Post-Concussion Syndrome

Post-concussion syndrome can be complicated to recognize and diagnose. There are a variety of symptoms including dizziness and headache that can last for up to several months following a concussion.

A concussion is considered a mild traumatic brain injury that occurs following the striking of the head into something or by something. It is a common injury following a motor vehicle accident. You don’t need to have a coma or even a loss of consciousness in order to sustain a concussion and get post-concussion syndrome. In many cases, the severity of the initial injury does not predict who will develop post-concussive system.

It takes about 7-10 days following the initial injury to develop post-concussive syndrome. Most cases disappear in about 3 months, although some people can be symptomatic for more than one year. The treatment of the condition depends on the type and severity of the symptoms the patient has.

What is Post-Concussion Syndrome?

Post-concussion syndrome is also called post-concussive syndrome. It has historically been called “shell shock”. It is a collection of symptoms that follow a type of head trauma called a concussion. The symptoms generally begin within days of getting the injury but it can take weeks or months before the symptoms begin to occur. The diagnosis of PCS is made when the symptoms following the concussion last for three months or more.

A concussion is a mild type of traumatic brain injury, which follows things like motor vehicle accidents, falls, sports injuries, child abuse or altercations. Following the initial period of injury in which the patient has disorientation, headaches, dizziness, decreased level of consciousness and poor balance (among other things), about 38-80 percent of the time the person has post-concussive syndrome.

Common symptoms of post-concussive symptoms include headache and cognitive deficits, problems with concentration and problems with both emotional health and behavioral health. Patients are often irritable and sometimes volatile. The symptoms of post-concussion syndrome are often vague and overlap other disorders. Unless the diagnostic physician is clued in on the fact that a concussion occurred, the diagnosis might be missed.

Post-concussive syndrome has no real cure but the symptoms can be managed until nature takes its course and heals the brain from the injury. Having PCS takes a lot of patience because it is not known when the symptoms will abate and they can be more than annoying when they do occur.

No one knows exactly what causes PCS, why it occurs and why it lasts so long. It can happen even when the patient has sustained an extremely mild traumatic brain injury. People who have had preexisting medical or psychiatric conditions and people who expect some time of post-traumatic disability are at higher risk of getting post-concussive syndrome. In addition, those who are of an older age are more likely to get the disease.

What are the symptoms of Post-Concussion Syndrome?

There are physical, behavioral, psychological and cognitive symptoms associated with PCS. Almost all patients experience a headache although many of these patients suffered from headaches before their injury. Following the injury, the headaches are more frequent and last longer than they had pre-injury. It is estimated that between 30 percent and 90 percent of people treated for this disease describe having more headaches than before they were injured.

Dizziness is the second most noticeable symptom in PCS. It occurs in about fifty percent of all patients with PCS and is still described by 25 percent of patients a year following the injury. It appears that people who are old are at a higher risk of chronic dizziness after sustaining a concussion.

Sensitivity to light or noise is described in about ten percent of patients with PCS and about five percent experience an alteration in their sense of smell or taste. About 14 percent of patients will have blurry vision from time to time and 20 percent of patients will lose their hearing in one or both ears.

Other physical symptoms associated with PCS include lack of sleep, feeling sleepy all the time, tiredness or other sleep disorder. Nausea and vomiting can be present as a part of having post-concussive syndrome.

About half of all patients with PCS will develop psychological and psychiatric symptoms. They feel irritable, anxious, depressed and feel a change in personality.

Some patients will describe a feeling of restlessness, mood swings, aggression, decreased libido, anger, lack of ability to tolerate stress, impulsiveness, and loss of social judgment. Some turn to alcohol to treat their symptoms and alcoholism is not uncommon. People who are with a person who has PCS will notice either a lack of emotional displays or emotional lability. Some experience a lack of motivation or apathy, which may be a direct result of the illness or secondary to the depression seen in PCS.

Cognitive abilities are impaired in post-concussive syndrome and people with the disorder can become confused and have problems with their ability to attend to things. Judgment is impaired and there are commonly memory problems, especially with short-term memory. Some patients can have amnesia that is random or is associated with the injurious event.

Twenty five percent of people with post-concussion syndrome will still suffer from memory difficulties a year after they suffer from the head injury. They have problems with abstract thinking, have slow information processing abilities, and react to stimuli slowly. Work performance and social interactions can be impaired. Fortunately, the cognitive symptoms tend to get better before the emotional, psychological and behavioral symptoms. Many are better within 6 months. Memory and language difficulties take the longest to get better but generally go away within a year.

What are the causes of Post-Concussion Syndrome?

No one knows the exact cause of post-concussion syndrome. Its cause has been debated by doctors and psychologists for many years. Some believe there are organic factors at play, such as microscopic damage to the cells of the brain. Others believe that there are psychological factors at play. In fact, people who have high expectations of having a post traumatic disability go on to get post-concussive syndrome. Many of the symptoms are so subjective with little ability to test for the symptoms. Still others believe the symptoms may be exaggerated by people wanting attention after an injury.

There is the possibility that the early symptoms seen in PCS are physiological and that, as they resolve, the symptoms become purely psychological. Some believe that any time past three months involves a psychological change in the individual or some combination of psychological, physical and psychosocial factors. Most experts feel that a mixture of factors is at play in most cases of post-concussive syndrome.

Remember that older people tend to get PCS to a greater degree.

Risk Factors for Post-Concussion Syndrome

Researchers have looked at the various things associated with getting PCS. Some of these things include being of a low socioeconomic status, having a severe injury associated with the head injury, having a history of headaches, having an ongoing court case regarding the injury and being of a female gender. Those older than age 40 tend to have the longest lasting symptoms. Women also tend to have the most severe symptoms of PCS.

People who are alcoholic tend to have the most severe symptoms as do people who have low cognitive abilities in the beginning. Persons with a psychiatric illness, particularly those with a personality disorder, have an increased likelihood of having a severe case of PCS. Depressed people and those with anxiety disorders can get PCS more likely than people who do not have these disorders.

If, at the time of the trauma, the patient had a mild brain injury associated with dizziness, headache, nausea, post-traumatic amnesia or a Glasgow coma scale of between 13 and 14, there is a higher risk of developing post-concussion syndrome in the days or weeks following the mild brain trauma. People who have traumatic memories of the event may have an increased risk of PCS and people who experience stress in general around the time of the injury are more likely to later experience post-concussive syndrome.

Diagnosis of Post-Concussion Syndrome

There is no specific test for post-concussion syndrome and many of the symptoms are completely subjective. Sometimes, especially if there are legal ramifications, psychometric testing an IQ testing are done to see if there are documented deficits in memory, cognition and other cognitive areas. Psychological testing can be done, such as the Minnesota Multiphasic Personality Inventory or MMPI. These types of tests can show if there are personality changes, depression or anxiety symptoms.

The problem is that it is difficult to compare test results with those test results that would be seen prior to the injury. Did the patient’s IQ decrease? Did the patient develop a change in personality or did they have a personality disorder predating the injury. Most people did not have these kinds of tests done before the injury so there is no way to compare the results of the testing with anything in particular.

Treatment of Post-Concussion Syndrome

Post-concussion syndrome has no known cure but, fortunately, it is self-limited and usually resolves within months. The treatments available are directed at controlling the symptoms, which vary from person to person.

Headaches can range from migraine headaches to tension headaches. There are several treatments for headaches. These include:

  • • Tricyclic Antidepressants. Many tricyclics are used to treat pain, including imipramine, nortriptyline and especially amitriptyline. These seem to control the headaches associated with PCS. It also seems to control some of the dizziness, depression and irritability.
  • • Intravenous dihydroergotamine and Reglan. These two medications must be given intravenously to control chronic headaches. Patients go to the hospital and get an injection via IV to stop the headache.
  • • Pain relievers. These include OTC medications or codeine preparations. The opioid medications can be addiction and are not recommended for these kinds of chronic headaches.
  • • Cervical Spine Manipulation. Physical therapy or chiropractic directed toward the cervical spine seems to relieve the headache in many patients, pointing to a myofascial reason behind the headaches.

There are no medications available for the cognitive deficits and memory problems the patient has. It takes time for these to resolve. Some people can undergo cognitive therapy or focused rehabilitation that trains the brain to think more clearly. The patient learns how to use a pocket calculator or electronic organizer in order to get around the memory issues. Relaxation therapy can help some of the cognitive defects.

Depression and anxiety often go together. Symptoms of PCS often improve with time; however, depression can persist for a period of time. If there is persistent depression or anxiety, the patient can undergo psychotherapy or continue to take antidepressants or anti-anxiety agents.

Antidepressants can include selective serotonin reuptake inhibitors (SSRIs), which increase serotonin in the brain. They include medicines like Prozac, Celexa, Lexapro and Zoloft, among others. One study reported an 87 percent chance that a patient will have improvement in their depressive symptoms. Cognitive deficits may also improve with SSRIs. Anti-anxiety medication includes benzodiazepine medication, including Xanax, Klonopin and lorazepam (Ativan).

If the patient has moderate to severe brain injury, they can always undergo neurocognitive rehabilitation therapy. While it is commonly used, there is no conclusive evidence out there that it actually shortens the duration of symptoms. Some research has shown that the cognitive abilities of the patient improve with this kind of therapy. Activities of daily living appear to be improved after several weeks of this kind of therapy.

Other therapies include those that provide education on PCS, reassurance, support, a gradual increase in activity and cognitive structuring activities.

Trazodone has been used in the management of sleep disturbances in the brain injured person. It also seems to help depressed patients who have insomnia. High doses are not recommended because of its anticholinergic and cardiac side effects.

It is felt in some cases that cholinergic dysfunction is the cause of the cognitive impairment, similar to what’s seen in Alzheimer’s disease. If this is the case, acetylcholinesterase inhibitors like physostigmine and donepezil can be used to improve cognition.

Complications of Post-Concussion Syndrome

Most people recover from their PCS without complication; however, it can take up to a year or more before the patient fully recovers. Some patients can have persistent cognitive deficits, prolonged headache events or persistent depression, anxiety or personality changes.

If you or a loved one has suffered post-concussion syndrome as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916-921-6400 or toll-free at 800-404-5400 to set up a FREE consultation.

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