Disoriented Christoph Kramer had to ask ref: Is it the World Cup final?

German continued playing for 14 minutes after collision with Argentina defender Ezequiel Garay

Christoph Kramer went off on 31 minutes of the final after a collision with Ezequiel Garay (Getty Images)

There were renewed concerns over football's approach to the handling of head injuries after the World Cup final referee revealed Germany's Christoph Kramer had been so disoriented during the match that he had asked the official to confirm that he was indeed playing in the tournament's final.

Nicola Rizzoli told the Italian newspaper Gazzetta dello Sport: "Shortly after the blow, Kramer came to me asking, 'Ref, is this the final?' I thought he was joking and made him repeat the question and then he said, 'I need to know if this is really the final'. When I said, 'Yes,' he concluded, 'Thanks, it was important to know that'."

The official added that he had told Kramer's team-mate Bastian Schweinsteiger about the exchange during Sunday's game but Kramer continued playing for 14 minutes after the collision with Argentina defender Ezequiel Garay.

Kramer, who had been called up just before kick-off after Sami Khedira was injured in the warm-up, was finally replaced in the 31st minute after falling to the ground with suspected concussion.

There was an outcry over the decision by the then Tottenham Hotspur manager Andre Villas-Boas not to substitute goalkeeper Hugo Lloris after he collided with Everton striker Romelu Lukaku and briefly lost consciousness in the Premier League at Goodison Park last November. A brain-injury charity described the decision as "irresponsible and cavalier".

At the World Cup two Argentina players, Javier Mascherano and Pablo Zabaleta, also carried on playing after suffering blows to the head, Mascherano in the semi-final against the Netherlands. Meanwhile Uruguay defender Alvaro Pereira refused to leave the field after being hit on the head against England.