Post Concussion Syndrome

May 6

What is post-concussion syndrome (PCS)?

PCS or post-concussion syndrome is a condition that occurs when the symptoms of a concussion last longer than the typical recovery times of a concussion. Normally, concussions last from weeks to months, however with PCS symptoms can last from half a year to years.

PCS can develop from any injury that can cause a normal concussion. This means it can result from a car accident (or any other motor vehicle accident), bicycle accidents, whiplash, contact sports (football, hockey, soccer), workplace injuries, or slips and/or falls.

It is believed that PCS is the result of both psychological and physiological origins. Pre-morbid, injury-related, and post-morbid psychological and neurological factors may affect the prognosis of PCS following a mild traumatic brain injury.

What factors increase the risk of PCS?

As mentioned above, post-concussion syndrome can be affected by factors outside of the MTBI. These factors include:

Previous history of multiple concussions
Previous psychiatic conditions (ie. anxiety or depression)
High severity of symptoms during initial onset
Younger age
Longer duration of Amnesia
Longer duration of unconsciousness at initial injury

“Whiplash injuries are the second most common cause of PTHA.”

— Barnat

How do I know if I have post-concussion syndrome?

Post concussion syndrome can occur following any type of head injury leading to a concussion. Symptoms typically include the same ones experienced during a concussion but may also progress to PCS symptoms.

The symptoms experienced can be placed in two categories: Early-phase and Late-phase. Early-phase posttraumatic disorder usually includes acute symptoms such as headache, dizziness, imbalance, fatigue, sleep impairment, decreased cognition, photophobia and phonophobia. Late-phase posttraumatic disorder includes somatic, emotion and cognitive symptoms and is influenced by psychosocial factors (and less on the brain injury).

Some symptoms experienced by patients include (in no particular order):

Headaches
Insomnia
Tinnitus
Irritability
Fatigue
Memory problems
Anxiety
Depression
Sensitivity to noise
Dizziness
Concentration problems
Confusion
Loss of libido
Nightmares
Visual Disturbances

If these symptoms are experienced following a head injury it will be important to contact your neurologist and psychologist to assess the extent of your injury. Paramedical services such as chiropractic or physiotherapy can be a great adjunct for assessing related physical symptoms and for managing associated secondary injuries.

How do you treat post-concussion syndrome?

Treatment success will require consideration for contributing factors and comorbidities. A complete treatment will include the management of depression, anxiety, headache, musculoskeletal pain, vertigo, and insomnia. A collaborated effort between health care practitioners is ideal. Generally consulting your medical doctor, neurologist, psychologist, and physiotherapist/chiropractor is recommended to address different aspects of PCS. Additionally guided aerobic exercise is beneficial for early and late phase post-concussion syndrome.

To contact a Markham physiotherapist or Markham chiropractor at Rehab Hero for your PCS you can click the button below.

How long does post-concussion syndrome usually last?

Post-traumatic headaches or PTHA can last anywhere from six months to many years. These types of headaches are common aftereffects after suffering from a concussion. MTBI or mild traumatic brain injuries increase the risk of PTHAs by ~40-60%. Due to the mild symptoms, these injuries can be under diagnosed as they can be too subtle to be diagnosed through tests.

Is post-concussion syndrome permanent?

Unfortunately, PCS can sometimes be permanent and lead to disability. Treatment can help to resolve or improve symptoms but may require a multidisciplinary effort to address the different contributing factors. One longitudinal study (3) on 285 patients revealed that PCS may be permanent if recovery has not occurred by 3 years, however authors do agree that more long-term follow-up studies are required.

Can an MRI detect post-concussion syndrome?

MRI can be helpful in diagnosing PCS. However, research shows that structural lesions on MRI may not always be present in those with PCS. A study by Panwar J et al. found that only 22% of PCS patients showed significant changes on MRI compared to the control group. That said, a review by Biagianti B et al. had found that MRI findings correlated with severity of PCS symptoms.

These findings suggest that MRI can be useful in assessing the severity of PCS if it is present on MRI. However since structural lesions are not always seen on MRI, a clinical examination may also be required to diagnose post-concussion syndrome.

Written By:

Dr. David Song, Chiropractor, Rehab Coach

References

Dwyer B, Katz DI. Postconcussion syndrome. Handb Clin Neurol. 2018;158:163-178. doi: 10.1016/B978-0-444-63954-7.00017-3. PMID: 30482344.
Ryan LM, Warden DL. Post concussion syndrome. Int Rev Psychiatry. 2003 Nov;15(4):310-6. doi: 10.1080/09540260310001606692. PMID: 15276952.
Hiploylee C, Dufort PA, Davis HS, Wennberg RA, Tartaglia MC, Mikulis D, Hazrati LN, Tator CH. Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers. J Neurotrauma. 2017 Apr 15;34(8):1511-1523. doi: 10.1089/neu.2016.4677. Epub 2016 Nov 29. PMID: 27784191; PMCID: PMC5397249.
Datta SG, Pillai SV, Rao SL, Kovoor JM, Chandramouli BA. Post-concussion syndrome: Correlation of neuropsychological deficits, structural lesions on magnetic resonance imaging and symptoms. Neurol India. 2009 Sep-Oct;57(5):594-8. doi: 10.4103/0028-3886.57810. PMID: 19934558.
Biagianti B, Stocchetti N, Brambilla P, Van Vleet T. Brain dysfunction underlying prolonged post-concussive syndrome: A systematic review. J Affect Disord. 2020 Feb 1;262:71-76. doi: 10.1016/j.jad.2019.10.058. Epub 2019 Nov 4. PMID: 31710931; PMCID: PMC6917917.
Panwar J, Hsu CC, Tator CH, Mikulis D. Magnetic Resonance Imaging Criteria for Post-Concussion Syndrome: A Study of 127 Post-Concussion Syndrome Patients. J Neurotrauma. 2020 May 15;37(10):1190-1196. doi: 10.1089/neu.2019.6809. Epub 2020 Jan 31. PMID: 31822164.