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Postconcussion Syndrome

(PCS; Persistent PCS)

Definition

Postconcussion syndrome (PCS) refers to continued symptoms of mild traumatic brain injury. Most often it resolves within a month but sometimes the symptoms persist for much longer.
Getting treated early for PCS may help you get better faster. If you think you have PCS, contact your doctor right away.
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Causes

The exact cause of PCS is unknown. Several factors contribute to PCS, including:
  • Microscopic brain damage from a mild brain injury
  • Psychological or emotional stress that results from a mild brain injury

Risk Factors

These factors increase your chance of developing PCS. Tell your doctor if you have any of these risk factors:
  • A mild concussion or brain injury caused by a car accident or assault
  • Feeling depressed or being diagnosed with depression after a mild brain injury
  • Low social support , including not having a lot of close friends or people to confide in after a mild brain injury

Symptoms

PCS symptoms vary from person-to-person. If you experience any of these symptoms do not assume it is due to PCS. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your doctor. Symptoms include:
  • Headache
  • Dizziness
  • Balance problems
  • Nausea
  • Vision problems
  • Being very sensitive to noise and/or light
  • Depression
  • Mood swings—a quick change in mood (eg, being happy to becoming very sad)
  • Anxiety
  • Becoming easily irritated or annoyed for little or no reason
  • Trouble remembering things
  • Trouble concentrating or paying attention
  • Trouble sleeping
  • Feeling tired all the time

Diagnosis

PCS is hard to diagnose. The brain damage caused by a mild brain injury is so slight that many tests cannot detect it. It is important to see a doctor with special training in brain injury. These doctors are called neurologists, neuropsychologists, and neurosurgeons. To find one of these doctors, call a local head injury foundation for a referral.
Your doctor will ask questions about:
  • Your personal and family medical history
  • Your head injury
  • Sleep habits
  • Recent missed work or school
  • Recent memory or relationship problems
  • Recent emotional problems, such as irritability, anxiety , and depression
Tests may include:
  • Memory and attention tests—to assess your memory and attention abilities
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head; to look for signs of persistent injury and/or to see if surgery may improve the symptoms
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the head; to look for signs of persistent injury and/or to see if surgery may improve the symptoms
  • Electroencephalogram (EEG)—A test which evaluates the electrical activity of the brain.

Treatment

PCS treatment depends on your symptoms. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Medications

  • Over-the-counter medications to reduce the severity of headaches
  • Antidepressants to help reduce depression and anxiety
  • Nerve blocks to relieve severe, nerve-injury induced pain/headaches

Psychological Treatment

  • Talking with a mental health professional about the problems you are having related to PCS
  • Learning how to cope with those problems in your life

Vocational Therapy

  • Learning skills and training to start or resume a career

Neurotherapy

Neurotherapy (also called biofeedback ) is a painless treatment using computers to help you learn how to modify your brainwaves to improve attention and memory.

Surgery

In some cases, a collection of blood in an area of bruising on the brain may require surgery, which may help resolve or improve symptoms.

Prevention

There are no guidelines for preventing PCS because the cause is not known. To help reduce your chances of getting PCS, take the following steps:

RESOURCES

Brain Injury Association of America National Help Line: 800-444-6443 http://www.biausa.org/

US Centers for Disease Control http://www.cdc.gov/index.htm/

CANADIAN RESOURCES

Canadian Psychiatric Association http://www.cpa-apc.org/

Ontario Brain Injury Association http://www.obia.on.ca/

References

Bazarian J, Atabaki S. Predicting postconcussion syndrome after minor traumatic brain injury. Academic Emergency Medicine . 2001;8:788-795.

Bruhns J, Jagoda A. Mild traumatic brain injury. Mt Sinai J Med. 2009;76:129-137.

Child Health A to Z. Quantitative EEG. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/cfapps/A2ZtopicDisplay.cfm?Topic=Quantitative%20EEG . Accessed July 17, 2005.

Duff J. The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clin EEG Neurosci . 2004;35:198-209.

Evans RW. The postconcussion syndrome and whiplash injuries: a question-and-answer review for primary care physicians. Journal of Primary Care . 2004; 31:1-17.

Facts about concussion and brain injury. Centers for Disease Control website. Available at: http://www.cdc.gov/doc.do/id/0900f3ec8000d370 . Accessed July 17, 2005.

Ferri F, ed. Ferri’s Clinical Advisor 2010. Philadelphia, PA: Mosby Elsevier; 2009.

Goetz C. Goetz’s Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders; 2007.

Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia: Saunders, 2008

Jagoda A, Bazarian J, Bruns J, et al. American College of Emergency Physicians (ACEP)/Centers for Disease Control and Prevention (CDC) Panel. Clinical policy: neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. Ann Emerg Med . 2008; 52(6):714-748.

Lewy J. Postconcussion syndrome. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 30, 2009. Accessed June 10, 2009.

Marx J, Hockberger R, Walls R, Adams J. Rosen's Emergency Medicine. 7th ed. St. Louis, MO: Mosby; 2009.

Mayo Clinic. Post-concussion syndromes. Mayo Clinic website. Available at: http://www.mayoclinic.com . Accessed June 10, 2009.

McCauley SR, Boake C, Levin HS, Contant CF, Song JX. Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities. J Clin Exp Neuropsychol . 2001;23:792-808.

Mittenberg W, Canyock EM, Condit D, Patton C. Treatment of post-concussion syndrome following mild head injury. J Clin Exp Neuropsychol . 2001;23:829-836.

Postconcussion syndrome: why this diagnosis is controversial and what treatments may help. Harvard Mental Health Letter. 2007;24:6.

Ryan LM, Warden DL. Post concussion syndrome. Int Rev Psychiatry . 2003;15:310-316.

Thornton KE, Carmody DP. Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child Adolesc Psychiatr Clin N Am . 2005;14:137-62,vii.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 09/2012 -
  • Update Date: 00/92/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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