Post-concussive syndrome

Background

• Definition: Concussion symptoms that continue beyond the expected 7-10d recovery period
  • Patients with more severe symptoms on initial presentation may be more at risk
  • History of migraine, depression, anxiety also a possible risk factor

Clinical Features

• Headache
• Dizziness
• Decreased concentration
• Memory problems
• Sleep disturbance
• Irritability
• Fatigue
• Visual disturbances
• Judgment problems
• Depression
• Anxiety

Differential Diagnosis

Head trauma

• Traumatic brain injury
  • Intracranial hemorrhage
    • Intra-axial
      • Traumatic intracerebral hemorrhage
    • Extra-axial
      • Epidural hemorrhage
      • Subdural hemorrhage
      • Subarachnoid hemorrhage
  • Moderate-to-severe traumatic brain injury
    • Elevated intracranial pressure
  • Mild traumatic brain injury
    • Clinical decision rules for head CT in trauma
    • Post-concussive syndrome
• Orbital trauma
• Maxillofacial trauma
• Scalp laceration
• Skull fracture
  • Basilar skull fracture
  • Skull fracture (peds)
• Pediatric head trauma
  • PECARN head trauma rule

Evaluation

• Neuropsychological testing
• Symptom checklist

Management

• Symptomatic management is mainstay of therapy
• Avoid re-injury

Disposition

• Discharge
  • Refer to TBI clinic or neuropsychologist, if available

See Also

• Head trauma (main)
• Mild traumatic brain injury (Concussion)