Post-concussion syndrome (PCS) is a common but controversial disorder with a variety of symptoms including, but not limited to, headache, dizziness, fatigue, and personality changes.
Description
Post-concussion syndrome occurs in some patients after a concussion. A concussion is a form of mild traumatic head injury. Often a concussion involves loss of consciousness for a brief period, but it is possible to have a concussion without ever losing consciousness. There are many different ways of defining PCS, but it is usually considered present if three or more symptoms (such as insomnia, headache, and dizziness) are present for at least three months. PCS is a controversial syndrome, because multiple studies have resulted in conflicting findings. Also, some experts believe that many of the symptoms are largely psychological, because usually no neurological causes for the symptoms can be found. Other experts, however, maintain that just because no one has been able to pinpoint neurological causes does not mean they do not exist.
Demographics
PCS occurs in approximately 23–93 percent of individuals 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 individuals who were unconscious after trauma. Females may be more likely to develop PCS than males.
Causes and symptoms
PCS is most commonly caused by a minor head injury called a concussion. Many patients who have experienced minor head injury develop PCS with distinct symptoms. They may report problems with concentration, short and medium term memory, and abstract thinking. Additionally, patients may develop dizziness, irritability, fatigue, and personality changes. It is not known what causes these symptoms. No studies have been able to deduce definitively any kind of neurological basis for the syndrome.
When to call the doctor
If a child is displaying the signs and symptoms of post-concussion syndrome, especially if known to have recently experienced a head injury, a doctor should be consulted.
Diagnosis
There are no specific or reliable tests to diagnose PCS. A doctor will do a physical examination. A neuropsychologist can perform an in-depth neuropsychologic assessment that can determine presence or absence and extent of impairment. Sometimes tests used to measure memory or cognitive capacity will be performed. Doctors may recommend seeing a psychologist to determine if depression or anxiety is present. Magnetic resonance imaging (MRI) or computed tomography (CT) scans
may be done to ensure that a lesion or bleeding is not responsible for the symptoms.
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, anxiety, or depression. 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 child. The overall aim of treatment for PCS is to allow the child to return to school and to the activities that he or she participated in before the traumatic incident.
Prognosis
The overall outcome is difficult to assess. Most individuals who have PCS recover fully, although if recovery has not occurred in one year it is less likely that it will ever occur. Patient recovery is determined by cognitive function changes, subjective symptoms, and return to school or work. Cases of PCS can be a strain and threaten family stability. There may be compensation and litigation claims, which are often stressful and aggravate symptoms.
Prevention
The only way to prevent post-concussion syndrome is to prevent the original concussion. Wearing a helmet while riding a bike, rollerblading, or skateboarding can reduce the risk of head injury. Putting children in age-appropriate safety seats in the car can also help to prevent head trauma in the event of an automobile accident.
Parental concerns Post-concussion syndrome can be very frustrating, because the symptoms are persistent and can affect the child's ability to perform in school or other activities. Counseling is thought to help the patient and family deal with the incapacitation and develop coping strategies. The best way to prevent PCS is to make sure that children avoid situations where they are likely to injure themselves.
KEY TERMS
Neuropsychologist—A clinical psychologist who specializes in assessing psychological status caused by a brain disorder.
Brain Injury of America8201 Greensboro Drive, Suite 611, McLean, VA 22102. Telephone: (703) 761-0750. Family Helpline: 1-800-444-6443. familyhelpline@biausa.org. <www.biausa.org>
