Post-concussion syndrome

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Post-concussion syndrome
Classifications and external resources
ICD-10 F07.2
ICD-9 310.2
eMedicine emerg/865

Post-concussion syndrome, or PCS, is a set of symptoms that a person may experience

for weeks, months, or even years after a concussion, a mild form of traumatic brain
injury. As many as 50% of patients who have experienced concussion have PCS
(Bazarian 1992), and some sources say as many as 90% of patients experience
postconcussion symptoms (Legome, 2004).

Contents
[hide]
1 Signs and symptoms
2 Treatment
3 Prognosis
4 Epidemiology
5 History

6 References

Signs and symptoms

People who have had concussions may experience physical, mental, or emotional
symptoms.

Physical symptoms can include:

headache
sensitivity to noise or light
dizziness
fatigue or sleepiness
inability to sleep
nausea and/or vomiting
double or blurred vision (Shepherd, 2004)
ringing in the ears
 decreased sense of taste, smell, or hearing
decreased libido (UCLA, 1999)

Emotional symptoms may include:

irritability
anxiety (Evans, 1992)
restlessness (King, 2003)
depression or lack of emotion (Merck, 2003)
emotional lability or mood swings

Cognitive or mental symptoms can include:

amnesia or difficulty remembering things

confusion or impaired cognition (Evans, 1992)
difficulty with abstract thinking (King, 2003)
difficulty concentrating (UCLA, 1999)

[edit] Treatment
Patients who have suffered a head injury must be examined by emergency medical care
providers to ensure that the head injury is not worse than concussion and potentially life
threatening. Thus, head injury patients with symptoms that may indicate a dangerous
injury are given CT scans or MRIs and are observed by medical staff. Later, the patient
may be tested to determine his or her level of cognitive functioning. A test called the
Rivermead Postconcussion Symptoms Questionnaire exists to measure the severity of the
patient's symptoms. Post-concussion syndrome is usually not treated, except with pain
relievers for headaches and medicine to relieve depression, nausea, or dizziness (Merck,
2003). When patients have ongoing disabilities, they are treated with therapy to help them
function at work, socially, or in other contexts (Shepherd, 2004). Patients are aided in
gradually returning to work and other preinjury activities as symptoms permit. Since
stress exacerbates post concussion symptoms, and vice versa, an important part of
treatment is letting the patient know that symptoms are normal and helping the patient
deal with impairments (King, 2003).

[edit] Prognosis
For most patients, post concussion symptoms go away within a few days to several weeks
after the original injury occurs (Merck, 2003). In others, symptoms may remain for three
to six months (Evans, 1992; UCLA, 1999). In a small percentage of patients, symptoms
may persist for years or may be permanent (UCLA, 1999). If symptoms are not resolved
by one year, they are likely to be permanent (Legome, 2004). However, the prognosis for
PCS is generally considered excellent, with total resolution of symptoms in the large
majority of cases.

If a patient receives another blow to the head after a concussion but before concussion
symptoms have gone away, there is a slight risk that he or she will develop the very rare
but deadly Second Impact Syndrome (SIS). In SIS, the brain may rapidly swell and be
damaged.

[edit] Epidemiology
The incidence of PCS is higher in females than in males (Legome, 2004). People over the
age of 55 are more likely to have long-lasting symptoms [1]. Since PCS by definition
only exists in people who have suffered a head injury, demographics and risk factors are
similar to those for head injury; for example, young adults are at higher risk than others
for receiving head injury (Legome, 2004).

[edit] History
People have known about post-concussion syndrome for hundreds of years (Evans,
1992). It is not known to exactly what degree the symptoms are due to microscopic
damage to the brain or to other factors, for example psychological factors (Merck, 2003).
This question has been heavily debated for many years. Psychological factors are known
to affect post concussion symptoms; however, it has been shown that structural damage
does occur after some concussions (Evans, 1992, King, 2003).

In the 1860s, a group of doctors began to support the idea that structural features were to
blame for symptoms, but the prevailing sentiment was still that psychological factors
caused PCS (Fisher, 1998). It was not until a century later, in the 1960s, that such
structural damage could be visualized using new brain scanning technology. Now it is
generally agreed that PCS does have a physical basis.

The name "post-concussive syndrome" was first coined by S. H. Auerbach [2].

[edit] References
Bazarian JJ and Atabaki S. 2001. Predicting postconcussion syndrome after minor
traumatic brain injury. Academic Emergency Medicine Volume 8, Number 8, 788-
795.
Evans RW . 1992. The postconcussion syndrome and the sequelae of mild head
injury. Neurol Clin Volume 10 Number 4, 815-847.
Fisher JD. 1998. Post concussion syndrome. Head Injury Hotline.
King NS. 2003. Post-concussion syndrome: clarity amid the controversy?
Legome E. 2004. Postconcussive syndrome. eMedicine.com.
Merck manuals online medical library. 2003. Concussion.
Shepherd S. 2004. Head trauma. eMedicine.com.
 Tolias C and Sgouros S. 2003. Initial evaluation and management of CNS injury."
UCLA Neurosurgery. 1999. Brain injury diseases and disorders: Concussion.

Retrieved from "http://en.wikipedia.org/wiki/Post-concussion_syndrome"

Category: Neurotrauma

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 CONDITION: Post-Concussion
Syndrome (PCS)
DESCRIPTION:
Post-concussion syndrome (PCS) is a specific set of neuropsychological (i.e., cognitive,
behavioral and emotional) disorders caused by a traumatic injury to the brain such as a
concussion. When the brain is subjected to a violent force it can bleed, swell and, occasionally,
shut down. In addition, PCS can manifest itself as chronic pain in the form of headaches and
neck pain.

How does post-concussion syndrome develop?

Leading causes of PCS are injuries from motor vehicle accidents, work place
injuries, acts of violence, falls and sports and recreational injuries. PCS can
occur without any outward physical evidence of injury or trauma. Examples
include whiplash and shaken babies. A brain injury is distinguished from a
superficial head injury by damage to the delicate brain as opposed to an outward
injury. There appears to be no precise correlation between the severity of the
injury and the development of PCS symptoms, since signs of the syndrome can
occur in someone who was simply dazed by an injury. Some studies suggest that
PCS symptoms occur at a higher rate among patients who were left unconscious
by the trauma.

What are the symptoms of post-concussion syndrome?

Symptoms include headaches, chronic neck pain, difficulty concentrating,
irritability, memory deficits, dizziness and vertigo. Intellectual dullness and
mental rigidity are also apparent signs of brain injury. Personality changes are
common, as are rapid mood swings that alternate with low and high energy
levels. The symptoms usually persist for a few days following the injury and may
prevent a return to normal activities.

Conventional medical treatments may help relieve the symptoms of post-

concussion syndrome, but they do not address the root of the problem. By
strengthening structural weaknesses in the body, as natural medicine treatments
do, symptoms associated with post-concussion syndrome may be alleviated
permanently.

Discover why we believe that natural medicine treatments are the best way to
treat post-concussion syndrome.

Learn about the treatments for Post-Concussion Syndrome (PCS)

This information is provided for informational purposes only. It is essential to

have your condition evaluated by your own personal physician. For an
appointment with one of the natural medicine specialists at Caring Medical,
please call 708-848-7789.
post-concussion syndrome

Wikipedia
Directory > Reference > Wikipedia
post-concussion syndrome
Post-concussion syndrome
ICD-10 F07.2
ICD-9 310.2
eMedicine emerg/865

Post-concussion syndrome, or PCS, is a set of symptoms that a person may experience

for weeks, months, or even years after a concussion, a mild form of traumatic brain
injury. As many as 50% of patients who have experienced concussion have PCS
(Bazarian 1992), and some sources say as many as 90% of patients experience
postconcussion symptoms (Legome, 2004).

Signs and symptoms

People who have had concussions may experience physical, mental, or emotional
symptoms.

Physical symptoms can include:

headache
sensitivity to noise or light
dizziness
fatigue or sleepiness
inability to sleep
nausea and/or vomiting
double or blurred vision (Shepherd, 2004)
ringing in the ears
decreased sense of taste, smell, or hearing
decreased libido (UCLA, 1999)

Emotional symptoms may include:

irritability
anxiety (Evans, 1992)
restlessness (King, 2003)
depression or lack of emotion (Merck, 2003)
emotional lability or mood swings
Cognitive or mental symptoms can include:

amnesia or difficulty remembering things

confusion or impaired cognition (Evans, 1992)
difficulty with abstract thinking (King, 2003)
difficulty concentrating (UCLA, 1999)

Differential Diagnosis
Traumatic brain injury may cause hypothalamic or pituitary damage. Deficiencies of
pituitary hormones (hypopituitarism) can cause similar symptoms to post-concussion
syndrome. As the symptoms can be similar the possibility of hypopituitarism should be
considered before diagnosing post-concussion syndrome. Hypopituitarism can be treated
by replacing any hormone deficiencies.

Treatment
Patients who have suffered a head injury must be examined by emergency medical care
providers to ensure that the head injury is not worse than concussion and potentially life
threatening. Thus, head injury patients with symptoms that may indicate a dangerous
injury are given CT scans or MRIs and are observed by medical staff. Later, the patient
may be tested to determine his or her level of cognitive functioning. A test called the
Rivermead Postconcussion Symptoms Questionnaire exists to measure the severity of the
patient's symptoms.

Post-concussion syndrome is usually not treated, except with pain relievers for headaches
and medicine to relieve depression, nausea, or dizziness (Merck, 2003). When patients
have ongoing disabilities, they are treated with therapy to help them function at work,
socially, or in other contexts (Shepherd, 2004). Patients are aided in gradually returning
to work and other preinjury activities as symptoms permit. Since stress exacerbates post
concussion symptoms, and vice versa, an important part of treatment is letting the patient
know that symptoms are normal and helping the patient deal with impairments (King,
2003).

Prognosis
For most patients, post concussion symptoms go away within a few days to several weeks
after the original injury occurs (Merck, 2003). In others, symptoms may remain for three
to six months (Evans, 1992; UCLA, 1999). In a small percentage of patients, symptoms
may persist for years or may be permanent (UCLA, 1999). If symptoms are not resolved
by one year, they are likely to be permanent (Legome, 2004). However, the prognosis for
PCS is generally considered excellent, with total resolution of symptoms in the large
majority of cases.
If a patient receives another blow to the head after a concussion but before concussion
symptoms have gone away, there is a slight risk that he or she will develop the very rare
but deadly Second Impact Syndrome (SIS). In SIS, the brain may rapidly swell and be
damaged.

Epidemiology
The incidence of PCS is higher in females than in males (Legome, 2004). People over the
age of 55 are more likely to have long-lasting symptoms [1]. Since PCS by definition
only exists in people who have suffered a head injury, demographics and risk factors are
similar to those for head injury; for example, young adults are at higher risk than others
for receiving head injury (Legome, 2004).

History
People have known about post-concussion syndrome for hundreds of years (Evans,
1992). Since it is not always possible to find a physical basis for the syndrome, some
have claimed that patients are merely malingering or overreacting. It is not known to
exactly what degree the symptoms are due to microscopic damage to the brain or to other
factors, for example psychological factors (Merck, 2003). This question has been heavily
debated for many years. Psychological factors are known to affect post concussion
symptoms; however, it has been shown that structural damage does occur after some
concussions (Evans, 1992, King, 2003).

In the 1860s, a group of doctors began to support the idea that structural features were to
blame for symptoms, but the prevailing sentiment was still that psychological factors
caused PCS (Fisher, 1998). It was not until a century later, in the 1960s, that such
structural damage could be visualized using new brain scanning technology. Now it is
generally agreed that PCS does have a physical basis.

The name "post-concussive syndrome" was first coined by S. H. Auerbach [2].

References
Bazarian JJ and Atabaki S. 2001. Predicting postconcussion syndrome after minor
traumatic brain injury. Academic Emergency Medicine Volume 8, Number 8, 788-
795.
Evans RW . 1992. The postconcussion syndrome and the sequelae of mild head
injury. Neurol Clin Volume 10 Number 4, 815-847.
Fisher JD. 1998. Post concussion syndrome. Head Injury Hotline.
King NS. 2003. Post-concussion syndrome: clarity amid the controversy?
Legome E. 2004. Postconcussive syndrome. eMedicine.com.
Merck manuals online medical library. 2003. Concussion.
Shepherd S. 2004. Head trauma. eMedicine.com.
Tolias C and Sgouros S. 2003. Initial evaluation and management of CNS injury."
 UCLA Neurosurgery. 1999. Brain injury diseases and disorders: Concussion.

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