Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

‘Concussion’ is not a true diagnosis


In current usage, ‘concussion’ describes a clinical presentation, but does not identify the underlying pathological process and therefore cannot be considered a true diagnosis. However, mounting evidence indicates diffuse axonal injury as a likely pathological substrate for concussion, thereby providing a framework to develop true diagnostic criteria.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Diffuse axonal injury in concussion.


  1. Taylor, C. A., Bell, J. M., Breiding, M. J. & Xu, L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths — United States, 2007 and 2013. MMWR Surveill. Summ. 66, 1–16 (2017).

    Article  Google Scholar 

  2. McInnes, K., Friesen, C. L., MacKenzie, D. E., Westwood, D. A. & Boe, S. G. Mild traumatic brain injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One 12, e0174847 (2017).

    Article  Google Scholar 

  3. Mackay, D. F. et al. Neurodegenerative disease mortality among former professional soccer players. N. Engl. J. Med. 381, 1801–1808 (2019).

    Article  Google Scholar 

  4. Johnson, V. E., Stewart, W. & Smith, D. H. Axonal pathology in traumatic brain injury. Exp. Neurol. 246, 35–43 (2013).

    Article  CAS  Google Scholar 

  5. Smith, D. H. & Meaney, D. F. Axonal damage in traumatic brain injury. Neuroscientist 6, 483–495 (2000).

    Article  Google Scholar 

  6. Blumbergs, P. C. et al. Staining of amyloid precursor protein to study axonal damage in mild head injury. Lancet 344, 1055–1056 (1994).

    Article  CAS  Google Scholar 

  7. Tang-Schomer, M. D., Johnson, V. E., Baas, P. W., Stewart, W. & Smith, D. H. Partial interruption of axonal transport due to microtubule breakage accounts for the formation of periodic varicosities after traumatic axonal injury. Exp. Neurol. 233, 364–372 (2012).

    Article  Google Scholar 

  8. Shenton, M. E. et al. A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging Behav. 6, 137–192 (2012).

    Article  CAS  Google Scholar 

  9. Siman, E. et al. Evidence that the blood biomarker SNTF predicts brian imaging changes and presistent neurocogrnitive fucntion in mildTBI patients. Front. Neurol. 4, 190 (2013).

    Article  Google Scholar 

  10. Johnson, V. E. et al. SNTF immunostaining reveals previously undetected axonal pathology in traumatic brain injury. Acta Neuropathol. 131, 115–135 (2016).

    Article  CAS  Google Scholar 

Download references


The authors’ work is supported by the Paul G. Allen Family Foundation, NHS Research Scotland and NIH grants NS38104, NS092389, NS056202, NS094003 and EB021293.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Douglas H. Smith.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Smith, D.H., Stewart, W. ‘Concussion’ is not a true diagnosis. Nat Rev Neurol 16, 457–458 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing