POST-CONCUSSION SYNDROME

POST-CONCUSSION SYNDROME

By Dr. Daniel Rancier MD


A concussion can occur when an individual suffers a blow that causes injury or trauma to the head. You’ll find a variety of definitions for a concussion, but in simple terms, it is an injury to your brain that affects brain function. Symptoms, which are usually temporary, include headaches, memory, balance, coordination, and problems concentrating. Taking a blow to the head that causes the brain to move back and forth is enough to cause a concussion.

Post-Concussion Syndrome, or PCS, is more complex and specific symptoms can last much longer than a typical concussion. Some specific symptoms of PCS, such as headaches, light sensitivity, and dizziness can last for weeks to sometimes years after the initial injury. Athletes, even at the professional level, are sometimes unable to return to their sport for months at a time due to ongoing symptoms from a concussion.  Post-concussion syndrome diagnosis was made in these athletes due to current symptoms.

PCS in Professional Sports

In hockey, superstar Sidney Crosby of the Pittsburgh Penguins was plagued by symptoms from concussions. Crosby, 29, missed significant time during the 2010-11 and 2011-12 seasons while recovering from post-concussion symptoms. He has since returned, but concerns are still there due to the hard hits prevalent in the sport of hockey.

Even baseball has its own inherent risks. Justin Morneau, who won MVP with the Minnesota Twins back in 2006, suffered a head injury in July of 2010 when he struck his head on Toronto infielder John McDonald’s knee while sliding into second base.

Morneau missed the rest of that season and much of the next while dealing with concussion-related symptoms and other injuries. His career tailed off so significantly that in spring training 2012, he announced that he would retire if concussion symptoms returned. Morneau did get better and returned to baseball, but that isn’t to say the concussion issue will ever go away completely. “It’s something that will always be with me,” he said. “I look at it like a pitcher who has had Tommy John surgery — every time he throws or his elbow gets sore, or something happens, you’re going to go back to that. I just needed time to build confidence in it. The further away you get from it, the better you feel. But it’s one of those things that will never be out of my mind or be completely gone. That’s the reality of the situation.”

Symptoms

Loss of consciousness is not required at the time of the initial injury for a diagnosis of concussion or post-concussion syndrome. In fact, the risk of post-concussion syndrome doesn’t appear to be associated with the severity of the initial injury. Most people who experience PCS will notice symptoms within 7 to 10 days of their injury, and those symptoms can last anywhere from a few months to years.

Loss of consciousness is not required at the time of the initial injury for a diagnosis of concussion or post-concussion syndrome. In fact, the risk of post-concussion syndrome doesn’t appear to be associated with the severity of the initial injury. Most people who experience PCS will notice symptoms within 7 to 10 days of their injury, and those symptoms can last anywhere from a few months to years.

Loss of consciousness is not required at the time of the initial injury for a diagnosis of concussion or post-concussion syndrome. In fact, the risk of post-concussion syndrome doesn’t appear to be associated with the severity of the initial injury. Most people who experience PCS will notice symptoms within 7 to 10 days of their injury, and those symptoms can last anywhere from a few months to years.

Besides headaches and dizziness, other symptoms of PCS can include memory loss and difficulty concentrating, fatigue, sleep disturbance and emotional and behavioral changes such as irritability. Some people may also experience neck pain, tinnitus (ringing in the ears) and sensitivity to light.

Causes

There are varying opinions on what causes someone to develop post-concussion syndrome. Some experts believe that post-concussion symptoms result from structural damage to the brain or disruption of the brain’s neurotransmitter systems, arising from the impact that caused the concussion. Others believe post-concussion symptoms are related to psychological factors, especially since the most common symptoms — headache, dizziness and sleep problems — are similar to those often experienced by people diagnosed with depression, anxiety or post-traumatic stress disorder. In many cases, both physiological effects of brain trauma and emotional reactions to these effects play a role in the development of symptoms. There does not appear to be a link between the severity of the initial injury and the likelihood of that person going on to have postconcussion symptoms.

Treatment

While there is no specific treatment for PCS, treatment for the symptoms is available. Medications, which can help with things like the headaches and dizziness can be used, as well as physical and behavioral therapy. Patients should also become educated about PCS and realize that the majority of cases will eventually resolve.

Risk Factors

So what are the risk factors for an individual who could be more prone to becoming a victim of post-concussion syndrome? Looking at the Mayo Clinic’s description of PCS, they list the following as key risk factors:

  • Age. Studies have found increasing age to be a risk factor for post-concussion syndrome.
  • Sex. Women are more likely to be diagnosed with post-concussion syndrome, but this may be because women are more likely to seek medical care.
  • Trauma. Concussions resulting from car collisions, falls, assaults and sports injuries are commonly associated with post-concussion syndrome.

According to HealhLine.comi, essential risk factors for the development of post-concussion syndrome are:

  • Anyone who has recently suffered a concussion is at risk for post-concussion syndrome.
  • You’re more likely to develop PCS if you’re over the age of 40.
  • Women are also more likely to have PCS. This might be because women are more apt to seek medical care.
  • Several of the symptoms mirror those associated with depression, anxiety, and posttraumatic stress disorder. Some experts believe that people with pre-existing psychiatric conditions are more likely to develop PCS after a concussion.

Some other information could be considered risk factors which include things like low socioeconomic status, a previous and severe associated injury, headaches, an ongoing court case, and female gender. Being older than 40 and being female have also been identified as being predictive of a diagnosis of PCS, and women tend to report more severe symptoms.

The development of PCS can be exacerbated by having a history of alcohol abuse, low cognitive abilities before the injury, a personality disorder or a medical illness not related to the injuryii. PCS is also more prevalent in people with a history of psychiatric conditions such as clinical depression or anxiety before the injury.

What is the prognosis for someone with post-concussion syndrome? Although there is a significant amount of frustration and the symptoms of PCS are not easy to live with, the prognosis is mostly positive. All cases do not see a complete resolution of symptoms but many will.

50% of PCS sufferers will see their post-concussion symptoms go away within a few days to several weeks after the original injury occursiii. For others, symptoms will remain for months, normally anywhere from 3 to 6 months’ time. The majority of symptoms are gone in about half of people with a concussion one month after the injury, and about two-thirds of people with minor head trauma are nearly symptom-free within three months.

For those who have persistent symptoms, it is most often the headaches, sometimes severe, that last the longest and the most likely symptom never fully to resolve. Estimates are not precise or agreed upon, but speculation is anywhere from 15% to 30% of patients are still not symptom-free after one year from the initial injury.

Most authorities feel that less than 15% of those with post-concussion syndrome go years without relief from symptoms and that those symptoms may become permanent. There are cases, however, where patients have some relief as long as two or three years after the initial injury. Older people or people who have previously suffered another head injury are likely to take longer to recover.

The only authentic way to prevent post-concussion symptom is to avoid the head injury in the first place. Here are some tips provided by the Mayo Cliniciv;

“Although you can’t prepare for every potential situation, here are some tips for avoiding common causes of head injuries:

  • Fasten your seat belt whenever you’re traveling in a car, and be sure children are in age-appropriate safety seats. Children under 13 are safest riding in the back seat, especially if your vehicle has airbags.
  • Use helmets whenever you or your kids are bicycling, roller skating, inline skating, iceskating, skiing, snowboarding, playing football, batting or running the bases in softball or baseball, skateboarding, or horseback riding. Wear a helmet when riding a motorcycle.
  • Take steps around the house to prevent falls, such as removing small area rugs, improving lighting and installing handrails.”

Risks of a concussion are also increased for those children or adults participating in sports, specifically, contact sports. Concussion risk is higher in football, soccer, and hockey but concussions can also occur in non-contact sports as well. This usually happens when there is a blow to the head caused by a fall. Coaches and trainers get concussion education regarding the signs and symptoms that might indicate a player has a concussion. As a result, schools and communities are coming up with guidelines restricting players from returning to practice or games after experiencing a concussion. As previously mentioned, the best way to prevent post-concussion syndrome is to avoid the concussion in the first place.

Coaches and trainers get concussion education regarding the signs and symptoms that might indicate a player has a concussion. As a result, schools and communities are coming up with guidelines restricting players from returning to practice or games after experiencing a concussion. As previously mentioned, the best way to prevent post-concussion syndrome is to avoid the concussion in the first place.
i http://www.healthline.com/health/post-concussion-syndrome#Riskfactors4 ii Hall RC, Hall RC, Chapman MJ (2005). “Definition, diagnosis, and forensic implications of

ii Hall RC, Hall RC, Chapman MJ (2005). “Definition, diagnosis, and forensic implications of post-concussional syndrome”. Psychosomatics. 46 (3): 195–202. doi:10.1176/appi.psy.46.3.195 iii “Concussion”. online medical library. Merck manuals. 2003. iv http://www.mayoclinic.org/diseases-conditions/post-concussionsyndrome/basics/prevention/con-20032705 http://www.webmd.com/brain/post-concussion-syndrome http://www.neurosymptoms.org/post-concussion-syndrome/4582101276

iii “Concussion”. online medical library. Merck manuals. 2003.

iv http://www.mayoclinic.org/diseases-conditions/post-concussionsyndrome/basics/prevention/con-20032705 http://www.webmd.com/brain/post-concussion-syndrome

http://www.neurosymptoms.org/post-concussion-syndrome/4582101276

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