Could You Have Postconcussive Syndrome?

If you're wondering if you have postconcussive syndrome (PCS), you're in good company. Many people have questions about postconcussive syndrome, including experts in traumatic brain injury (TBI). And many physicians struggle to agree on even an exact definition of postconcussive syndrome. Because of this, research on the subject has been muddy and sometimes conflicting.

Symptoms

In general, the most commonly accepted definition is that postconcussive syndrome consists of someone having suffered from mild TBI and then goes on to suffer from the following. The Mayo Clinic reports the following symptoms common with postconcussive syndrome:

• Headaches
• Dizziness
• Fatigue
• Irritability
• Anxiety
• Insomnia
• Loss of concentration and memory
• Ringing in the ears
• Blurry vision
• Noise and light sensitivity
• Rarely, decreases in taste and smell

Most experts agree that symptoms should begin no later than four weeks after the head injury, while headache should occur within one week. In general, the large majority of people with postconcussive syndrome have their symptoms resolve completely. Most of the time this happens within weeks of the original injury, with about two-thirds of people being symptom-free within three months of their accident. Only a small fraction of patients are estimated to still have problems after a year. Older age and previous head injury are risk factors for a longer recovery. One longitudinal study published in 2017 shows some do not recover at all.

Problems With Diagnosis

Also complicating the diagnosis of PCS is the fact that PCS shares many symptoms with other conditions, many of which, like depression and post-traumatic stress disorder, are common in people with PCS. Also, many of the symptoms of PCS are shared by people without any other illness, or with an injury to another area of the body. This has led some experts to question whether postconcussive syndrome actually exists as a distinct entity.

No one knows exactly why people with head injury develop these symptoms. Historically, physicians debated whether the cause of PCS was primarily physical or psychological, but the truth is probably that PCS involves a combination of both physical and psychological factors. After all, the brain is responsible for psychological experiences, and physical injuries can cause psychological changes.

For example, many patients with postconcussive syndrome lack motivation, which may be directly related to brain injury or related to concomitant depression. Similarly, some clinicians have noted that patients with postconcussive syndrome tend to be preoccupied with their symptoms in a manner similar to hypochondria. This may cause people with PCS to over-emphasize their symptoms, but could their anxiety somehow stem from the physical injury sustained by their brain?

Many seem to suggest that the longer the symptoms of postconcussive syndrome last, the more likely it is that psychological factors are playing an increased role. The development of symptoms lasting over a year can be predicted by a history of alcohol abuse, low cognitive abilities, a personality disorder, or a psychiatric problem such as clinical depression or anxiety. On the other hand, the risk of prolonged symptoms was also increased if the initial injury was associated with a more severe Glasgow Coma Score or a history of previous head trauma.

Postconcussive syndrome is a clinical diagnosis, meaning no additional tests are usually required beyond a physician's examination. That said, positron emission tomography (PET) scans have shown the diminished use of glucose by the brain in patients suffering from symptoms of postconcussive syndrome, although problems like depression may cause similar scans.

Evoked potentials have also shown abnormalities in people with PCS. People with PCS have also been found to have decreased scores on certain cognitive tests. On the other hand, even prior to any head injury, children with postconcussive syndrome had poorer behavioral adjustments than those whose symptoms did not persist after a concussion.

Ultimately, the diagnosis of postconcussive syndrome may be of less importance than recognizing the symptoms involved. There is no other treatment for PCS than to address the individual symptoms. Headaches can be treated with pain medication, and anti-emetics may be useful for dizziness. A combination of medication and therapy can be beneficial for symptoms of depression. Any physical disabilities may be addressed with occupational therapists to improve the sufferer's ability to function well at work.

It is important to recognize that for most people, the postconcussive symptoms lessen over time and then resolve, with an only small minority of people having problems that last a year or more. The best approach to recovery is probably to focus on treating the individual symptoms, both physical and psychological, associated with this perplexing condition.