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What is Post Concussion Syndrome and How Can You Improve Your Situation

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What if the symptoms from your head injury linger for months or even years?  What is the best way to improve someone’s quality of life after suffering from a traumatic brain injury?


Head injuries and their associated symptoms can be confusing. The hardest part is quickly determining how severe the damage is, the proper course of treatment, and if a medical professional is needed.


Because of this, most people have struggled to apply a proper course of treatment to themselves or their loved ones, allowing for the possibility of lingering symptoms.


Many parents know the feeling of taking their child to the doctor with head trauma and how scary it is. In most cases, doctors examine the child, make sure they don't have a fractured skull or a cerebral bleed, and then prescribe things like ice, pain medications, and rest, leaving the parent wondering if they're doing enough. 


In this article, we're discussing one of the most common complications of a head injury. It is called post-concussion syndrome and often leads to long-lasting consequences that we want to avoid at all costs. That's why we're tackling this problem head-on and giving you helpful advice on what to do to help improve your situation.


What is Post Concussion Syndrome (PCS)?

Post-concussion syndrome is a set of cognitive, physical, behavioral, and emotional symptoms that arise after a concussion and last for an extended period. Unlike usual concussion symptoms, post-concussion syndrome is not just limited to a few days. It can take several weeks, months, or even years to fully recover.


A syndrome is a constellation of symptoms that usually appear under similar circumstances. Syndromes can be experienced differently in two patients, and not all symptoms will show up at once. The variability often makes a syndrome more challenging to study compared to a well-known and limited ailment such as type 2 diabetes. Thus, some details of post-concussion syndrome are still elusive to modern science (1).


Is PCS permanent?

Someone experiencing post-concussive syndrome would likely feel helpless because their symptoms do not improve after a certain amount of time. However, that doesn't mean that PCS is permanent. Although it takes longer than usual to recover, some symptoms can go away faster than others. In other words, particular symptoms improve while others do not resolve completely. For example, a patient can have headaches for 3 months, insomnia for 4 months, and sleep disturbances and dizziness for 6 months. After experiencing a full recovery of those symptoms, they may continue to notice difficulties in learning and recalling memories. That is why many patients can experience an impact on their quality of life and have significant impairments in their cognitive and emotional capacities months after the initial injury(2).


What causes Post-Concussion Syndrome?

Every concussion, from mild to severe, has the potential to lead to post-concussion syndrome. These concussions are often caused by direct head trauma after a fall, a car wreck, a blow on the head, or a sports-related injury.


If the person is fully conscious after the injury and has somewhat “normal” cognitive function, the concussion severity will be ruled a mild traumatic brain injury. Following a CT scan, the doctor can determine how complicated the head injury is by the abnormalities of the results. 


Patients with a concussion AND macro injury such as fractures, hematomas, or a subarachnoid bleed have a higher chance of post-concussion syndrome due to their severity. According to the available data, repeated head trauma can also cause post-concussion syndrome, even if they are not very severe or complicated.


Thus, the cause of post-concussion syndrome is not always related to the severity of the lesion. Instead, it is a combination of metabolic changes and structural injuries in the brain arising after a very severe impact, or building up over time in mild but repeated head trauma. 


According to studies, brain damage in PCS occurs in the white matter and the autonomic nervous system, causing long-lasting effects in cerebral blood flow, concentration, blood pressure, exercise tolerance, balance, and more (1,3).


What are the symptoms of PCS?

PCS symptoms are very similar to those experienced immediately after a concussion. The main difference is the prolonged time frame. Typical concussions from a mild traumatic brain injury are limited to hours, days, or a few weeks. In contrast, patients with post-concussion syndrome still have symptoms after several months, to years. According to some sources, it only takes 1 month with persisting symptoms to start suspecting a case of PCS.


As noted above, PCS patients have alterations to their autonomic nervous system. Thus, they can have symptoms such as (1, 2):

  • Difficulty in concentration

  • Confusion

  • Dizziness

  • Headache

  • Vision changes

  • Early fatigue and exercise intolerance

  • Worsening of the symptoms when changing posture (orthostatic intolerance)


Other symptoms not related to the autonomic nervous system include:

  • Depression

  • Irritability

  • Mood changes

  • Personality changes or apathy

  • Sleep disturbances


These are residual symptoms after traumatic brain injury has resolved, and detecting them requires time and careful follow-up. In most cases, the diagnosis for post-concussion syndrome will need at least three of the symptoms listed above.


Is PCS common, and can you test for it?

Certain aspects of PCS are still elusive, and there is not a single standardized way to diagnose the syndrome. Instead, there are two branches, each diagnosing the disease differently: 

    1) DSM-IV 

    2) International Classification of Diseases 10th revision (1). 


Both methods give varying results, and the incidence is often affected by what approach the doctor is following. Thus, the reported incidence of PCS can range from 30% to 80% of patients enduring a concussion, depending on the method used.


PCS is mainly a clinical diagnosis, and the evaluation is based on the signs and symptoms listed above and the doctor's experience working with others who have been affected. There is not a devoted test to rule out PCS. However, CT scans, vestibular-ocular motor screening, cranial nerve, balance, and mental status assessments can be used depending on each case. Imaging studies are often used to rule out specific causes triggering the symptoms instead of PCS (4).


PCS Risk Factors – Why Do Some People Have It And Others Don't

One would expect that only a patient with very severe head trauma will develop a post-concussive syndrome. However, this is not always the case. Some people can have a PCS after a relatively mild event, while others recover promptly and without sequela after more severe trauma.


Some people do have risk factors that may increase their likelihood of suffering from PCS:

  • Complicated traumatic brain injury: As noted above, patients with hematoma, hemorrhages, fractures, and other complications are at a higher risk of PCS. These complications are typically found in severe head trauma, but some mild cases may also develop similar complications.

  • Female gender: Most statistical analyses show that women are at a higher risk than men for PCS. Neck strength could contribute to a higher rate of symptom reporting for females(5). 

  • Older age: Older adults are more likely to have lasting neurologic sequela after a concussion. They experience loss of consciousness for a longer time, which is by itself a symptom of a bad prognosis (6).

  • Psychiatric history: Patients with a psychiatric history are more likely to suffer from PCS. That includes patients with depression, anxiety disorders, schizophrenia, and other neuropsychiatric conditions (1).

  • Repeated head trauma: The metabolic changes and structural brain damage can build up over time. Thus, a previous concussion increases PCS risk, especially if there are multiple concussion events (7).


PCS Treatments and Recovery

Management of PCS is individualized because each person experiences the syndrome differently. Depending on the individual’s complaints, supportive therapy is initiated to relieve their symptoms or provide different options and solutions.

PCS treatment should start immediately after a concussion, especially in patients considered at risk, as described above. Cognitive and physical rest is recommended for one or two days in most cases, and then patients are prompted to gradually go back to their baseline activities. 


Additional treatments include (1):

  • Upper cervical care: In severe head trauma, car wrecks featuring a whiplash syndrome, and similar instances, upper cervical care should be promptly established. Immobilization is fundamental in the early post-concussive stage. After that, physical therapy is required to recover neck strength and mobility. Upper cervical care is also essential in cases of recurrent headaches, usually triggered by neck damage.

  • Physical Therapy: A physical therapist will be assigned to patients with severe symptoms to achieve a gradual recovery of their motor function when it is compromised. In many cases, the cause of PCS is related to vestibular-ocular damage. Thus, vision therapy and vestibular therapy are both critical for patient recovery. Vision therapy aims to improve gaze stability, eye coordination, and other motor parameters. Vestibular therapy is helpful to reduce vertigo and balance, improving gait stability and speed (8,9).

Additionally, we can adopt measures from day one to prevent PCS and other long-lasting complications. They include:

  • Dietary recommendations: One of the causes of PCS is a metabolic change in the brain. There is ongoing inflammation that affects the autonomic branch of the central nervous system and other brain structures. Thus, a diet with anti-inflammatory nutrients will be helpful to prevent long-term consequences from day one after head trauma. The Mediterranean diet is an excellent example of an anti-inflammatory diet, including fresh foods, fish, nuts, and seeds. It is also essential to reduce the consumption of inflammatory foods such as sugar, red meat, processed food, and saturated fats (10).

  • Inflammation-fighting supplements: In addition to nutritional recommendations, we highly recommend the anti-inflammatory properties of certain supplements. For example:

    • CoQ10: Coenzyme Q10 is a substance naturally synthesized in the mitochondria. It is a potent antioxidant and has anti-inflammatory properties. It reduces brain inflammation and oxidative stress (11).

    • DHEA: The full name is dehydroepiandrosterone. The body also produces this substance naturally, this time in the adrenal glands. DHEA provides a potent anti-inflammatory activity in the brain because it works similarly to a steroid. Having normal levels of this vital supplement prevents mood swings and cognitive problems (12).

    • Alpha-lipoic acid: Several studies have evaluated the effects of alpha-lipoic acid in brain injury, stroke, subarachnoid hemorrhage, and other ailments. It shows promising therapeutic potential as a neuroprotectant to prevent edema and brain injury (13, 14).

    • Curcumin: This herb contains a very important anti-inflammatory known as turmeric. According to studies, turmeric restores neuroplasticity and membrane function after a concussion. Thus, it helps patients recover their cognitive function, avoiding long-term PCS consequences (15).

    • Fish oil: This supplement is an excellent source of omega 3, a healthy fat with tremendous anti-inflammatory potential. Studies show that omega 3 fatty acids maintain gene stability in the neurons and brain homeostasis after enduring a concussion (15).

    • Resveratrol: This is the anti-inflammatory substance that makes wine a healthy pick in the Mediterranean diet. It has a neuroprotective effect and increases nerve cell survival after a concussion (16).

  • Return to light physical activity: When it is safe to do so, patients should gradually go back to their baseline activities. If they were sedentary before their accident, they should start engaging in light physical activity. Studies show that an earlier return to activity is associated with faster improvements. However, remember safety measures, get clearance by your doctor, and only engage in low-level exercise during the recovery period (1).


Who to See for PCS?

As you can see from this article, post-concussion syndrome is much more than head trauma and temporary dizziness. It is often a complex problem to treat, and only a licensed professional should handle these cases.


We recommend going to the neurologist or a concussion specialist. Depending on your case, you might also require the assistance of a physiatrist or a neuro-rehabilitation specialist.


Above all, health literacy is critical, and we encourage you to continue educating yourself about concussion and post-concussion syndrome. Be sure to ask your doctor whenever you have questions and concerns. Remember that we can experience this syndrome differently, and management should be individualized to each patient.


Conclusion

Post-concussion syndrome is a set of cognitive, emotional, behavioral, or physical symptoms that do not resolve after a few days or weeks after a concussion. It includes dizziness, headaches, irritability, personality changes, memory impairments, and other symptoms that still linger after the recovery period has ended.


These patients need specialized medical attention because PCS is a complex etiology that requires supportive therapy. You may need to undergo imaging tests to rule out other diagnoses and start with supportive treatment, depending on your symptoms.

To prevent PCS and contribute to your recovery, you should eat a healthy diet with anti-inflammatory nutrients, take anti-inflammatory supplements to stop the damage, and engage in low-level exercise when your doctor considers it is safe. 

References:

  1. https://www.ncbi.nlm.nih.gov/books/NBK534786/
  2. https://www.tandfonline.com/doi/abs/10.3109/02699052.2011.558042
  3. https://content.iospress.com/articles/neurorehabilitation/nre00708
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384826/
  5. https://pubmed.ncbi.nlm.nih.gov/11483453/
  6. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/EF1FEB417F6C3AC2D9CAC326114FC2E8/S0317167118003220a.pdf/div-class-title-age-gender-and-mechanism-of-injury-interactions-in-post-concussion-syndrome-div.pdf
  7. https://pubmed.ncbi.nlm.nih.gov/23753087/
  8. https://journals.lww.com/optvissci/Abstract/2017/01000/Vision_Therapy_for_Post_Concussion_Vision.11.aspx
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435903/
  10. https://www.xiahepublishing.com/m/ArticleFullText.aspx?sid=2&jid=2&id=10.14218%2FERHM.2017.00029
  11. https://www.sciencedirect.com/science/article/abs/pii/S1383576918303453
  12. https://www.sciencedirect.com/science/article/abs/pii/S0960076014000983
  13. https://www.tandfonline.com/doi/abs/10.1080/10715760902988843
  14. https://pubblicazioni.unicam.it/retrieve/handle/11581/405815/84608/Inflammation Research%2c 2017%2c 66%2c 11%2c 947%E2%80%93959 Tibullo et al..pdf
  15. https://journals.lww.com/acsm-csmr/fulltext/2016/01000/the_role_of_nutritional_supplements_in_sports.9.aspx
  16. http://s3.amazonaws.com/ClubExpressClubFiles/132320/attach/1933841_1_Ashbaugh_2016_Role_of_Nutritional_Supplements_in_Sports_Concussion_Treatment.pdf

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