Postconcussion Syndrome

Definition

A concussion is an injury to your brain that causes problems with how the brain works. It can affect brain tasks like memory, balance, concentration, judgment, and coordination. Postconcussion syndrome (PCS) refers to concussion symptoms that continue longer than expected, often at least a month after the injury. Symptoms that persist more than 6 months are called persistent postconcussion syndrome.

The Brain

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Causes

The exact cause of PCS is unknown. A concussion may cause a temporary change to how the brain cells function. This change can interfere with physical and mental tasks. The trauma or difficulty managing symptoms can also lead to psychological symptoms like anxiety that complicate recovery.

Risk Factors

PCS is more common in females. Other factors that may increase your chance of PCS include:

• Previous head injury or concussion
• Increased age
• Substance abuse
• Previous anxiety issues or physical impairments
• Loss of consciousness during original trauma
• Loss of memory of the event
• Abnormal neurological tests after the event

Anxiety, trouble with thought process, and noise sensitivity that is present a few days after the injury may also increase the risk of PCS.

Symptoms

PCS symptoms vary from person to person. Common symptoms include:

• Lightheadedness
• Fatigue
• Headache
• Sleeping problems
• Lack of interest or enthusiasm
• Depression
• Irritability
• Personality changes
• Being very sensitive to noise and/or light
• Difficulty with concentration

These symptoms can interfere with daily activities, social interactions, and ability to work.

Diagnosis

The doctor will ask about your symptoms and activity levels since the injury. A history of health before the concussion will also be needed. Questionnaires and neurological and mental tests will help the doctor rate the degree of symptoms. PCS is diagnosed based on the presence of specific symptoms and time since concussion. You may be referred to a specialist to rule out other potential problems such as bleeding in the brain, damage to the neck, or skull fracture.

Treatment

Over time, symptoms will eventually fade away for most people. Treatment can help to manage symptoms until they pass. Exact treatment steps will depend on your symptoms and how much they are interfering with your everyday life. Talk with your doctor about the best treatment plan for you. Options include:

Rest and Gradual Recovery

Mental and physical rest is the best known treatment for a concussion. Returning to regular activity too quickly can cause a worsening of symptoms or the development of new ones.

Physical rest may include decreasing work hours, having help at home with daily tasks, and taking naps when needed. It will also require avoiding activities that can jolt the brain like sports, rollercoasters, or certain recreational activities. Athletes should not return to sports until symptoms have passed. Mental rest may include avoiding multitasking, decreasing work hours, and avoiding long periods of time on the computer or doing mental tasks.

The return to previous mental and physical levels need to be done gradually. A medical team will do regular testing to help determine when it is safest to progress.

Medications

Medications to help manage symptoms may include:

• Over-the-counter or prescription pain relievers
• Antidepressants—may help manage depression, anxiety, sleep problems, mood changes, and fatigue
• Sleep medication—for severe sleep disturbance

Counseling and Support

PCS is associated with a number of psychological symptoms like anxiety, depression, and mood swings. Managing a long-term medical condition can also be stressful. Psychological counseling can help to:

• Develop healthier thought patterns about current situation.
• Create skills to manage problems with interpersonal relationships brought on by PCS symptoms.
• Learn coping skills and stress reduction techniques.

Rehabilitation

Some symptoms can make daily activities difficult. Occupational and physical therapy may help you develop new ways to handle these tasks. Therapy may also help you develop habits that help manage the intensity of certain symptoms.

Prevention

There are no current guidelines to prevent PCS.