Postconcussive Syndrome

Excerpt

Traumatic brain injury (TBI) occurs in patients of all age groups and is a significant public health issue. In the United States, 1.5 million TBIs occur annually, 75% of TBIs are classified as mild, and costs are generated of $17 billion each year. Most patients that suffer from TBI will have spontaneous resolution of symptoms, but for some patients, symptoms may linger and negatively affect daily cognitive function. Post-concussive syndrome (PCS) demarcates the constellation of symptoms seen most often in prolonged mild TBI, however, it may also occur following moderate and severe TBI. Clinical criteria for PCS are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

PCS is a constellation of physical, cognitive, behavioral, and emotional symptoms occurring after TBI. These symptoms include a headache, fatigue, vision changes, disturbances in balance, confusion, dizziness, insomnia, neuropsychiatric symptoms, and difficulty with concentration. Approximately 90% of concussion symptoms are transient, with symptoms resolving within 10 to 14 days but may linger for weeks. Persistent PCS occurs when symptoms persist past 3 months. Fifteen percent of mild TBI patients will suffer from PCS, and a small minority of those patients will experience persistent PCS requiring further evaluation and treatment.

Research has shown that mild TBI resulting in persistent PCS has lasting effects on cognition, memory, learning, and executive function. Patients who suffer more than one brain injury are at increased risk for PCS. Due to limited diagnostic tools, those permanent changes in executive function can go undocumented. Thus, the 15% incidence of PCS is an underestimation of the true incidence.