Post-Concussion Syndrome


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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.
A constellation of symptoms that follow traumatic brain injury, which is more common in athletes
References in periodicals archive ?
Hyperbaric oxygen may induce angiogenesis in patients suffering from prolonged post-concussion syndrome due to traumatic brain injury.
I had been stuck in a cycle of not divulging the struggles of life with post-concussion syndrome to most people I interacted with.
Hopefully the guidelines will prevent many cases of second-impact syndrome and post-concussion syndrome.
Diagnosed with post-concussion syndrome, the Cheltenham Festival-winning rider, long regarded as among the best in his profession, has suffered from dizziness and lack of balance.
He had problems after he previously suffered injuries and he was diagnosed with post-concussion syndrome.
McConnell and Shubrook correctly point out that neuroimaging should be reserved for focal neurologic symptoms, advancing symptoms, or prolonged symptoms as seen in post-concussion syndrome, and they cite a relatively new article to support the use of sertraline in post-concussion treatment--which many of us in primary care sports medicine have been using for years.
For athletes identified as being at increased risk for a complex post-concussion syndrome, the key management strategy is rest, both physical and mental: no going to the weight room, no studying for exams, perhaps not even going to the classroom.
They also may be more at risk for developing post-concussion syndrome.
She was later diagnosed with a fractured skull which sparked post-concussion syndrome, a condition which can last months or even years.
Hogg was diagnosed with post-concussion syndrome and after 10 days' rest he returned to training last week.
TBI is also known as a concussion, and Soldiers with a TBI are dealing with post-concussion syndrome, he said.
But, say doctors, untreated injuries can lead to post-concussion syndrome.

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