Which neurologic exam 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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Answer

Neurologic examination should include special attention to the following:

  • Cranial nerves: Anosmia stems from damage to the olfactory tracts, confirming injury to the limbic system. Visual-field mapping may identify damage to the optic nerves. Nystagmus may reflect subtle labyrinth injury.

  • Weakness: Hemiparesis may reflect diffuse axonal injury (DAI).

  • Cerebellar signs include dysmetria and nystagmus.

  • Signs of parkinsonism, including tremor, cogwheeling, and abnormal gait, confirm damage to the basal ganglia.

  • Mental status examinations should be conducted repeatedly, with the date and time carefully noted, to follow changes over time.

  • Mental status:

    • Orientation: Patients with postconcussive syndrome may or may not be oriented to time and place. Disorientation is a very serious sign.

    • Appearance: Grooming and hygiene are usually intact, but in severe cases self-care declines.

    • Affect and mood: Depression, anxiety, labile mood, irritability or apathy may be present.

    • Speech: Fluidity may be impaired.

    • Concentration: Concentration is often significantly impaired.

    • Memory: Short-term memory and ability to learn new things is often impaired. Remote memory is intact.

    • Psychomotor activity: Patients are often slowed up but could be agitated from lack of control and stress.

    • Energy: Patients are easily fatigued.

    • Sleep: Patients are often disordered.

    • Headache: Headache is often present.

    • Dizziness or vertigo: Dizziness or vertigo is often present. [19]

    • Suicidal ideation: Suicidal ideation is a significant consideration in severe cases.

    • Homicidal ideation: Homicidal ideation is not typically associated with patients with postconcussive syndrome.

    • Delusions and hallucinations: Delusions and hallucinations are not part of the syndrome.

    • Comprehension: Comprehension may be impaired in severe cases.

    • Insight: Insight is variable.

    • Judgment: Patients with postconcussive syndrome may have impaired judgment from impaired cognitive abilities.


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