Postconcussion Syndrome (Mild Traumatic Brain Injury)

Descriptive text is not available for this image Basics

Description

  • Postconcussion syndrome (PCS) is defined by the persistence of symptoms following a concussion (mild traumatic brain injury [mTBI]) beyond 4 weeks from the time of injury; language changing to “persistent symptoms following concussion”
  • Persistent symptoms include:
    • Cognitive (attention, memory, delayed processing speed)
    • Somatic (headache, neck pain)
    • Vestibular/ocular (visual change, light/noise sensitivity)
    • Emotional (depression, irritability)
    • Autonomic (sleep changes, exercise intolerance)

Epidemiology

Incidence

The reported frequency of patients persistent symptoms varies widely, around 18–31%. Variability in incidence is largely due to differing diagnostic criteria regarding symptom burden and duration.

  • 80–90% of individuals with concussion recover symptomatically within 7 to 10 days, longer in children/adolescents.

Prevalence

Female sex, youth and adolescents, as well as older age are risk factors for prolonged concussion symptoms.

Etiology and Pathophysiology

  • Controversial; exact mechanism(s) is unknown. It is likely that PCS results as a combination of multiple neurobiologic and psychogenic factors.
  • Only some individuals with mTBI develop persistent symptoms; 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 persistent symptoms. It can be challenging to differentiate exacerbation of preexisting neuropsychological disorders from persistent postconcussive symptoms.

Risk Factors

  • Strongest predictor is severity of initial concussion symptoms.
  • Initial symptoms including retrograde amnesia, difficulty concentrating, disorientation, insomnia, loss of balance, sensitivity to noise, or visual disturbance
  • Preexisting psychiatric disorders including depression, anxiety, personality disorder, and posttraumatic stress disorder (PTSD)
  • Preexisting expectation of poor outcomes following mTBI
  • Nonsport concussion/mTBI
  • Low socioeconomic status
  • Loss of consciousness is not predictive of persistent symptoms.

General Prevention

  • Prevention of concussion (see mTBI) including education, public health, and policy is key.
  • Early clinical evaluation and treatment following concussion prevents persistent symptoms.
  • Identified symptom constellations should be treated early.
  • Treatment of preexisting comorbidities such as anxiety, depression, attention disorders, migraines, or insomnia early in concussion treatment may reduce the likelihood of developing persistent symptoms following concussion.

Commonly Associated Conditions

  • PTSD
  • Anxiety
  • Depression
  • Fibromyalgia
  • ADHD

There's more to see -- the rest of this topic is available only to subscribers.