Postconcussion Syndrome
all information

Postconcussion Syndrome

(PCS; Persistent PCS)

En Español (Spanish Version)

Definition

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.

Getting treated early for PCS may help you get better faster. If you think you have PCS, contact your doctor immediately.

The Brain

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Causes

The exact cause of PCS is unknown. Several factors contribute to PCS, including:

  • Microscopic brain damage from a mild brain injury
  • Psychological or emotional stress that results from a mild brain injury

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. More research is needed to understand all the risk factors for PCS. The following factors increase your chances of developing PCS:

  • A mild concussion or brain injury caused by a car accident or assault
  • 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

Symptoms

PCS symptoms vary from person-to-person. If you experience any of these symptoms do not assume it is due to PCS. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician. Symptoms include:

  • Headaches
  • Dizziness or light headedness
  • Vertigo
  • Ringing in the ears or hearing impairment
  • Loss of appetite
  • Sensitivity to noise and light
  • Anxiety
  • Irritability
  • Depression
  • Problems with sleep, such as being tired all the time, or not being able to sleep
  • Nausea or vomiting
  • Confusion
    • Signs of confusion include a vacant stare, disorientation, delayed responses, and concentration/attention problems
  • Memory problems
  • Slower intellectual processing speed
  • Slurred speech
  • Blurred and/or double vision
  • Decreased sense of smell and/or taste
  • Lack of balance and coordination
  • Alcoholic beverage intolerance
  • Personality changes
  • Decreased sex drive

Diagnosis

PCS is hard to diagnose. The brain damage caused by a mild brain injury is so slight that many 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, call a local head injury foundation for a referral.

Your doctor will ask questions about:

  • Your personal and family medical history
  • Your head injury
  • Sleep habits
  • Recent missed work or school
  • Recent memory or relationship problems
  • Recent emotional problems, such as irritability, anxiety , and depression

Tests may include:

  • Memory and attention tests to assess your memory and attention abilities
  • CT or MRI scan may be performed to look for signs of persistent injury and/or to see if surgery may improve the symptoms (due to persistent bleeding into a bruised area of the brain, for example, called a hematoma)
  • Electroencephalogram (EEG). A test which evaluates the electrical activity of the brain.

Treatment

PCS treatment depends on your symptoms. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Medications

  • Over-the-counter medications to reduce the severity of headaches
  • Antidepressants to help reduce depression and anxiety
  • Nerve blocks to relieve severe, nerve-injury induced pain/headaches

Psychological Treatment

  • Talking with a mental health professional about the problems you are having related to PCS
  • Learning how to cope with those problems in your life

Vocational Therapy

  • Learning skills and training to start or resume a career

Neurotherapy

  • Also called biofeedback or neurofeedback
  • 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 guidelines for preventing PCS because the cause is not known. To help reduce your chances of getting PCS, take the following steps:

  • Prevent brain injury by following the recommendations of the Centers for Disease Control and the Brain Injury Association of America.
  • See a doctor who specializes in brain injury as soon as you think you may have PCS.

RESOURCES:

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

Head and Brain Injuries
National Library of Medicine/National Institutes of Health
http://www.nlm.nih.gov

US Centers for Disease Control
http://www.cdc.gov/index.htm

CANADIAN RESOURCES:

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

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

References:

Bazarian, JJ, Atabaki, S. Predicting postconcussion Syndrome after minor traumatic brain injury. Academic Emergency Medicine . 2001;8(8):788-795.

Child Health A to Z. Quantitative EEG. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/cfapps/A2ZtopicDisplay.cfm?Topic=Quantitative%20EEG . Accessed July 17, 2005.

Duff J. The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clin EEG Neurosci . 2004;35(4):198-209.

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

Facts about concussion and brain injury. Centers for Disease Control website. Available at: http://www.cdc.gov/doc.do/id/0900f3ec8000d370 . Accessed July 17, 2005.

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(6):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(6):829-36.

Ryan LM, Warden DL. Post concussion syndrome. Int Rev Psychiatry . 2003;15(4):310-6.

Thornton KE, Carmody DP. Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child Adolesc Psychiatr Clin N Am . 2005;14(1):137-62, vii.



Last reviewed January 2008 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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