Post-Concussion Syndrome

Post-Concussion Syndrome 

Definition

Post-concussion syndrome (PCS) is a common but controversial disorder that presents with variety of symptoms including—but not limited to—headache, dizziness, fatigue, and personality changes.

Description

PCS occurs in approximately 23-93% of persons with mild to severe head injuries. It is estimated that a neurologist (a physician who specializes in nerve and brain disorders) sees five patients with PCS per month. There is no accurate correlation between the severity of injury and the development of PCS symptoms, since signs of the disorder can occur in someone who was just dazed by an injury. Some studies suggest that PCS symptoms occur at a higher rate in patients who were unconscious after trauma.

Causes and symptoms

PCS is most commonly caused by minor head injury called a concussion. The majority of patients with minor head injury characteristically develop PCS with distinct symptoms. Patients may report problems with concentration, recent memory, and abstract thinking. Additionally, patients may develop dizziness, irritability, fatigue, and personality changes. Elderly patients are particularly affected by disequilibrium and chronic dizziness even after minor trauma.

Diagnosis

There are no specific or reliable tests to diagnose PCS. A neuropsychologist can perform an in-depth neuropsychologic assessment that can determine presence or absence and extent of impairment. These tests may be performed for medical purposes.

Treatment

Treatment for PCS can be extensive. Medications for headache and pain may be indicated (analgesics and muscle relaxants). Antidepressants may be given to improve insomnia, irritability, or anxiety. Pain control could be achieved with acupuncture, nerve blocks, or transcutaneous electrical nerve stimulation (TENS, electrical stimulation of muscle groups). It is important for clinicians to educate caretakers and to provide referrals for family therapy and cognitive rehabilitation for the affected person.

Prognosis

The overall outcome is difficult to assess. Limited interpretation in literature is primarily due to the subjective nature of symptoms. Patient recovery is directed and evaluated by cognitive function changes, subjective symptoms, and return to work. Most cases of PCS can be a financial strain and threaten family stability. There may be compensation and litigation claims, which is often stressful and aggravates symptoms.

Resources

Books

Coper, Paul R., and John G. Golfinos, et al, editors. HeadInjury. 4th ed. New York: McGraw-Hill, 2000.

Goetz, Christopher G., et al., editors. Textbook of Clinical Neurology. 1st ed. Philadelphia: W. B. Saunders Company, 1999.

Goldman, Lee, et al. Cecil's Textbook of Medicine. 21st ed. Philadelphia: W. B. Saunders Company, 2000.

Key terms

Disequilibrium — Difficulty with equilibrium that can mean a deficiency in balance and/or orientation.

Neuropsychologist — A clinical psychologist who specializes in assessing psychological status caused by a brain disorder.