On its own?Does post concussion syndrome go away on its own?

Post concussion syndrome (PCS) is a condition that can develop after a head injury. It can cause problems with memory, concentration, and thinking. PCS can last for months or years. There is no cure for PCS, but there are treatments that can help.

If you have a head injury, it is important to see a doctor. The doctor will examine you and give you a diagnosis. The doctor may also refer you to a neurologist or a neuropsychologist. These doctors can help you to understand your symptoms and to find treatments that will help you to recover.

There is no one cure for PCS. However, there are treatments that can help. These treatments may include physical therapy, medication, and counseling.

It is important to keep your head injury and PCS in mind when you are planning your recovery. You may need to take some time to recover, and you may need to be careful while you are recovering.

Other names: post-concussion syndrome, post-concussive syndrome, post-concussive syndrome, post-concussive syndrome, post-concussive syndrome, post-concussive syndrome, post-con

Post-concussion syndrome (PCS) is a collection of symptoms that can last for weeks, months, or even a year or more after a concussion--medically known as a mild traumatic brain injury (TBI).[1][2][3][4] About 34 to 35% of people with concussion have persistent or prolonged symptoms 3 to 6 months after injury. (PCS) is a set of symptoms that may continue for weeks, months, or a year or more after a concussion – medically classified as a so-called mild traumatic brain injury (TBI).[1][2][3][4] About 34 to 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury.[5] Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.[6]

A diagnosis of concussion or post-concussion syndrome may be made when symptoms from the injury last for more than three months after the injury.[7][8][9] Loss of consciousness is not required for a diagnosis of concussion or post-concussion syndrome.[10] However, it is critical that patients seek help as soon as they notice lingering symptoms within one month, and especially when they notice their mental health deteriorating, because they are at risk of post-con

Though there is no specific treatment for PCS, symptoms can be improved with medications, physical and behavioral therapy, and education about symptoms and recovery expectations.The vast majority of PCS cases are resolved after some time.

Signs and symptoms[edit]

Previously, the term PCS was also used to refer to immediate physical symptoms or post-concussive symptoms following a minor TBI or concussion.[13] The severity of these symptoms typically decreases rapidly.[14] Furthermore, the nature of the symptoms may change over time: acute symptoms are most commonly of a physical nature, whereas persisting symptoms are predominantly psychological.

The condition is associated with a wide range of non-specific symptoms, including physical symptoms such as headaches, cognitive symptoms such as difficulty concentrating, and emotional and behavioral symptoms such as irritability. Because many of the symptoms associated with PCS are common or may be exacerbated by other disorders, there is a high risk of misdiagnosis.Headaches that occur after a concussion may feel like migraine headaches or tension-type headaches, with the majority of headaches being tension-type headaches that may be associated with a neck injury that occurred at the same time as the head injury.needs update]

Physical[edit]

While most people have headaches of the same type they had before the injury, people diagnosed with PCS often report more frequent or longer-lasting headaches.[18] Between 30% and 90% of people treated for PCS report having more frequent headaches, and between 8% and 32% still report them a year after the injury.needs update] While most people have headaches of the same type they experienced before the injury, people diagnosed with PCS often report more frequent or longer-lasting headaches.[18] Between 30% and 90% of people treated for PCS report having more frequent headaches and between 8% and 32% still report them a year after the injury.[18][needs update]

Dizziness is another common symptom reported in approximately half of people diagnosed with PCS, and it is still present in up to a quarter of them a year later.[18] Older people are especially vulnerable to dizziness, which can contribute to subsequent injuries and higher rates of mortality due to falls.

About 10% of people with PCS develop sensitivity to light or noise, 5% have a decreased sense of taste or smell, and 14% have blurred vision.[18] People may also have double vision or ringing in the ears, also known as tinnitus.[20] PCS may cause insomnia, fatigue,[21] or other sleep problems.

Psychological and behavioral[edit]

Some common symptoms, such as apathy, insomnia, irritability, or lack of motivation, may result from other co-occurring conditions, such as depression.

Higher mental functions[edit]

Common symptoms associated with a PCS diagnosis include cognition,[25] attention,[26] and memory, particularly short-term memory, which can exacerbate other problems such as forgetting appointments or difficulties at work.[18] In one study, one in four people diagnosed with PCS reported memory problems a year after the injury,[18][27], but most experts agree that cognitive symptoms clear within six months to a year after injury in the vast majority of cases.needs update]

Causes[edit]

The cause or causes of PCS have been heavily debated for many years and continue to be controversial. [medical citation needed] It is not known to what extent the symptoms are due to physiological changes or to other factors, such as pre-existing psychiatric disorders or factors related to secondary gain or disability compensation.medical citation needed] It is not known to exactly what degree the symptoms are due to physiological changes or to other factors, such as pre-existing psychiatric disorders or factors related to secondary gain or disability compensation.[28] The subjectivity of the complaints complicates assessment and makes it difficult to determine whether symptoms are being exaggerated or feigned.[18]

Psychosocial factors, chronic pain, or an interaction of some or all of these may also exacerbate PCS.[29] The majority of experts believe that PCS is caused by a combination of factors, including preexisting psychological factors and those directly related to the physical injury.

It is unknown what causes PCS to occur and persist[30], or why some people who have a mild traumatic brain injury later develop PCS while others do not.PCS is thought to be caused by physiological and psychological factors present before, during, and after the injury.[13][needs update]needs update] The nature of the syndrome and the diagnosis itself have been the subject of intense debate since the 19th century. However, certain risk factors have been identified; for example, preexisting medical or psychological conditions, expectations of disability, being female, and older age all increase the chances that someone will have PCS. Physiological and psychological factors present before, during, and after the injury are all thought to be involved in the development of PCS.[13][needs update]

Some experts believe that post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems as a result of the impact that caused the concussion.[medical citation needed] Others believe that post-concussion symptoms are related to common psychological factors, such as headache, dizziness, and sleep problems.medical citation needed] Others believe that post-concussion symptoms are related to common psychological factors. Most common symptoms like headache, dizziness, and sleep problems are similar to those often experienced by individuals diagnosed with depression, anxiety, or post traumatic stress disorder.[medical citation needed] In many cases, both physiological effects of brain trauma and emotional reactions to these events play a role in the development of symptoms.[32]

Physiological[edit]

Conventional neuroimaging studies of the brain following a concussion are typically normal; however, studies using more novel imaging modalities have discovered some subtle physiological changes associated with PCS.[medical citation needed] Studies using positron emission tomography have linked PCS to a reduction in glucose use by the brain.[medical citation needed] Changes in cerebral blood flow have also been observed as long as three years after a concussion in studies usimedical citation needed] Studies using positron emission tomography have linked PCS to a reduction in glucose use by the brain.[medical citation needed] Changes in cerebral blood flow have also been observed as long as three years after a concussion in studies using single photon emission computed tomography (SPECT).[18][needs update] At least one study with functional magnetic resonance imaging (fMRI) has shown differences in brain function during tasks involving memory after mild traumatic brain injury (mTBI) although they were not examining PCS specifically.[33]

However, not all people with PCS have imaging abnormalities, and abnormalities found in studies such as fMRI, PET, and SPECT could be due to other comorbid conditions such as depression, chronic pain, or posttraumatic stress disorder (PTSD).[29] Supporters of the view that PCS has a physiological basis point to findings that children demonstrate deficits on standardized tests of cognitive function following a mild TBI.

It has been proposed that brain inflammation plays a role in post-concussive syndrome.

Psychological[edit]

It has been argued that psychological factors play an important role in the presence of post-concussion symptoms.[37] The development of PCS may be due to a combination of factors such as adjustment to the effects of the injury, preexisting vulnerabilities, and brain dysfunction.

Iatrogenic effects (those caused by medical intervention) may also occur when people are given misleading or incorrect information about symptom recovery, which may cause people to focus and dwell on the idea that their brains are permanently damaged.[29] It appears that even the expectation of symptoms may contribute to the development of PCS by causing individuals with mTBI to focus on symptoms and thus perceive them to be more severe.

Diagnosis[edit]

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The International Classification of Diseases and Related Health Problems (ICD-10) and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, respectively, have established criteria for post-concussion syndrome (PCS) and post-concussional disorder (PCD).post-concussion syndrome (PCS) and post-concussional disorder (PCD), respectively.

In 1992, the ICD-10 established a set of diagnostic criteria for PCS.[39] To meet these criteria, a patient must have had a head injury "usually sufficiently severe to result in loss of consciousness"[34][40] and then develop at least three of the eight symptoms marked with a check mark in the table at right under "ICD-10" within four weeks.[39][41] Approximately 38% of people who have a head injury with symptoms of concussion and no radiological

The DSM-IV lists criteria for PCD diagnosis in people who have had a head trauma with persistent post-traumatic amnesia, loss of consciousness, or post-traumatic seizures.[34] In addition, patients must have neuropsychological impairment as well as at least three of the symptoms marked with a check mark in the table at right under "DSM-IV."

The Stroop Color Test and the 2&7 Processing Speed Test (which both detect deficits in mental processing speed) can predict the development of cognitive problems from PCS.[18] The Rivermead Postconcussion Symptoms Questionnaire, a set of questions that measure the severity of 16 different post-concussion symptoms, can be self-administered or administered by a healthcare professional.

Differential diagnosis[edit]

PCS, which shares symptoms with a number of other conditions, is highly likely to be misdiagnosed in people with these conditions.[47][needs update] Cognitive and affective symptoms that occur following a traumatic injury may be attributed to mTBI, but in fact be due to another factor such as posttraumatic stress disorder,[37], which is easily misdiagnosed as PCS and vice versa.needs update] Cognitive and affective symptoms that occur following a traumatic injury may be attributed to mTBI, but in fact be due to another factor such as posttraumatic stress disorder,[37] which is easily misdiagnosed as PCS and vice versa.[47] Affective disorders such as depression have some symptoms that can mimic those of PCS and lead to a wrongful diagnosis of the latter; these include problems with concentration, emotional lability, anxiety, and sleep problems.[18] Depression, which is highly common in persistent PCS, can worsen other PCS symptoms, such as headaches and problems with concentration, memory, and sleep.[48] PCS also shares symptoms with chronic fatigue syndrome, fibromyalgia, and exposure to certain toxins.[21] Traumatic brain injury may cause damage to the hypothalamus or the pituitary gland, and deficiencies of pituitary hormones (hypopituitarism) can cause similar symptoms to post-concussion syndrome; in these cases, symptoms can be treated by replacing any hormones that are deficient.[medical citation needed]

Treatment[edit]

Treatments for post-concussion syndrome typically involve treatments addressing specific symptoms; for example, people can take over-the-counter pain relievers for headaches and medicine to relieve depression or insomnia.[49][needs update] Participation in low-risk physical activities that raise the heart rate and mental activities is advised, at a level that does not worsen symptoms.needs update] Participation in low-risk physical activities that raise the heart rate and mental activities is advised, at a level that does not worsen symptoms.[50] Prolonged rest is not suggested.[50] Physical and behavioral therapy may also be prescribed for problems such as loss of balance and difficulties with attention, respectively.[51]

Medication[edit]

Though there are no pharmacological treatments for PCS, doctors may prescribe medications for symptoms that also occur in other conditions; for example, antidepressants are used for the depression that frequently follows mTBI.[52] Side effects of medications may affect people with mTBI more severely than they do others, so medications should be avoided if possible;[52] there may be a benefit to avoiding narcotic medications.

Psychotherapy[edit]

Psychological treatment, to which approximately 40% of PCS patients are referred for consultation, has been shown to reduce problems.[3] Ongoing disabilities may be treated with therapy to improve function at work, or in social or other contexts, with the goal of assisting in the gradual return to work and other preinjury activities as symptoms permit.A PCS treatment protocol has been developed based on the principles of Cognitive behavioral therapy (CBT), a psychotherapy aimed at influencing disturbed emotions by improving thoughts and behaviors.[29] CBT may help prevent the persistence of iatrogenic symptoms[52]- those that occur because health care providers create the expectation that they will.

Post-concussion syndrome may be accompanied by posttraumatic stress disorder in situations such as motor vehicle accidents or following a violent attack, which is important to recognize and treat in its own right. People with PTSD, depression, and anxiety can be treated with medication and psychotherapy.

Upper cervical care[edit]

Post-concussion syndrome can sometimes be the result of a misalignment in the upper cervical spine (neck) specifically the C1 (Atlas) or C2 (Axis) which surround the brain stem. Some individuals have found relief through upper cervical careAn upper cervical chiropractor is a specialist who uses x-rays to identify misalignments in the upper cervical spine and then gently repositions the top two bones of the neck. There are currently approximately seven different chiropractic methods of repositioning the C1 bone, but the three most popular techniques are NUCCA (hand adjustment), Blair Technique (hand adjustment), and Atlas Orthogonal (machine adjustment).[56]

Education[edit]

Education about symptoms and their usual time course is a part of psychological therapy, and is most effective when provided soon after the injury.[52] Since stress exacerbates post-concussion symptoms, and vice versa, an important part of treatment is reassurance that PCS symptoms are normal, and education about how to deal with impairments.[22] One study found that PCS patients who were coached to return to activities gradually, told what symptoms to expect, and trained how to manage them had a reduction in symptoms compared to a control group of uninjured people.[15] Early education has been found to reduce symptoms in children as well.[51]

Neurotherapy[edit]

Neurotherapy is an operant conditioning test where patients are given conditional audio/visual rewards after producing particular types of brainwave activity. Recent neurotherapy improvements in quantitative electroencephalography can identify the specific brainwave patterns that need to be correctedNeurotherapy has been shown in studies to be effective in the treatment of post-concussion syndrome and other disorders with similar symptoms.

Prognosis[edit]

The prognosis for PCS is generally considered positive, with total resolution of symptoms in many, but not all, cases. For 50% of people, post-concussion symptoms go away within a few days to several weeks after the original injury occurs.[28] In others, symptoms may remain for three to six months,[25] but evidence indicates that many cases are completely resolved within six months.[18] The majority of symptoms are largely gone in about half of people with concussion one month after the injury, and about two thirds of people with minor head trauma are nearly symptom-free within three monthsPersistent, often severe headaches are the most likely symptom to never fully resolve in most cases.[52] It is frequently stated in the literature and considered common knowledge that 15-30% of people with PCS have not recovered by a year after the injury, but this estimate is imprecise because it is based on studies of people admitted to a hospital, the methodologies of which have been criticized.

The way in which children cope with the injury after it occurs may have more of an impact than factors that existed prior to the injury.[34] Children's mechanisms for dealing with their injuries may have an effect on the duration of symptoms, and parents who do not deal effectively with anxiety about children's post-injury functioning may be less able to help their children recover.[34]

If another blow to the head occurs after a concussion but before its symptoms have gone away, there is a slight risk of developing the serious second-impact syndrome (SIS).[60][61] In SIS, the brain rapidly swells, greatly increasing intracranial pressure.[60] People who have repeated mild head injuries over a prolonged period, such as boxers and Gridiron football players, are at risk for chronic traumatic encephalopathy (or the related variant dementia pugilistica), a severe, chronic disorder involving a decline in mental and physical abilities.[62]

Epidemiology[edit]

It is not known exactly how common PCS is. Estimates of the prevalence at three  months post-injury are between 24 and 84%, a variation possibly caused by different populations or study methodologies.[13][needs update] The estimated incidence of PPCS (persistent postconcussive syndrome) is around 10% of mTBI cases.[43] Since PCS by definition only exists in people who have had a head injury, demographics and risk factors are similar to those for head injury; for example, young adults are at higher risk than others for receiving head injury, and, consequently, of developing PCS.[44]needs update] The estimated incidence of PPCS (persistent postconcussive syndrome) is around 10% of mTBI cases.[43] Since PCS by definition only exists in people who have had a head injury, demographics and risk factors are similar to those for head injury; for example, young adults are at higher risk than others for receiving head injury, and, consequently, of developing PCS.[44]

The existence of PCS in children is controversial. It is possible that children's brains have enough plasticity that they are not affected by long-term consequences of concussion (though such consequences are known to result from moderate and severe head trauma).[63] On the other hand, children's brains may be more vulnerable to the injury, since they are still developing and have fewer skills that can compensate for deficits.[64] Clinical research has found higher rates of post-concussion symptoms in children with TBI than in those with injuries to other parts of the body, and that the symptoms are more common in anxious children.[38] Symptoms in children are similar to those in adults, but children exhibit fewer of them.[38] Evidence from clinical studies found that high school-aged athletes had slower recoveries from concussion as measured by neuropsychological tests than college-aged ones and adults.[64] PCS is rare in young children.[53]

Risk factors[edit]

A variety of factors have been identified as being predictive of PCS, including low socioeconomic status, previous mTBI, a serious associated injury, headaches, an ongoing court case, age, and female sex.[55][65] Being older than 40 and female have also been identified as being predictive of a diagnosis of PCS,[13], and women tend to report more severe symptoms.

Mild brain injury-related factors that increase the risk of persistent post-concussion symptoms include an injury accompanied by acute headache, dizziness, or nausea; an acute Glasgow Coma Score of 13 or 14; and having another head injury before recovering from the first.

History[edit]

For hundreds of years, the symptoms that occur after a concussion have been described in various reports and writings.[25] The idea that this set of symptoms forms a distinct entity began to gain greater recognition in the latter part of the 19th century.[69] John Erichsen, a surgeon from London, played an important role in developing the study of PCS.By 1934, the current concept of post-concussion syndrome (PCS) had replaced ideas of hysteria as the cause of post-concussion symptoms.[18] British authorities banned the term shell shock during World War II to avoid an epidemic of cases, and the term posttrauma concussion state was coined in 1939 to describe "disturbance of consciousness with no immediate or obvious pathologic change in the brain."

H. Miller coined the term "accident neurosis" to describe the syndrome that is now known as PCS in 1961, claiming that the condition only occurs in situations where people stand to be compensated for their injuries.[35] The true causes of the condition remain unknown.

Controversy[edit]

Though there is no universally accepted definition of postconcussive syndrome, the majority of the literature defines it as the development of at least three of the following symptoms: headache, dizziness, fatigue, irritability, impaired memory and concentration, insomnia, and decreased tolerance for noise and light.(see diagnosis above).[72]

Headache is one of the criteria for PCS, but it is unclear where the headache originates. Couch, Lipton, Stewart, and Scher (2007)[73] argue that headaches, one of the hallmarks of PCS, occur in a variety of head and neck injuries.Furthermore, Lew et al. (2006)[74] reviewed numerous studies comparing headaches to post-traumatic headaches and discovered that the source and causes of headaches vary greatly.They point out that the International Headache Society lists 14 known causes of headaches, and that the headaches may be better explained by mechanical causes, such as whiplash, which is frequently misdiagnosed as PCS.[75] Another possibility is that posttraumatic stress disorder can account not only for some cases diagnosed as PCS,[76], but also for emotional regulation.

Depression, posttraumatic stress disorder, and chronic pain all share symptoms similar to post-concussion syndrome.[29] One study discovered that while people with chronic pain without TBI report many symptoms similar to post-concussion syndrome, they report fewer symptoms related to memory, slowed thinking, and sensitivity to noise and light than people with mTBI.

Because PCS symptoms are so varied and many can be associated with a large number of other conditions, there is some debate about whether the term "syndrome" is appropriate for the constellation of symptoms found after concussion.[80] The fact that the persistence of one symptom is not necessarily linked to that of another has also been raised.

The nature of PCS's etiology - that is, the cause behind it - and the extent to which psychological factors and organic factors involving brain dysfunction are responsible have long been debated, and the debate has been referred to as 'psychogenesis versus physiogenesis' (psychogenesis referring to a psychological origin for the condition, physiogenesis referring to a physical one).

See also[edit]

• Daniel Amen, National Football League post-concussion expert

References[edit]

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