How is postconcussion syndrome (PCS) diagnosed?

Updated: Sep 24, 2018
  • Author: Eric L Legome, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

The ICD-10 criteria include a history of traumatic brain injury (TBI) and the presence of 3 or more of the following 8 symptoms: (1) headache, (2) dizziness, (3) fatigue, (4) irritability, (5) insomnia, (6) concentration or (7) memory difficulty, and (8) intolerance of stress, emotion, or alcohol.

According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), postconcussion syndrome is given a diagnosis of either major or mild neurocognitive disorder (NCD) due to TBI. [4] The DSM-5 criteria for neurocognitive disorder due to TBI include the following:

  • Evidence of traumatic brain injury: impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull with any of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, neurologic signs such as new onset of seizures, anosmia, or hemiparesis.
  • The neurocognitive disorder presents immediately after the occurrence of the TBI or immediately after recovery of consciousness and persists past the acute post-injury period.

Findings may include headache; cranial nerve signs and symptoms such as dizziness, vertigo, and nausea; psychological and neurovegetative problems such as anxiety, depression, or sleep disturbance; and cognitive impairment such as memory loss and decreased ability to concentrate. [6]

Imaging modalities such as MRI, SPECT, and MEG have been shown to be more sensitive than CT at detecting brain injuries associated with postconcussion syndrome.

Patients with the symptom constellation consistent with postconcussion syndrome require thorough physical and neurological examinations. A CT scan should be obtained if significant concern about intracranial hemorrhage exists.

See Pediatric Concussion and Other Traumatic Brain Injuries, a Critical Images slideshow, to help identify the signs and symptoms of TBI, determine the type and severity of injury, and initiate appropriate treatment.


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