What is Post Concussion Syndrome?

There you were, travelling along and suddenly everything changes. There is a gap in your memory - and you wake up to find that you've been in an accident, and people are all around, asking if you are all right. Of course you want to panic, you aren't quite sure how it all happened, and you are in pain. You are taken to the hospital, and after lots of tests they send you home with some pain medication. You go to bed hoping that things will be better tomorrow.

But things aren't better the next day, in fact they seem worse, as your head is aching and you feel dizzy and unwell. You struggle to go and see your local doctor, and they tell you that you have had a concussion.

Now that's probably a bit surprising, isn't concussion something that boxers and footballers get? Well, that's not the only way you get it - it happens in all sorts of accidents (cars & other vehicles, falling off bikes or horses, being hit in the head etc). So what is it? Basically its an alteration of mental state following a blow to the head.

The early symptoms include:

• headache

• dizziness

• vomiting

• nausea

• drowsiness

• blurred vision

These are often thought of as "acute" meaning that ordinarily they get better in a short time (usually about two weeks). So the usual advice is to take a couple of weeks to rest and recover. At this stage lots of people recover and go back to their usual lives.

However, sometimes people don't just bounce back, they go on to develop further symptoms. Researchers estimate variable numbers, but overall it seems that about 10-15% of people go on to develop symptoms, which can include:

• irritability

• anxiety

• depression

• poor memory

• impaired concentration

• insomnia

• fatigue

• visual and auditory complaints

That’s when things get uncomfortable - people start to worry about whether they will ever get better, maybe the injury was more serious than everyone is saying - and that keeps them awake at night. Even though they might have been told that the brain scan was clear, they are still concerned. That becomes a cycle of worry that makes things worse again. This is is often referred to as a Post Concussion Syndrome (PCS).

This is where a neuropsychologist can help. On the brain scan the doctors looked at structure, we can look at function of the brain. We can do tests to see if cognitive skills are impaired - so we test memory, concentration, thinking, speed of responding and problem solving. The great thing about this is that it is objective - we compare how people perform to data from thousands of others collected in a scientific manner. If there are cognitive problems, we will give suggestions for ways to manage them. If there aren't problems, then it's good news, and one less thing to worry about.

The other thing we can do is look at mood and how people are coping. Often as the situation wears on, mood can deteriorate. With all those unanswered questions, it is understandable. However, the great thing is that the international research literature clearly shows that intervening early with good quality psychological treatment can help improve outcome for people with PCS. This is a chance to learn strategies to manage thoughts and feelings (especially under stress) to lead to recovery.

So, the bottom line is - if you have had a concussion and the symptoms persist for longer than expected, it is important to have them looked into. The first step is a medical review to make sure there isn't something else going on. Neuropsychological assessment can help clarify whether there is cognitive impairment (and if so what to do about it) and evaluate whether psychological intervention is needed. The good thing is that the research shows that early intervention, with particular techniques appropriate to PCS patients, can improve outcome.

Brisbane Neuropsychology Clinic are happy to help.