Which clinical history findings are characteristic of postconcussive syndrome (PCS)?

Updated: Jul 25, 2019
  • Author: Roy H Lubit, MD, PhD; Chief Editor: David Bienenfeld, MD  more...
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Rapid improvement of head injury typically occurs within the first 6 months and often continues for 18 months. Problems continuing after 18 months usually continue indefinitely. Headache, dizziness, memory impairment, and fatigue are present in 30-50% of people during the first month after a mild head injury. In a prospective study of mild CHI conducted in Belfast, these symptoms disappeared within 6 months in 52% of cases and persisted in 16%. Of survivors, 32% reported a worsening of symptoms between 6 weeks and 6 months.

Significant functional impairment, marked by unemployment and marital dysfunction, typically accompanies postconcussive syndrome. In research populations, involvement in litigation plays a relatively small role in either the genesis or the resolution of patients' complaints.

Patients treated for sequelae of head injury should be screened for the development psychiatric [11] or neurologic problems, including the following:

  • Irritability

  • Sleep problems

  • Concentration and attention issues

  • Headaches

  • Dizziness

  • Apathy and depression: Rates of apathy have been assessed to be occur in 23-71% of patients; it results from disruption of frontal-subcortical pathways. Apathy can be measured by the Apathy Evaluation Scale (AES) and Apathy sub-scale of the Frontal Systems Behavior Scale (FrSBe-A)

  • Anxiety disorders, such as panic disorder, agoraphobia, and generalized anxiety

  • Impulsivity and social inappropriateness

  • Seizure disorder

  • Suicide risk

  • Homicide risk: Because of their impulsivity and impatience, persons with head trauma can be combative to others, including family members and caregivers.

Standard rating scales, especially the Hamilton Depression Rating Scale and the Positive and Negative Symptom Scales, are sometimes useful.

Also inquire about subsyndromal complaints and nonspecific somatic distress, especially fatigue and headache. These, along with irritability, anxiety, apathy, and dysphoria, are cardinal features of postconcussive syndrome. Seizure phenomena, especially partial-complex seizures, should be explored specifically.

The nature and severity of head trauma affect the nature and severity of sequelae. Obtain information from patients and usually from their hospital records about the injury, the immediate sequelae including unconsciousness and seizures, and the medical treatment received. [17, 18]

Neuropsychological testing is the most sensitive means of characterizing the cognitive deficits of survivors of head injury.

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