The Germany midfielder Christoph Kramer was disoriented and confused after taking a heavy blow to the head early in the World Cup final, according to the match referee.

“Shortly after the blow, Kramer came to me asking: ‘Ref, is this the final?’” Nicola Rizzoli told the Gazzetta dello Sport on Thursday. “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.’”

Rizzoli said he let the Germany midfielder Bastian Schweinsteiger know about the exchange during Sunday’s game but Kramer continued playing for 14 minutes following the collision with the Argentina defender Ezequiel Garay.

He was eventually replaced in the 31st minute after slumping to the ground with suspected concussion. Germany went on to beat Argentina 1-0 in extra time to lift the trophy.

Kramer’s continuation in the game, after suffering an apparent concussion, revived concerns about the way football deals with the issue, as there were worrying head injuries for several other players earlier in the tournament.

The Argentina players Javier Mascherano and Pablo Zabaleta also played on in their team’s semi-final against Holland after hard knocks to the head. The Uruguay defender Álvaro Pereira refused to leave the field after being hit in the head during the group stage.

The incidents have led to debate over whether Fifa should allow a temporary substitution so a player can have a head injury properly checked.