Post-concussion syndrome (PCS), also known as persisting postconcussive symptoms, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI or, more specifically, mTBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults. A diagnosis may be made when symptoms resulting from concussion last for more than three months after the injury. Loss of consciousness is not required for a diagnosis of concussion or post-concussion syndrome. However, it is important that patients find help as soon as they notice lingering symptoms within one month, and especially when they notice their mental health deteriorating, since they are at risk of post-concussion syndrome depression. Though there is no specific treatment for PCS, symptoms can be improved with medications and physical and behavioral therapy. Education about symptoms and details about expectation of recovery are important. The majority of PCS cases resolve after a period of time.
Signs and symptoms Concussion can be associated with a wide range of non-specific symptoms after the initial injury: physical, such as headache; cognitive, such as difficulty concentrating; and emotional and behavioral, such as irritability, anxiety of depression. Many of the symptoms associated with persisting symptoms after concussion are common or may be exacerbated by other disorders, so there is considerable risk of misdiagnosis. Persisting symptoms after concussion are usually defined as symptoms lasting more than 4 weeks after the initial injury. Headaches that occur after a concussion may feel like migraine headaches (which resolve with the same medications) or tension-type headaches. Most headaches are tension-type headaches (which may be associated with a neck injury with sneezing and swallowing symptoms) that occurred at the same time of the head injury.
Physical A common condition after a concussion is headache. While most people have headaches of the same type they experienced before the injury, people with persisting symptoms after concussion often report more frequent or longer-lasting headaches. They may need their migraine medicine twice a day rather than per month. Between 30% and 90% of people treated for PCS report having more frequent headaches and between 8% and 32% still report them a year after the injury. Dizziness is another common symptom reported in about half of people diagnosed with PCS and is still present in up to a quarter of them a year after the injury. Older people are at especially high risk for dizziness, which can contribute to subsequent injuries and higher rates of mortality due to falls. About 10% of people with PCS develop sensitivity to light or noise, about 5% experience a decreased sense of taste or smell, and about 14% report blurred vision. People may also have double vision or ringing in the ears, also called tinnitus. PCS may cause insomnia, fatigue, or other problems with sleep.
Psychological and behavioral Psychological conditions, which are present in about half of people with PCS, may include irritability, anxiety, depression, and a change in personality. Other emotional and behavioral symptoms include restlessness, aggression, and mood swings. Some common symptoms, such as apathy, insomnia, irritability, or lack of motivation, may result from other co-occurring conditions, such as depression.
Higher mental functions Common symptoms associated with a diagnosis of PCS are related to cognition, attention, and memory, especially short-term memory, which can also worsen other problems such as forgetting appointments or difficulties at work. In one study, one in four people diagnosed with PCS continued to report memory problems a year after the injury, but most experts agree that cognitive symptoms clear within six months to a year after injury in the vast majority of individuals.
Causes Some people have an increased risk of experiencing persisting symptoms after concussion, however, it is not fully understood what causes symptoms to persist, or why some people who have a mild traumatic brain injury later develop PCS while others do not. The majority of experts believe that PCS results from a mix of factors, including preexisting psychological factors and those directly relating to the physical injury. Certain risk factors have been identified; for example, preexisting medical or psychological conditions, expectations of disability, being female, and older age all increase the chances that someone will experience persisting symptoms after a concussion. The nature of the syndrome/symptoms and the diagnosis itself have been the subject of intense debate since the 19th century. Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion. Others believe that post-concussion symptoms are related to common psychological factors. Most common symptoms like headache, dizziness, and sleep problems are similar to those often experienced by individuals diagnosed with depression, anxiety, or post traumatic stress disorder. In many cases, both physiological effects of brain trauma and emotional reactions to these events play a role in the development of symptoms.
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