Post-concussion syndrome (PCS) is a complex disorder with symptoms persisting from weeks to months after concussion episode.
Fully recover from concussion in days to weeks, but some have prolonged symptomatic challenges.
While most recover quickly, some deal with prolonged physical, cognitive, and emotional symptoms after a concussion.
PCS occurs after mild traumatic brain injury (TBI) with increased risk for those with multiple injuries.
Symptoms persisting beyond 3 months indicate persistent PCS with lasting effects on cognition, memory, learning, and executive function.
Epidemiology
Over 2 million cases of traumatic brain injury happen annually in the US with a study on mild TBI ER visits.
About 50% of patients with MHI experience PCS symptoms at 1 month, with 15% still having symptoms at 1 year.
Persistent symptoms in mTBI patient’s difficult resumption of normal functions. 14-29% of children still experience post-concussion symptoms after 3 months.
Children are at higher risk for concussions due to their activity levels, participation in sports, and underdeveloped brains making them more vulnerable.
Anatomy
Pathophysiology
Debated whether PCS symptoms are organic or psychological. Hypothesized early symptoms organic, while those lasting over 3 months are nonorganic, psychological.
PCS symptoms may have organic basis, supported by neuropsychological assessments shows cognitive deficits in memory, attention, and learning in patients.
Study showed PCS patients had persistent impaired eye movements unrelated to depression or intellectual ability compared to controls.
Neuropsychological evaluations show symptom severity not dependent on immediate neurologic status.
Etiology
Nonsporting mechanisms, LOC, event amnesia, female gender, and abnormal neurobehavioral testing are PCS risk factors.
Patients with PCS from head injury often blame someone for the injury and seek legal action.
Some evidence suggests that neck pain after a head injury does not necessarily lead to PCS, but patients with nausea, headache, and dizziness may be more likely to develop PCS.
Patients with pre-existing physical issues are more likely to experience PCS after MHI
Genetics
Prognostic Factors
Predicting outcomes is challenging due to under-representation of mild cases and over-representation of severe cases in research studies.
Many patients fully recover within 3 months, while some small studies report long-lasting minor cognitive issues.
Around 15% of patients have ongoing issues beyond 12 months post-injury. They may face persistent, treatment-resistant symptoms and lasting disability.
PCS may be permanent if recovery does not occur within 3 years. Noncompliant individuals are less likely to recover fully.
Clinical History
Collect details including initial injury details, past medical and psychiatric history to understand clinical history of patient.
Physical Examination
Neurological Examination
Vestibular and Balance Testing
Cognitive Screening
Musculoskeletal Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Headache, confusion, dizziness/imbalance, nausea and vomiting
Chronic symptoms are:
Chronic headaches, dizziness, or visual disturbances, persistent memory, attention, depression, and anxiety
Differential Diagnoses
Depression
Vertebral Artery Dissection
Fibromyalgia
Posttraumatic Stress Disorder
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Emergency department patients with possible post-concussion syndrome need detailed physical and neurological exams. No specific care needed in ED.
CT scan is recommended for suspected intracranial hemorrhage in patients with late non-focal exam findings.
Supportive care for PCS may include nonnarcotic analgesics and antiemetics but no discharge medications yet prevent or speed recovery.
Minor head injuries patients may have lower PCS incidence and related social and psychological burdens.
Consult primary care physician, neurologist, or psychiatrist based on patient’s symptoms.
No proven treatments for PCS, but neurotherapy or EEG biofeedback may help improve symptoms.
Outpatient care for PCS includes cognitive rehabilitation, psychotherapy, stress management, and vocational counselling under guidance of multidisciplinary teams.
Use occipital nerve blocks therapy in persistent occipital neuralgia or post-traumatic headache cases.
Vestibular rehabilitation procedures are indicated to reduce dizziness and vertigo of vestibular dysfunction.
Post-concussion syndrome (PCS) is a complex disorder with symptoms persisting from weeks to months after concussion episode.
Fully recover from concussion in days to weeks, but some have prolonged symptomatic challenges.
While most recover quickly, some deal with prolonged physical, cognitive, and emotional symptoms after a concussion.
PCS occurs after mild traumatic brain injury (TBI) with increased risk for those with multiple injuries.
Symptoms persisting beyond 3 months indicate persistent PCS with lasting effects on cognition, memory, learning, and executive function.
Over 2 million cases of traumatic brain injury happen annually in the US with a study on mild TBI ER visits.
About 50% of patients with MHI experience PCS symptoms at 1 month, with 15% still having symptoms at 1 year.
Persistent symptoms in mTBI patient’s difficult resumption of normal functions. 14-29% of children still experience post-concussion symptoms after 3 months.
Children are at higher risk for concussions due to their activity levels, participation in sports, and underdeveloped brains making them more vulnerable.
Debated whether PCS symptoms are organic or psychological. Hypothesized early symptoms organic, while those lasting over 3 months are nonorganic, psychological.
PCS symptoms may have organic basis, supported by neuropsychological assessments shows cognitive deficits in memory, attention, and learning in patients.
Study showed PCS patients had persistent impaired eye movements unrelated to depression or intellectual ability compared to controls.
Neuropsychological evaluations show symptom severity not dependent on immediate neurologic status.
Nonsporting mechanisms, LOC, event amnesia, female gender, and abnormal neurobehavioral testing are PCS risk factors.
Patients with PCS from head injury often blame someone for the injury and seek legal action.
Some evidence suggests that neck pain after a head injury does not necessarily lead to PCS, but patients with nausea, headache, and dizziness may be more likely to develop PCS.
Patients with pre-existing physical issues are more likely to experience PCS after MHI
Predicting outcomes is challenging due to under-representation of mild cases and over-representation of severe cases in research studies.
Many patients fully recover within 3 months, while some small studies report long-lasting minor cognitive issues.
Around 15% of patients have ongoing issues beyond 12 months post-injury. They may face persistent, treatment-resistant symptoms and lasting disability.
PCS may be permanent if recovery does not occur within 3 years. Noncompliant individuals are less likely to recover fully.
Collect details including initial injury details, past medical and psychiatric history to understand clinical history of patient.
Neurological Examination
Vestibular and Balance Testing
Cognitive Screening
Musculoskeletal Examination
Acute symptoms are:
Headache, confusion, dizziness/imbalance, nausea and vomiting
Chronic symptoms are:
Chronic headaches, dizziness, or visual disturbances, persistent memory, attention, depression, and anxiety
Depression
Vertebral Artery Dissection
Fibromyalgia
Posttraumatic Stress Disorder
Emergency department patients with possible post-concussion syndrome need detailed physical and neurological exams. No specific care needed in ED.
CT scan is recommended for suspected intracranial hemorrhage in patients with late non-focal exam findings.
Supportive care for PCS may include nonnarcotic analgesics and antiemetics but no discharge medications yet prevent or speed recovery.
Minor head injuries patients may have lower PCS incidence and related social and psychological burdens.
Consult primary care physician, neurologist, or psychiatrist based on patient’s symptoms.
No proven treatments for PCS, but neurotherapy or EEG biofeedback may help improve symptoms.
Outpatient care for PCS includes cognitive rehabilitation, psychotherapy, stress management, and vocational counselling under guidance of multidisciplinary teams.
Emergency Medicine
Provide comfortable seating and workspaces for remote workers. Create consistent sleep routine and avoid screens before bed.
Provide alternatives options for tasks heavy visual or auditory focus.
Long drives or crowded public transportation should be avoided if motion triggers symptoms.
Proper awareness about PCS should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Emergency Medicine
Acetaminophen:
It promotes pulmonary and physical therapy regimens.
Emergency Medicine
Metoclopramide:
It blocks dopamine receptors in the chemoreceptor trigger zone of the CNS.
Ondansetron:
It blocks serotonin in peripheral and central regions.
Prochlorperazine:
It blocks postsynaptic mesolimbic dopamine receptors through anticholinergic effects.
Emergency Medicine
Use occipital nerve blocks therapy in persistent occipital neuralgia or post-traumatic headache cases.
Vestibular rehabilitation procedures are indicated to reduce dizziness and vertigo of vestibular dysfunction.
Emergency Medicine
The treatment phase includes:
Acute phase (0–7 Days Post-Injury)
Subacute phase (7 Days to 4 Weeks)
Chronic phase (Beyond 4 Weeks)
Pharmacologic therapy is effective in the treatment phase as it includes the use of analgesics and antiemetic agents.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Post-concussion syndrome (PCS) is a complex disorder with symptoms persisting from weeks to months after concussion episode.
Fully recover from concussion in days to weeks, but some have prolonged symptomatic challenges.
While most recover quickly, some deal with prolonged physical, cognitive, and emotional symptoms after a concussion.
PCS occurs after mild traumatic brain injury (TBI) with increased risk for those with multiple injuries.
Symptoms persisting beyond 3 months indicate persistent PCS with lasting effects on cognition, memory, learning, and executive function.
Over 2 million cases of traumatic brain injury happen annually in the US with a study on mild TBI ER visits.
About 50% of patients with MHI experience PCS symptoms at 1 month, with 15% still having symptoms at 1 year.
Persistent symptoms in mTBI patient’s difficult resumption of normal functions. 14-29% of children still experience post-concussion symptoms after 3 months.
Children are at higher risk for concussions due to their activity levels, participation in sports, and underdeveloped brains making them more vulnerable.
Debated whether PCS symptoms are organic or psychological. Hypothesized early symptoms organic, while those lasting over 3 months are nonorganic, psychological.
PCS symptoms may have organic basis, supported by neuropsychological assessments shows cognitive deficits in memory, attention, and learning in patients.
Study showed PCS patients had persistent impaired eye movements unrelated to depression or intellectual ability compared to controls.
Neuropsychological evaluations show symptom severity not dependent on immediate neurologic status.
Nonsporting mechanisms, LOC, event amnesia, female gender, and abnormal neurobehavioral testing are PCS risk factors.
Patients with PCS from head injury often blame someone for the injury and seek legal action.
Some evidence suggests that neck pain after a head injury does not necessarily lead to PCS, but patients with nausea, headache, and dizziness may be more likely to develop PCS.
Patients with pre-existing physical issues are more likely to experience PCS after MHI
Predicting outcomes is challenging due to under-representation of mild cases and over-representation of severe cases in research studies.
Many patients fully recover within 3 months, while some small studies report long-lasting minor cognitive issues.
Around 15% of patients have ongoing issues beyond 12 months post-injury. They may face persistent, treatment-resistant symptoms and lasting disability.
PCS may be permanent if recovery does not occur within 3 years. Noncompliant individuals are less likely to recover fully.
Collect details including initial injury details, past medical and psychiatric history to understand clinical history of patient.
Neurological Examination
Vestibular and Balance Testing
Cognitive Screening
Musculoskeletal Examination
Acute symptoms are:
Headache, confusion, dizziness/imbalance, nausea and vomiting
Chronic symptoms are:
Chronic headaches, dizziness, or visual disturbances, persistent memory, attention, depression, and anxiety
Depression
Vertebral Artery Dissection
Fibromyalgia
Posttraumatic Stress Disorder
Emergency department patients with possible post-concussion syndrome need detailed physical and neurological exams. No specific care needed in ED.
CT scan is recommended for suspected intracranial hemorrhage in patients with late non-focal exam findings.
Supportive care for PCS may include nonnarcotic analgesics and antiemetics but no discharge medications yet prevent or speed recovery.
Minor head injuries patients may have lower PCS incidence and related social and psychological burdens.
Consult primary care physician, neurologist, or psychiatrist based on patient’s symptoms.
No proven treatments for PCS, but neurotherapy or EEG biofeedback may help improve symptoms.
Outpatient care for PCS includes cognitive rehabilitation, psychotherapy, stress management, and vocational counselling under guidance of multidisciplinary teams.
Emergency Medicine
Provide comfortable seating and workspaces for remote workers. Create consistent sleep routine and avoid screens before bed.
Provide alternatives options for tasks heavy visual or auditory focus.
Long drives or crowded public transportation should be avoided if motion triggers symptoms.
Proper awareness about PCS should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Emergency Medicine
Acetaminophen:
It promotes pulmonary and physical therapy regimens.
Emergency Medicine
Metoclopramide:
It blocks dopamine receptors in the chemoreceptor trigger zone of the CNS.
Ondansetron:
It blocks serotonin in peripheral and central regions.
Prochlorperazine:
It blocks postsynaptic mesolimbic dopamine receptors through anticholinergic effects.
Emergency Medicine
Use occipital nerve blocks therapy in persistent occipital neuralgia or post-traumatic headache cases.
Vestibular rehabilitation procedures are indicated to reduce dizziness and vertigo of vestibular dysfunction.
Emergency Medicine
The treatment phase includes:
Acute phase (0–7 Days Post-Injury)
Subacute phase (7 Days to 4 Weeks)
Chronic phase (Beyond 4 Weeks)
Pharmacologic therapy is effective in the treatment phase as it includes the use of analgesics and antiemetic agents.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
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