessary for further evaluation.
I sincerely appreciate your advice! Thank you very much!

Xiao Lin, 50~59 year old female. Ask Date: 2024/02/22

Dr. Jiang Junyi reply Neurology

Dear Miss Hsiao-Lin,
You mentioned that your child needs an MRI, which is not inexpensive, and you would like to ask the doctor whether, given your child's current condition, an MRI is necessary for further examination.
Currently, the out-of-pocket cost for MRI in Taiwan is approximately NT$7,000 to NT$8,000.
This imaging can primarily visualize intracranial blood vessels and detect any minor hemorrhages, which cannot be provided by a standard non-contrast CT scan.
However, if there are no obvious clinical symptoms, the National Health Insurance does not cover the cost.
Clinically, it is recommended to closely monitor the situation for 3 to 6 months.
Regarding nerve repair, it is suggested to consider supplementing with Vitamin B complex or Coenzyme Q10 to assist in recovery.
In some cases, families may also choose to self-pay for Cerebrolysin injections.
I recommend discussing the examination and treatment options with your child's attending physician.
Thank you for your inquiry, and feel free to reach out with any further questions.
Wishing you and your child good health and happiness.
Sincerely,
Dr.
Chuan-Yi Jiang

Reply Date: 2024/02/22

More Info

When it comes to mild concussions, the decision to perform an MRI scan can be nuanced and should be based on specific clinical indicators and the patient's symptoms. In your son's case, he experienced a mild concussion while skiing, which was followed by a brief episode of memory loss. Fortunately, he underwent a CT scan shortly after the incident, which showed no signs of internal bleeding, and his memory returned almost completely after a night's sleep.
In general, mild concussions do not always require an MRI. The primary purpose of an MRI is to provide detailed images of the brain's structure, which can help identify any abnormalities that might not be visible on a CT scan. However, MRI scans are typically reserved for cases where there are ongoing symptoms that warrant further investigation, such as persistent headaches, dizziness, or neurological deficits that do not resolve.

Given that your son has shown no significant symptoms since the initial incident and has returned to normal function, it may not be necessary to pursue an MRI at this time. The American Academy of Pediatrics suggests that most children with mild concussions recover well with appropriate rest and monitoring. The key is to observe for any delayed symptoms, such as worsening headaches, confusion, or changes in behavior, which could indicate a more serious issue.

If your son begins to experience any new or worsening symptoms, it would be prudent to consult with a healthcare provider. They can assess whether an MRI or further evaluation is warranted based on his clinical presentation. Additionally, if there are concerns about his cognitive function or if he experiences any lingering issues, a follow-up with a pediatric neurologist might be beneficial.

In summary, while MRI can be a valuable tool in assessing brain injuries, it is not always necessary for mild concussions, especially when the patient is asymptomatic. Monitoring your son's recovery and consulting with a healthcare professional if any new symptoms arise is the best course of action. If you have any lingering concerns, discussing them with your child's doctor can provide peace of mind and ensure that he receives the appropriate care.

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