Cognitive Deficit following Concussion

Aka: Cognitive Deficit following Concussion, Post-Concussion Delayed Recovery, Persistent Neurologic Dysfunction Following Mild Head Injury, Persistent Cognitive Deficit Following Mild Traumatic Brain Injury, MTBI Associated Cognitive Deficit

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II. Risk Factors

  1. History of prior Concussion (risk of Second Impact Syndrome)
  2. Age younger than 18 years old
  3. Medical comorbidities
  4. Medications (psychotropics or Anticoagulants)
  5. High risk sport (e.g. collision or Contact Sport or dangerous athletic play)
  6. Symptom related (see Concussion Symptom Checklist)
    1. More than three Concussion symptoms at presentation
    2. Specific symptoms such as Fatigue or fogginess
    3. Headache lasting more than 60 hours
    4. Loss of consciousness >60 seconds
    5. Amnesia

III. Complications: Repeated Concussion

  1. Second Impact Syndrome
  2. Chronic Traumatic Encephalopathy
    1. Progressive degenerative changes due to repeated Traumatic Brain Injury
    2. May demonstrate features similar to alzheimer's Dementia
  3. Dementia Pugilistica (Punch Drunk Syndrome)
    1. Subset of Chronic Traumatic Encephalopathy
    2. Dementia with parkinsonian Movement Disorder

IV. Management

  1. See Postconcussion Syndrome
  2. Consider referral to neurologist or other specialist knowledgeable in Concussion
  3. Consider formal Neuropsychological Testing
  4. Consider neurorehabilitation Consultation

V. Precautions: Red Flags

  1. See Concussion Red Flags

VI. References

  1. Arciniegas (2005) Neuropsychiatr Dis Treat 1(4): 311-27 [PubMed]
  2. Scorza (2012) Am Fam Physician 85(2): 123-32 [PubMed]

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