Postconcussion Syndrome

(PCS; Persistent PCS)
  • Definition

    A concussion is a type of traumatic brain injury. An injury to the head can affect the way your brain works. In most cases, concussions resolve within hours or days of the injury. Postconcussion syndrome (PCS) refers to continued symptoms of mild traumatic brain injury. Most often it resolves within a month, but sometimes the symptoms persist for much longer.
    Treatment depends on the severity and length of time of your symptoms. Options include rest, reduced activity, various therapies, and medications.
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  • Causes

    The exact cause of PCS is unknown. Factors that may contribute to PCS include:
    • Microscopic brain damage from a mild brain injury
    • Psychological or emotional stress that results from a mild brain injury
  • Risk Factors

    Factors that may increase your chance of having PCS include:
    • Previous head injury or concussion
    • Genetics
    • Persistent headaches or lightheadedness after a mild brain injury
    • Feeling depressed, or being diagnosed with depression after a mild brain injury
    • Low social support, including not having a lot of close friends or people to confide in after a mild brain injury
    • Learning difficulties
    • Preoccupation with injury symptoms, and fear of real or imagined permanent brain damage
  • Symptoms

    PCS symptoms vary from person-to-person. Headache is the most common and earliest symptom of PCS.
    Other symptoms may include:
    • Lightheadedness
    • Balance problems
    • Nausea
    • Vision problems
    • Being very sensitive to noise and/or light
    • Depression
    • Mood swings
    • Anxiety
    • Irritability
    • Memory problems
    • Concentration problems
    • Trouble sleeping
    • Feeling tired all the time
  • Diagnosis

    PCS is hard to diagnose. The brain damage caused by a mild brain injury is so slight that most tests cannot detect it. It is important to see a doctor with special training in brain injury. These doctors are called neurologists, neuropsychologists, and neurosurgeons. To find one of these doctors, talk with your primary care doctor, or call a local head injury foundation for a referral.
    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
    • Memory and attention tests
    • Sports Concussion Assessment Tool
    • Electroencephalogram (EEG)—to look for abnormal brain electrical activity
    Imaging tests evaluate the brain and surrounding structures. These may include:
  • Treatment

    PCS treatment depends on your symptoms. Talk with your doctor about the best treatment plan for you. Options include:
    Medications
    Your doctor may recommend:
    • Pain relievers
    • Antidepressants
    • Nerve blocks
    Psychological Treatment
    You may be referred to a therapist to:
    • Talk about the problems you have related to PCS
    • Learn how to cope with those problems in your life
    Vocational Therapy
    Vocational therapy may be needed to help you with learning skills and training to start, or resume, a career.
    Neurotherapy
    Neurotherapy, also called biofeedback is a painless treatment using computers to help you learn how to modify your brainwaves to improve attention and memory.
    Surgery
    In some cases, a collection of blood in an area of bruising on the brain may require surgery, which may help resolve or improve symptoms.
  • Prevention

    There are no current guidelines to prevent PCS.
    To help reduce your chance of getting a head injury, take these steps:
    • Use the child car seat or booster seat based on your child's age and weight
    • Use your seat belt every time you drive or ride in a motor vehicle
    • Wear a helmet to protect your head while playing sports, or riding a motorcycle, bicycle, or snowmobile
    • Use window guards to keep children from falling out of the window
    • Use safety gates at the top and bottom of stairs
  • RESOURCES

    Brain Injury Association of AmericaNational Help Line: 800-444-6443 http://www.biausa.org

    Centers for Disease Control and Prevention http://www.cdc.gov

    CANADIAN RESOURCES

    Canadian Psychiatric Association http://www.cpa-apc.org

    Ontario Brain Injury Association http://www.obia.on.ca

    References

    Bazarian J, Atabaki S. Predicting postconcussion syndrome after minor traumatic brain injury. Acad Emerg Med. 2001;8:788-795.

    Bruhns J, Jagoda A. Mild traumatic brain injury. Mt Sinai J Med. 2009;76:129-137.

    Concussion and mild TBI. Centers for Disease Control website. Available at: http://www.cdc.gov/concussion/index.html. Updated May 29, 2014. Accessed June 2, 2014.

    Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 22, 2014. Accessed June 2, 2014.

    Duff J. The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clin EEG Neurosci. 2004;35:198-209.

    Eisenberg MA, Meehan WP III, et al. Duration and course of post-concussive symptoms. Pediatrics. 2014 May. [Epub ahead of print].

    Evans RW. The postconcussion syndrome and whiplash injuries: a question-and-answer review for primary care physicians. Prim Care. 2004; 31:1-17.

    Jagoda A, Bazarian J, Bruns J, et al. American College of Emergency Physicians (ACEP)/Centers for Disease Control and Prevention (CDC) Panel. Clinical policy: neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008; 52(6):714-748.

    McCauley SR, Boake C, Levin HS, Contant CF, Song JX. Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities. J Clin Exp Neuropsychol. 2001;23:792-808.

    Mittenberg W, Canyock EM, Condit D, Patton C. Treatment of post-concussion syndrome following mild head injury. J Clin Exp Neuropsychol. 2001;23:829-836.

    Postconcussion syndrome: why this diagnosis is controversial and what treatments may help. Harvard Mental Health Letter. 2007;24:6.

    Potential effects of TBI. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/TraumaticBrainInjury/outcomes.html. Updated September 25, 2012. Accessed June 2, 2014.

    Thornton KE, Carmody DP. Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child Adolesc Psychiatr Clin N Am. 2005;14:137-62,vii.

    Zemek RL, Farion KJ, et al. Prognosticators of persistent symptoms following pediatric concussion: a systematic review. JAMA Pediatr. 2013;167(3):259-265.

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