Postconcussion Syndrome

(PCS; Persistent PCS)

Definition

A concussion is an injury to your brain. It causes problems with how it works. It can make memory, balance, thinking, and coordination hard. Postconcussion syndrome (PCS) is when it lasts longer than 6 months.

The Brain

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Causes    TOP

The cause of PCS is unknown. A brain injury may cause a brief change in how brain cells work. This change can get in the way of using your mind and body to do tasks. PCS can also lead to mental health problems.

Risk Factors    TOP

PCS is more common in women. It is also more common in older adults.

Other things that may raise your risk are:

  • A prior concussion
  • Abusing drugs or alcohol
  • Prior anxiety or physical problems
  • Loss of consciousness during the event
  • Loss of memory of the event
  • Abnormal neurological tests after the event

Anxiety, trouble with thinking, and noise sensitivity that lasts a few days after the injury may also raise your risk.

Symptoms    TOP

Not everyone with PCS feels the same. You may have:

  • Lightheadedness
  • Lack of energy
  • Headache
  • Sleeping problems
  • Lack of interest in the things you use to do
  • Feelings of despair
  • Irritability
  • Personality changes
  • A sensitivity to noise and light
  • Problems focusing

PCS may affect daily tasks, your social life, and working.

Diagnosis    TOP

The doctor will ask about your symptoms and activity levels since you got hurt. You will also be asked about your health before you got hurt. Questionnaires and neurological and mental tests may be done. They will help the doctor find out how badly you were hurt. PCS is based on symptoms and how long it has been since you were hurt.

Treatment    TOP

You will get better with time. Things can be done to ease symptoms until they pass. The steps you take will depend on your symptoms and how much they get in the way of your everyday life. Talk with your doctor about the best plan for you. Here are some ways to treat PCS:

Rest

Resting your body and mind is the best way to treat PCS. Resuming normal activities too quickly can cause you to get worse. You may also get more symptoms.

Physical rest may mean not working as much, having help at home with daily tasks, and taking naps when needed. It will also mean not doing things that can jolt the brain, such as sports, rollercoasters, or certain recreational activities. Athletes should not return to sports until symptoms have passed. Mental rest may mean avoiding multitasking, working less, and not spending too much time on the computer or doing mental tasks.

You will need to return to your normal activities slowly. A medical team will do testing to help find out when it is safest for you to do so.

Medications

Here are some medicines that may help:

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

Counseling     TOP

Managing a health problem can be stressful. You may also have mental health problems like anxiety, depression, and mood swings. Counseling can help to:

  • Make healthier thought patterns
  • Come up with skills to manage problems with your relationships
  • Learn coping skills and ways to reduce stress

Rehabilitation    TOP

Some symptoms can make it hard for you to complete tasks. Occupational and physical therapy may help you find new ways to handle these tasks. Therapy may also help you make habits that help ease some symptoms.

Prevention    TOP

PCS can’t be prevented.

RESOURCES:

Brain Injury Association of America
http://www.biausa.org
Centers for Disease Control and Prevention
http://www.cdc.gov

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org
Ontario Brain Injury Association
http://www.obia.ca

References:

Broshek DK, De Marco AP, Freeman JR. A review of post-concussion syndrome and psychological factors associated with concussion. Brain Inj. 2015;29(2):228-237.
Concussion and mild traumatic brain injury. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 11, 2018. Accessed June 25, 2018.
Eisenberg MA, Meehan WP 3rd, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133(6):999-1006.
Ellenborgen RG, Batjer H, Cardenas J, et al. National Football League Head, Neck and Spine Committee’s Concussion Diagnosis and Management Protocol: 2017-2018 season. Br J Sport Med. 2018; pii: bjsports-2018-099203. doi: 10.1136/bjsports-2018-099203. [Epub ahead of print]
Post-concussion syndrome. EBSCO Nursing Reference Center website. Available at: https://www.dynahealth.com. Updated February 10, 2017. Accessed June 25, 2018.
Postconcussion syndrome: why this diagnosis is controversial and what treatments may help. Harvard Ment Health Let. 2007;24(6):6.
Rose SC, Fischer AN, Heyer GL. How long it too long? The lack of consensus regarding the post-concussion syndrome diagnosis. Brain Inj. 2015;29(7-8):798-803.
TBI: Get the facts. Centers for Disease Control website. Available at:
...(Click grey area to select URL)
Updated April 27, 2017. Accessed June 25, 2018.
Zemek RL, Farion KJ, Sampson M, McGahem C. Prognosticators of persistent symptoms following pediatric concussion: A systematic review. JAMA Pediatr. 2013;167(3):259-265.
Last reviewed June 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 6/25/2018

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