Post Concussion Syndrome

POST CONCUSSION SYNDROME 

Post-Concussion Syndrome (PCS) AKA persistent concussion symptoms is essentially ongoing symptoms after a concussion. Concussion is an acute injury with a short term recovery where PCS is a chronic injury with long term deficits. Based on different definitions symptoms are still present at 1 or 3 months after the injury occurs.

The International Classification of Diseases (ICD-10) states that one must have at least 3 of the following symptoms 4-weeks after injury:

• Headache • Dizziness • Fatigue • Irritability • Sleep problems • Concentration problems • Memory problems • Problems tolerating stress/emotion/alcohol

Where the DSM-IV criteria are at least 3 of the following symptoms 3 months after injury with social problems b/c of it: •

• Headache • Dizziness • Fatigue • Irritability • Sleep Problems • Affect changes, anxiety, or depression • Changes in personality • Apathy

The more recent DSM V leaves the diagnosis out all together.

Various studies have looked into the percentage of concussions that transition to PCS and the studies vary from 10-70% so there is a broad range and many factors. A study from 2018 had a total of 275 cases who were young workers in Ethiopia. They were interviewed during data collection period with response rate of 95.2%. About 41.5% of study participants had at least three symptoms of PCS which falls right into our data range of 10-70%. PCS may be prevalent because concussion treatment is not well managed but that is changing and people are receiving better care due to the uptick of recent research. Two other articles from 2018 found the prevalence of PCS  58% (Adolescents) Howell et al., 2018 – and 39% (pediatrics)– Ewing-Cobba et al., 2018.

The potential causes of PCS are thought to be:

• Visual & Vestibular Dysfunction
• Cervical Dysfunction
• Hormonal
• Metabolic
• Inflammatory
• Blood flow changes
• Psychologic
• Blood brain barrier disruption

Treatment of PCS needs to be an interdisciplinary approach (this means multiple providers working together to improve patient outcomes). The team could consist of a medical doctor, naturopathic doctor, neurologist, physical therapist, occupational therapist, speech therapist, chiropractor, counselor, psychiatrist, psychologist, neuro-optometrist.

If you think you have PCS you should consult your healthcare provider and look for a concussion specialist in that field. There are also steps that you can take towards your recovery from home.

1. Start eating a healthier diet: increase anti-inflammatory foods and reduce processed foods such as pasta, snacks, breads, sugars.
2. Increase your hydration by drinking 2 liters of water daily.
3. Start a sub symptom workout: this means a light workout that does not increase your symptoms.
4. Use pacing tools to track how much you do in a certain day to prevent overload.
5. Start breathing techniques to reduce your respiratory rate

References: 

Bedaso, A., Geja, E., Ayalew, M. et al. Post-concussion syndrome among patients experiencing head injury attending emergency department of Hawassa University Comprehensive specialized hospital, Hawassa, southern Ethiopia. J Headache Pain 19, 112 (2018). https://doi.org/10.1186/s10194-018-0945-0