1. Postconcussion Syndrome
by William D. MacInnes, Ph.D., A.B.N.

2. Postconcussion syndrome. What is it?
Physical symptoms
Forgetfulness
Attention span
Slow mental processing
Personality and mood changes
Thought processes

3. What Causes PCS? Brain anatomy and function Rigid Skull Muscular scalp
Membrane layers
Meninges
Dura matter
Pia matter

4. What Goes Wrong?
Neurons
Glia
Synapses

5. How is it Diagnosed?
Brain injury caused by a concussion can not be seen on x-rays or laboratory studies, nor will it always show up during neurological or radiological measures such as EEGs, CTs or MRI scans

6. Complications of PCS
The major complication of PCS is the failure to realize a person has a physical problem related to concussion and that these symptoms can interfere with various functions in daily life

7. Goals of Treatment Manage physical symptoms
Modify home and work activities to reduce stress by decreasing the number of demands

8. Goals of Treatment
The overall goal of treatment is to return the individual to previous roles, relationships and capabilities as early and as easily as possible

9. Diagnostic Recommendations for Postconcussion Disorder
History of head injuries and includes at least 2 of the following:
Loss of consciousness for 5 minutes or less.
Posttraumatic amnesia of 12 hours or more.
Onset of seizures (posttraumatic epilepsy) within 6 months of head injury.

10. Diagnostic Recommendations for Postconcussion Disorder
Current symptoms to include:
At least the following 2 cognitive difficulties:
Learning or memory (recall)
Concentration

11. Diagnostic Recommendations for Postconcussion Disorder
Current symptoms to include:
At least 3 of the following affective or vegetative symptoms:
Easy fatigability
Insomnia or sleep/wake cycle disturbances
Headache
Vertigo/dizziness
Irritability and for progression on little or no provocation
Anxiety, depression, or lability of affect
Personality change
Aspontaneity/apathy

12. Diagnostic Recommendations for Postconcussion Disorder
Symptoms are associated with significant difficulty with maintaining premorbid occupational or academic performance or with a decline in social, occupational or academic performance

13. Previous Research Criteria for Postconcussion Disorder
A history of head trauma that has caused significant cerebral concussion
Evidence from neuropsychological testing for quantified cognitive assessment of difficulty in attention or memory

14. Previous Research Criteria for Postconcussion Disorder
3 or more of the following occur shortly after the trauma and last at least 3 months:
Becoming fatigued easily
Disordered sleep
Headache
Vertigo or dizziness
Irritability or aggression on little or no provocation
Anxiety, depression or affective lability
Changes in personality (e.g., social or sexual inappropriateness)
Apathy or lack of spontaneity

15. Issues with Previous Criteria Defining Postconcussion Syndrome
Setting loss of consciousness at 5 minutes or less is arbitrary
Distinguishing concussion from postconcussion syndrome:
Concussion
Postconcussive disorder
Acute
Subacute
Chronic

16. Does preinjury functioning play a role in development of symptoms?
YES

17. Comorbid features that contribute to symptoms
Neck injuries
Back pain
Vestibular injuries
Chronic pain

18. References
Bigler, E.D. (1990). Traumatic Brain Injury: Mechanisms of damage, assessment, intervention and outcome. Pro-Ed
Fraser, R.T. & Clemmons, D.C. (2000). Traumatic brain injury rehabilitation. CRC Press
Varney, N.R. & Roberts, R.J. (1999). The evaluation and treatment of mild traumatic brain injury. Lawrence Erlbaum Associates

19. THE END