Which clinical history findings are characteristic 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

Most patients present shortly after a minor head injury (MHI). Often, patients return after a previous evaluation in the emergency department (ED) because of persistent postconcussion symptoms. [6] Findings may include the following:

  • Headache - This is the most common symptom of PCS. The specific type is variable. One study found a prevalence of persistent posttraumatic headache in 15.3% of patients with minor head injury compared to 2.2% of matched minor injury ED controls. [22]

  • Cranial nerve symptoms and signs - Dizziness (the second most common symptom), vertigo, nausea, tinnitus, blurry vision, hearing loss, diplopia, diminished sense of taste and smell, light and noise sensitivity

  • Psychological and neurovegetative problems - Anxiety, irritability, depression, sleep disturbance, change in appetite, decreased libido, fatigue, personality change

  • Cognitive impairment - Memory impairment, diminished concentration and attention, delayed information processing and reaction time

Tator and Davis performed a retrospective cohort study of 138 patients who had sports-related postconcussion syndrome (PCS) based on three or more postconcussion symptoms lasting 1 month or longer. The patients averaged 3.4 concussions, ranging from 1 to more than 12. Over 80% of the PCS patients had at least one previous concussion, and only 19.6% had no previous concussion. In 21% of patients, the authors identified a history of a previous psychiatric condition, attention-deficit disorder or attention-deficit/hyperactive disorder, learning disability, or previous migraine headaches. [23]


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