Postconcussion Syndrome (Mild Traumatic Brain Injury)
- Postconcussion syndrome (PCS) is a constellation of symptoms involving physical, cognitive, and/or behavioral symptoms persisting after a concussion (synonymous with mild traumatic brain injury [mTBI]) that may continue for weeks to years (1).
- It is difficult to define when concussive symptoms transition to become postconcussive syndrome. A recent consensus suggests persistent symptoms lasting >10 to 14 days in adults and 4 weeks in children (2).
- PCS may present with any symptoms of concussion including (1)
- Poor focus
- Poor organization
- Diminished academic/intellectual performance
- Slowed response time
- Visual changes
- Light or noise sensitivity
- Dizziness and balance problems
- Fatigue and sleep disturbance
- Irritability/emotional lability
- Increased sensitivity to alcohol
- Diagnosis is based on history and clinical symptoms.
The reported frequency of patients with concussion who develop PCS varies widely between 5% and 80%.
- Largely due to difficulty differentiating postconcussion symptoms from PCS
- 80–90% of individuals with concussion recover from postconcussion symptoms within 7 to 10 days, slightly longer in children/adolescents (2). A diagnosis of PCS is made in patients with persistent concussive symptoms.
Predominant sex: Females are slightly more likely to experience prolonged symptoms following a concussive injury.
Etiology and Pathophysiology
- Controversial; exact mechanism(s) unknown
- Microscopic axonal injury from shearing forces leads to inflammation causing secondary brain injury.
- Conflicting data on structural brain damage and correlation of imaging with physical symptoms (1)
- Because the pathophysiology of PCS is not well understood and because of symptom overlap with other psychiatric conditions, PCS remains difficult to diagnose and to manage.
- Only some individuals with mTBI develop PCS; it is unclear what causes postconcussion symptoms to persist leading to PCS.
- Behavioral factors are commonly associated with (and may play a role in) the development of PCS. It can be challenging to differentiate some behavioral disorders from PCS (1). Neuropsychiatry evaluation can be helpful.
- Strongest predictor is severity of initial symptoms (2).
- Initial symptoms including retrograde amnesia, difficulty concentrating, disorientation, insomnia, loss of balance, sensitivity to noise, or visual disturbance (4)
- Preexisting psychiatric disorders including depression, anxiety, personality disorder, and posttraumatic stress disorder (PTSD)
- Preexisting expectation of poor outcomes following mTBI (1)
- Nonsport concussion/mTBI
- Unclear if previous history of concussion(s) is a risk factor for PCS
- Low socioeconomic status
- Loss of consciousness is NOT predictive of PCS.
- Education of players, coaches, parents, and athletic trainers about concussion, PCS, and appropriate safety rules
- Head injury precautions are advised. Evidence is lacking that these decrease incidence of mTBI/PCS.
- Screening and intervention for anxiety and depression
Commonly Associated Conditions
- Personality disorders (namely, compulsive, histrionic, and narcissistic)
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