Postconcussion Syndrome in the ED
Postconcussion Syndrome in the ED
Head injuries across all age groups represent an extremely common emergency department (ED) presentation. The main focus of initial assessment and management rightly concentrates on the need to exclude significant pathology, that may or may not require neurosurgical intervention. Relatively little focus, however, is given to the potential for development of post-concussion syndrome (PCS), a constellation of symptoms of varying severity, which may bear little correlation to the nature or magnitude of the precipitating insult. This review aims to clarify the aetiology and terminology surrounding PCS and to examine the mechanisms for diagnosing and treating.
Postconcussion syndrome (PCS) is a much maligned complex of symptoms that includes headache, dizziness, nausea and cognitive impairment occurring commonly following a mild traumatic brain injury (mTBI). While the majority of patients experiencing mTBI will have a rapid and complete resolution of any adverse sequelae within days, if not weeks, a significant proportion will suffer a protracted course of symptoms which may result in considerable disability. The symptoms can be quite profound and are associated with significant morbidity from the physical, emotional, occupational and social sequelae of the disorder. Even though its existence is widely acknowledged by the so-called experts, the vague nature of its symptoms, its unpredictability, a perceived association with mental health disorders and the pursuit of litigation and difficulties with treatment lead to persistent controversy and debate about its existence. With head injury representing an extremely common emergency department (ED) presentation across all age groups, the potential for large numbers of patients to suffer protracted symptoms in the form of PCS is high, yet ED management strategies still focus on excluding significant structural sequelae, with little or no attempt made to either predict those at risk of PCS or present potential management strategies.
Abstract and Introduction
Abstract
Head injuries across all age groups represent an extremely common emergency department (ED) presentation. The main focus of initial assessment and management rightly concentrates on the need to exclude significant pathology, that may or may not require neurosurgical intervention. Relatively little focus, however, is given to the potential for development of post-concussion syndrome (PCS), a constellation of symptoms of varying severity, which may bear little correlation to the nature or magnitude of the precipitating insult. This review aims to clarify the aetiology and terminology surrounding PCS and to examine the mechanisms for diagnosing and treating.
Introduction
Postconcussion syndrome (PCS) is a much maligned complex of symptoms that includes headache, dizziness, nausea and cognitive impairment occurring commonly following a mild traumatic brain injury (mTBI). While the majority of patients experiencing mTBI will have a rapid and complete resolution of any adverse sequelae within days, if not weeks, a significant proportion will suffer a protracted course of symptoms which may result in considerable disability. The symptoms can be quite profound and are associated with significant morbidity from the physical, emotional, occupational and social sequelae of the disorder. Even though its existence is widely acknowledged by the so-called experts, the vague nature of its symptoms, its unpredictability, a perceived association with mental health disorders and the pursuit of litigation and difficulties with treatment lead to persistent controversy and debate about its existence. With head injury representing an extremely common emergency department (ED) presentation across all age groups, the potential for large numbers of patients to suffer protracted symptoms in the form of PCS is high, yet ED management strategies still focus on excluding significant structural sequelae, with little or no attempt made to either predict those at risk of PCS or present potential management strategies.