Post-Concussion Syndrome (PCS)
Post-Concussion Syndrome (PCS) is a condition in which concussion symptoms prevail and persist for months or years following a mild traumatic brain injury (mTBI) (Cognitivefx USA, 2020). Post-Concussion Syndrome is usually the result of an injury to the brain caused by a concussive event (i.e. a car accident, sports injury, fall) or whiplash/jolting of the brain.
Pathology of Post-Concussion Symptoms:
When a person experiences an injury to the brain, the cells in the brain are deprived of oxygen interfering with their basic tasks such as signaling. That is why it hard to perform functions such as recalling words, learning new things, and remembering memories, because the cells lack the oxygen to complete the task. Our brain, being the incredible organ that it is, tries to compensate for this by creating alternative neural pathways in an attempt to pass information on or complete signaling. These pathways, however, are often not as efficient or effective as the original pathways, causing the brain to work less efficiently. The lack of efficient signaling still feeds the brain deoxygenated blood. This causes problems for the brain that may last months or even years (Cognitive FX USA, 2020).
Multiple concussions or head trauma, early symptoms of headache after injury, mental changes, being female, and being of older age are all risk factors of developing PCS (WebMD). Because of this, it is not fair to call it a syndrome, which denotes that it is not understood. We know what it is and where it stems from, so why are so many people still struggling with post-concussion symptoms (PCS)? It is simply because no two brain injuries are alike.
Common Post-Concussion Symptoms:
Common post-concussion symptoms include headaches, dizziness, poor concentration, irregular sleep
patterns, changes in mood, and so much more.
Other common symptoms are:
- Vision problems
- Light sensitivity
- Sleep disturbances
- Difficulty exercising
- Brain fog
Oftentimes these symptoms last longer than the three month period that most medical professionals believe it takes to recover from a concussion. Because no concussion or brain injury is alike, symptoms specific to one person may deviate from the norm, making it harder to treat and therefore diagnose. In addition, these symptoms may have a compounding effect, in which they cause other symptoms i.e. sleep disturbances causing depression and/or anxiety. If you have long term persistent PCS, your brain cannot heal without first addressing the cause of the problem (i.e. the TBI) and not just managing the symptoms.
Post-Concussion Symptoms Diagnosis:
Diagnosis is difficult for PCS because symptoms can be vague, commonplace, or attributable to other reasons (WebMD). Signs such as loss of consciousness are often mistakenly related to PCS, when in fact over 90% of concussion of patients do not experience a loss of consciousness (Cognitivefx USA, 2020). As of right now, there is no one definitive test for PCS. Diagnosis is made on the basis of prior head injury, a physical exam, CT scan or MRI, or other causes such as infections or bleeding on the brain (WebMD). CT scans and MRIs are often used to identify or rule out structural abnormalities, but they cannot detect the presence of post-concussive injury to the brain.
Post-Concussion Symptoms are diagnosed using the following methods:
- SCAT2: short for Sport Concussion Assessment Tool 2, is used to diagnose concussions using clinical expertise, description or symptoms, and an in-person examination
- PCSS: short or Post-Concussion Symptoms Scale, where symptoms are rated on a scale of 0 to 6, with 6 being the most severe
- Physical Evaluation: apart of the SCAT2 diagnostic test that evaluations physical symptoms and responses such as reflex response, vision tracking, state of consciousness, balance, and hand-eye coordination
- Cognitive Evaluation: a part of the SCAT2 evaluation that focuses on the ability to focus and remember (immediate and delayed recall)
- CT Scan: Computerized Tomography is used to rule out other causes of symptoms such as structural damage or tumors
- MRI: Magnetic Resonance Imaging shows soft tissue and can confirm whether or not the brain is intact, strokes, aneurysms, tumors, bleeding in the brain, etc. It cannot definitively diagnose PCS but rules out other issues
- EEG: information from an EEG can support the PCS diagnosis because it measures the electrical activity coming from the brain. It, however, can be inaccurate if the damage is not near the scalp. If the damage is closer to the skull, then there is better information regarding the electrical activity, so an EEG can indicate a problem but not where or what it is
- Baseline Testing: a test that mainly athletes take to determine their pre-injury cognitive abilities. This information is helpful to compare a pre- and post-test result by tracking for weeks to determine if the impact had any effects
- fNCI: Functional Neurocognitive Imaging is an excellent method to confirm PCS because it takes before and after fNCI scans that show exactly which regions of the brain were affect by a traumatic injury. More importantly, it allows the quantification of improvement after treatment and gives a targeted recovery plan.
- Biomarkers: Biomarkers in addition to fNCI are crucial for accurately diagnosing PCS. Five biomarkers (Attentional, Subcortical Visual, Language, and Executive) are evaluated for PCS. Four percent of suspected PCS patients meet all five, 43% meet four, 88% meet three, and 100% meet at least two. This is compared to non-concussed people where 95% meet only one or none at all, meaning it is important to a diagnosis (Cognitivefx USA, 2020). A study from 2020 by the National Institutes of Health even confirms that neurofilament light chains as blood biomarkers can detect traumatic brain injury and predict recovery in patients (National Institutes of Health, 2020).
Treatment of Post-Concussion Symptoms (PCS):
Treatments for PCS include:
- Natural Remedies
Most patients are just told to rest or given medications that just deal with symptoms instead of the underlying functional issue. It is important that post-concussive patients be given more options and ways to manage their condition without being reliant on medications that do not treat the condition in its entirety.