What is the prognosis of postconcussion syndrome (PCS)?

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

True prognosis is difficult to define given that many patients with minor symptoms may not enter the health care system and those that participate in research appear to have more significant symptoms at baseline. In addition, a wide heterogeneity exists in patients enrolled in studies.

Most patients recover fully in less than 3 months, although some small studies suggest persistence of minor cognitive defects for asymptomatic minor traumatic brain injury patients. [17]

Approximately 15% of patients complain of problems more than 12 months after injury. This group is likely to experience persistent and intrusive symptoms that may be refractory to treatment and impose a lifelong disability.

At least one study found the persistence of dizziness as a symptom seemed to portend a longer and more significant symptom complex. [18] Other studies found the depression, pain, and symptom invalidity were correlated with longer and worse symptoms. [19] Another found patients with early clinical symptoms, such as headache, dizziness, and intracranial lesions were more likely to have persistent PCS.

PCS is commonly associated with multiple concussions, but in one series, 23.1% of patients experienced PCS after only 1 concussion (average was 3.3 concussions). Median duration of symptoms in this series was 7 months. [20]

Hiploylee et al found that time to recovery often depended on the number of initial symptoms reported, with each symptom reducing recovery rate by about 20%. They also found that PCS may be permanent if recovery hasn't occurred withiin 3 years. Those who did not recover were more likely to be noncompliant regarding the recommendation to not return to play. [21]


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