Persistent post-concussive symptoms
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Post-concussion syndrome, also known as persistent post-concussive symptoms, occurs when the aftereffects of a mild traumatic brain injury, or concussion, linger beyond the expected recovery timeframe. Such injuries, which can result from falls, vehicle accidents, playing contact sports, or any forceful shaking of the head or body, don’t necessarily lead to a loss of consciousness. Interestingly, the severity of the initial injury does not directly correlate with the likelihood of experiencing prolonged symptoms, which can include headaches, dizziness, and issues with concentration and memory. While most individuals start to see symptoms within the first week to ten days post-injury and recover within three months, there are instances where symptoms persist for over a year. Managing these symptoms effectively becomes the primary focus of treatment, aiming to alleviate the prolonged impact they have on daily life.
Symptoms
Concussions are a type of traumatic brain injury that can have a range of symptoms, often mirroring those immediately following the concussion but extending over a longer period. It’s crucial to recognize that even a brief loss of consciousness after a head impact or a whiplash event suggests a likely concussion, necessitating immediate medical attention.
Concussion symptoms are diverse, falling into four broad categories:
- Physical symptoms:
- Persistent headaches
- Balance issues
- Fatigue
- Nausea
- Coordination problems
- Altered sleep patterns (insomnia or hypersomnia)
- Sensory symptoms: These symptoms can impact the five main senses and related senses like balance.
- Light sensitivity (photophobia)
- Visual disturbances (seeing stars, visual snow)
- Blurred or double vision
- Dizziness and vertigo
- Sound sensitivity (phonophobia)
- Night vision troubles
- Eye tracking difficulties
- Convergence disorder (trouble focusing on close objects)
- Mental symptoms:
- Memory loss
- Concentration difficulties
- Mental fog
- Slower cognitive processing
- Behavioral symptoms:
- Irritability
- Depression or sadness
- Anxiety
- Agitation
- Mood swings
- Restlessness
- Thoughts of self-harm or suicide
Immediate action is necessary if you or someone you know experiences thoughts of self-harm or suicide.
Causes
Additional research is necessary to deepen our understanding of the underlying mechanisms responsible for persistent post-concussive symptoms following specific injuries. These symptoms might stem directly from the injury’s impact or potentially trigger other conditions like migraines. Moreover, factors such as sleep disturbances, dizziness, stress, and mental health issues could also play a role in symptom manifestation. Your healthcare provider will work with you to identify the primary cause of your symptoms and suggest suitable treatment approaches.
Risk factors
Developing chronic post-concussive symptoms is associated with risk variables such as:
- Age. There are studies showing that getting older increases the chance of chronic post-concussive symptoms.
- Gender. Persistent post-concussive symptoms are more commonly diagnosed in women, although this correlation may also reflect the higher likelihood of women seeking medical attention in general.
- Head traumas or previous concussions. With each subsequent concussion or head injury, your chance of PCS increases.
- Complications from concussions. PCS is more likely to occur if the concussion results in other issues with your skull or brain. A fractured skull, bleeding within the skull or brain, and midline shift—the brain shifting off-center inside the skull—are a few examples.
- Experiencing other brain-related ailments. Individuals who suffer from learning disabilities or attention-deficit/hyperactivity disorder (ADHD) may be more susceptible to PCS.
- Having a history of problematic behaviors. Anxiety, depression, bipolar illness, and other disorders may also increase a person’s chance of getting PCS.
- An increase in concussion-related symptoms. Early after an incident, experiencing greater concussion symptoms may indicate a higher risk of PCS.
- Severer concussion-related symptoms. You may be more susceptible to PCS if your symptoms are more severe.
Diagnosis
Diagnosing post-concussion syndrome (PCS) involves a multi-faceted approach due to the absence of a singular test that can definitively confirm a concussion. Healthcare professionals rely on a combination of clinical judgment and the evaluation of symptoms to diagnose a concussion and, subsequently, PCS.
The process typically includes the following steps:
- Physical and neurological examination: This initial assessment focuses on your nervous system’s functionality, checking for signs that are indicative of a concussion.
- Medical history and symptom discussion: Your healthcare provider will discuss the injury leading to the suspected concussion and any symptoms you’ve experienced since the incident.
- Imaging scans: Tools like computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, or X-rays are employed. Although they cannot diagnose PCS directly, they are crucial for identifying or ruling out complications such as skull and neck fractures, brain bleeds, and other brain injuries.
For those suspected of having PCS, ongoing monitoring is essential:
- Follow-up visits: Your healthcare provider will likely schedule regular follow-ups to monitor any symptom changes. These appointments may involve repeating tests or revisiting questions to detect subtle changes in your condition.
- Additional tests: Depending on your symptoms and medical history, your provider may suggest other tests to gain a deeper understanding of your condition. These tests are selected based on their potential to provide valuable insights into your symptoms and overall health.
Your healthcare provider will guide you through the recommended tests and explain their relevance to your situation, ensuring a comprehensive approach to managing and understanding PCS.
Treatment
There isn’t a one-size-fits-all treatment plan for managing persistent post-concussive symptoms. Instead, your healthcare provider will tailor the treatment to address your specific symptoms. The nature and frequency of these symptoms can vary greatly from person to person.
Headaches
Medications commonly prescribed for migraines or tension-type headaches have shown effectiveness in treating headaches associated with post-concussion syndrome. These medications may include those typically used for managing depression, high blood pressure, and seizures. However, the selection of medication is typically tailored to each individual’s needs, and you will collaborate with your doctor to determine the most suitable options for you.
It’s important to note that excessive use of pain medication may exacerbate persistent post-concussion headaches. This risk applies to both prescription pain medication and over-the-counter options purchased without a prescription.
Memory and thinking problems.
Currently, there are no prescribed medications for addressing memory and cognitive issues following mild traumatic brain injury. In many cases, the passage of time proves to be the most effective form of therapy, with symptoms typically diminishing naturally within weeks to months post-injury.
Certain types of cognitive therapy may offer assistance, such as targeted rehabilitation aimed at strengthening specific areas of concern. Additionally, individuals may benefit from occupational or speech therapy as needed. Given that stress can exacerbate cognitive symptoms, learning stress management techniques can be beneficial. Furthermore, relaxation therapy may also provide relief.
Depression and anxiety
When patients realize what is causing their symptoms and that they will probably go away with time, their symptoms frequently get better. Knowledge can calm anxieties and promote tranquility.
Following a concussion, some therapeutic options if you’re dealing with new or worsening depression or anxiety include:
- Psychotherapy. Speaking with a psychologist or psychiatrist who has experience treating patients with brain injury might be beneficial in addressing your worries.
- Medications. To help treat anxiety or depression, doctors may prescribe antidepressants or anxiety medications.
