Postconcussional syndrome


Postconcussional syndrome

Description, Causes and Risk Factors:

Concussion is an injury to your brain that can occur after a blow to your head (a head injury). The blow to your head causes your brain to move slightly within your skull. This can momentarily disrupt the electrical activity within some of the cells in your brain so that your brain stops working properly for a short period of time. It is this disruption that leads to the symptoms of concussion. Concussion is also known as a minor traumatic brain injury by some doctors.

Post-concussion syndrome is a collection of symptoms that some people develop after they have had concussion. It is a complication of concussion. It is sometimes called post-concussive syndrome.

The exact reason why some people develop post-concussion syndrome is not clear. There are a number of different theories. One theory is that it is caused by tiny areas of bruising or other damage to the nerve cells in the brain caused by the initial head injury. Some doctors believe that post-concussion syndrome develops because of a psychological or emotional reaction to the initial head injury.

When the head receives a sharp blow, the difference in the movement between the brain and the skull produces forces that result in traumatic brain injuries (TBIs). Although maximum injury is suffered at the point of impact, the frontal and temporal regions have been shown to be consistently vulnerable to contusions regardless of the direction or the point of impact due to percussion and shearing forces on delicate brain tissue. A "contre-coup" due to a percussion wave travelling through the brain matter and impacting the skull diagonally opposite can cause further contusion, and shear forces at the boundary between white and grey matter can result in axonal shearing.

The term post-concussion syndrome or post-concussional disorder as it is referred to in the DSM-IV has been used to describe the range of residual symptoms that persist 12 months and beyond, sometimes years after the injury. Although minor head injuries are generally considered benign, a significant number of people report persistent symptoms for weeks or months and some for years after injury despite a lack of evidence of brain abnormalities on MRI and CT scans. The core deficits of post-concussion syndrome overlap with those of Attention Deficit Disorder, Adjustment disorder and Mood Disorders. In addition, sufferers often report memory and socialisation problems, frequent headaches and personality changes.

About 700,000 people visit Accident and Emergency departments each year in England and Wales because of a head injury. Some studies have shown that up to half of these people have symptoms of post-concussion syndrome one month after a head injury and around 15 in 100 of these people still have symptoms one year after a head injury.

For some reason, post-concussion syndrome seems to be more common in women than in men.

Symptoms:

The symptoms of post-concussion syndrome may include:

Physical symptoms:

    Headache.

  • Dizziness.

  • Nausea (feeling sick).

  • Double or blurred vision.

  • Hearing loss and/or a ringing noise in the ears (tinnitus).

  • Reduced sense of smell and taste.

  • Problems tolerating light and noise.

Psychological symptoms:

    Being easily irritable.

  • Feeling anxious easily.

  • Depression.

  • Having disturbed sleep and feeling tired.

  • Reduced sex drive.

  • Changes in your appetite.

  • Personality changes such as showing socially or sexually inappropriate behaviour.

  • Having a lack of energy and a lack of interest in things.

  • Having sudden outbursts of emotion - for example, sudden crying or laughing episodes.

Problems with mental processes (called cognitive symptoms):

    Forgetfulness.

  • Concentration and attention problems.

  • Slowed reaction times.

  • Problems processing information and problems reasoning.

  • Difficulty learning new things.

Diagnosis:

Your doctor will usually diagnose post-concussion syndrome by your typical symptoms. They may also do a physical examination, paying particular attention to your nervous system to check that there are no signs of any problems. A physical examination of your nervous system includes simple tests of your muscle strength in your arms and legs as well as tests of your muscle reflexes, your coordination and your sensation. Your doctor may ask you to perform a number of movements of your arms, legs and face, etc. They may also ask you to do some of these movements against resistance from them. There should be no signs of problems with your nervous system on physical examination if you have post-concussion syndrome.

Your doctor may also suggest some tests to check your mental processes. For example, tests of your memory and perhaps maths and drawing. Sometimes, your doctor may suggest a scan of your brain, such as a CT scan or an MRI scan. This is mainly to make sure that there are no other reasons for your symptoms - for example, bleeding in the brain after a head injury.

Other Tests:Quantitative EEG (QEEG): QEEG is the statistical evaluation of the electrical activity of the brain. It is particularly suitable for the evaluation of post-concussion syndrome, as it is empirical, objective, non-intrusive and has been shown to be highly accurate in identifying and discriminating various neurophysiological patterns of brain dysfunction associated with MTBI (Mild traumatic brain injury) and post-concussion syndrome.A recently published review of the scientific literature confirms studies that suggest that QEEG is superior to other structural Neuroimaging techniques in detecting brain dysfunction related to MTBI and post-concussion syndrome.

Treatment:

The symptoms of post-concussion syndrome usually improve and go away within three months after the initial head injury for most people. In the meantime, at present, there is not any treatment that seems to speed up recovery. However, most people find that having a diagnosis and an explanation for their symptoms helps.

There are some other things that you may find helpful if you have been diagnosed with post-concussion syndrome:

    Medication to help symptoms - your doctor may suggest some medication to help some of the symptoms of post-concussion syndrome that you may have. For example, painkillers for headache, medication to help with nausea symptoms or an antidepressant if you have symptoms of depression.

  • Don't rush back into things - it is generally advised that anyone who has had a head injury takes things slowly and doesn't rush straight back into things. If possible, try to return to your usual activities gradually after a head injury.

  • Sleep hygiene - if you are having problems sleeping and are feeling very tired, try to stick to a regular schedule. The separate leaflet, 'Sleeping Problems - Self Help Guides' gives more details.

  • Keep your stress levels down.

  • Avoid alcohol.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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