Neuro

Postconcussion Syndrome

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Postconcussion Syndrome, Post-Concussion Syndrome, Post-Traumatic Headache, Postconcussive Symptoms

  • Definition
  1. Persistent Concussion-related symptoms beyond 3 months
  2. Mild Traumatic Brain Injury (MTBI) is a preferred term to Postconcussion Syndrome
    1. Postconcussion Syndrome is a subjective term with symptoms that may be altered by Secondary Gain and other external factors
  • Epidemiology
  1. Incidence 5-20% of Concussions (or MTBI)
    1. Some estimates are as high as postconcussive syndrome in 38-80% of Concussions
  • Risk Factors
  1. Female gender
  2. Children and older age
  3. Inadequate social support
  4. Lower baseline functional status or socioeconomic status
  5. Pre-existing conditions
    1. Major Depression
    2. Anxiety Disorder
    3. Attention Deficit Disorder
    4. Migraine Headaches
    5. Post-Traumatic Stress Disorder (PTSD)
    6. Substance Abuse
  • Symptoms
  1. Common Symptoms
    1. Headache (most common)
    2. Dizziness
  2. Cognitive Symptoms
    1. Impaired attention and memory
    2. Difficult Executive Function (e.g. organization, planning, reasoning)
  3. Behavioral Symptoms
    1. Irritability
    2. Altered mood
    3. Insomnia
    4. Fatigue
  4. Other Symptoms
    1. Blurred Vision
    2. Neck Pain
    3. Tinnitus
    4. Balance difficulty
    5. Hearing Loss
    6. Loss of Taste or smell sense
  • Diagnostics
  1. Chronic Headaches after Concussion (esp. severe or progressive Headache without prior head imaging)
    1. Head CT or Head MRI
  2. Persistent Dizziness after Concussion
    1. Electronystagmography (ENG)
    2. Fistula Test
    3. Posturography
  3. Persistent neurologic or behavioral changes
    1. Neuropsychological Testing (including computerized Neuropsychological Testing)
  • Precautions
  • Red Flags
  • Prognosis
  1. See Cognitive Deficit following Concussion
  2. Prolonged course risk factors
    1. See Risk Factors above
  • Management
  • Targeted symptom management
  1. Cognitive deficit
    1. See Cognitive Deficit following Concussion
    2. Consider Neuropsychological Testing
    3. Consider brain imaging
    4. Assess for comorbid conditions
      1. Major Depression
      2. Anxiety Disorder
      3. Insomnia
  2. Mood Disorder
    1. Major Depression Management
    2. Anxiety Management
    3. Consider Selective Serotonin Reuptake Inhibitor (SSRI)
  3. Headaches
    1. Consider Migraine Prophylaxis
  4. Vertigo
    1. See Vertigo Management
  5. Sleep Disturbance
    1. See Disorder of Initiating and Maintaining Sleep (Insomnia)
    2. See Sleep Hygiene
  6. Sports
    1. No sports participation until symptoms resolve
    2. See Return to Play after Concussion
  7. Other symptom management
    1. Fatigue management
    2. Insomnia management
  8. Consultations to consider
    1. Physical therapy
      1. Vestibular and balance therapy
      2. Neck rehabilitation
    2. Occupational Therapy
      1. Functional therapy on specific tasks
    3. Speech Therapy
    4. Neuropsychology
    5. Mental Health