Postconcussion syndrome (PCS) in the emergency department: predicting and pre-empting persistent symptoms following a mild traumatic brain injury

Abstract

Head injuries across all age groups represent an extremely common emergency department (ED) presentation. The main focus of initial assessment and management rightly concentrates on the need to exclude significant pathology, that may or may not require neurosurgical intervention. Relatively little focus, however, is given to the potential for development of post-concussion syndrome (PCS), a constellation of symptoms of varying severity, which may bear little correlation to the nature or magnitude of the precipitating insult. This review aims to clarify the aetiology and terminology surrounding PCS and to examine the mechanisms for diagnosing and treating.

Posttraumatic Headache in Concussed Young Adult Athletes

“…Concussions can and do occur across the continuum of care from infancy to the elderly. 7 However, the largest proportion of concussions occurs in young adult athletes in organized sports. 1 According to the International Conference in Sport a concussion is defined as a complex pathophysiological process that alters brain functioning, including: focal neurological deficits, alteration in mental state, ante grade or retrograde amnesia, or any period of loss of consciousness by either direct or indirect external force.…”

“…Unnecessary diagnostic tests are commonly completed on concussed athletes leading to delay and potentially incorrect diagnosis. 7,9 Undiagnosed, underreported, or delayed diagnoses of concussions are common occurrences in the United States increasing associated costs among healthcare systems. 9 Concussions and symptoms following predominately PTH are unidentifiable or not visualized using common neuro imaging such as a computerized tomography (CT) scan 3 consequently increasing time to diagnosis and cost to the healthcare system.…”

“…6 Currently there are arguably different definitions of what constitutes a concussion among health professionals and across specialties. 7 Concussions are not limited by demographic factors such as sex, age, race, or ethnicity. Concussions can and do occur across the continuum of care from infancy to the elderly.…”

“…The most common of these protracted symptoms commonly found in concussed athletes and post concussive syndrome is posttraumatic headache. 7 Identification of this population in order for primary prevention strategies to be implemented is the initial step to improve outcomes and decrease the burden of disease. 11 Interventions aimed at primary prevention include recognition, education, pre-season neuro cognitive testing, and increasing awareness at both the high school and college levels in both male and female collegiate sports.…”

Detection of Subtle Cognitive Changes after mTBI Using a Novel Tablet-Based Task

“…A tool such as this also may be critical in differentiating conditions, evaluating interventions, or identifying other laboratory biomarkers that may improve outcome and recovery in patients suffering from concussion. 15 Although current standard neuropsychological methods of concussion assessment have been validated and remain clinically useful, they often lack the sensitivity to immediately detect or distinguish subtle functional deficits due to injury. 4,16 Primary limitations of these evaluations include the subjectivity in selfreporting, practice effects, and administrator reliability, as well as cultural, second language, and educational influences.…”