Post Concussion Syndrome

19 August 2019

Concussion and Post-concussion Syndrome – Helpful Videos

The American Academy of Neurology has some new and little known videos that are very helpful summaries of concussion and post-concussion syndrome. Made from a medical field perspective, they will also be helpful for anyone trying to understand the treatment of concussion today.

Concussion (a type of traumatic brain injury), because of its frequent connection to sport, is a highly controversial and often political issue. But whatever your personal point of view, it’s important to understand the terms that are being used today to even talk about the issue. The first video gives an overview of terms and the current understanding of the condition.

The second video gives a very brief overview of current treatment guidelines. A lot of of understanding of concussion has changed significantly in the last few years, as our understanding of the brain has improved, so you may be surprised by some of the recommendations.

One caution that might be needed – when we talk about a “gradual return to activities”, that may include 1-2 days of complete rest. That’s a component that is often missing from concussion treatment. When we talk about complete rest, that means no video games, no homework – very limited physical and mental activities. After that, a very gradual return to normal activities, with careful supervision, as you’ll see in the video below.

For more detailed recommendations, check out Coaches, Parents: Know the Sports Related Concussion Global Recommendations.

11 July 2016

What causes the symptoms of a concussion?

James Discoveries & Stats, Information 2

Confusion, sensitivity to noise, drowsiness, headache – these are some of the symptoms that may occur minutes, or even days, after a concussion. But exactly what causes concussion symptoms?

Concussion is a type of brain injury usually caused by a blow to the head, although it can be caused by any whiplash-type motion, even if the head is never touched. This is another way to see that helmets protect the skull, but can never give 100% protection against concussion.

A concussion is not structural damage that can be seen in a typical CT or MRI scan. The damage actually goes down to the cellular level.

Brain tissue is very soft – think soft butter. When the brain tissue is pushed against the skull, or suddenly twisted, the brain cells themselves can twist and tear.

Cells are like little factories, with highly developed communication systems tying them together. When the little factory is damaged, a number of things can happen.

For example, important materials may “leak” out of the cell, no longer properly contained. Communication between cells may break down. Normal balance is lost. And those little factories go into high gear to try to get everything working again. They may start to produce more of certain things that your brain may have trouble dealing with, such as free radicals or inflammation.

Clean up Think of a city after a war, or riot. Bricks are lying everywhere. Normal communication is broken down. There may be looting. But hopefully most citizens are trying to get things back to normal. Meanwhile, nothing is normal. Buildings may not be recognized. Family members may not know where other family members are. There are gas leaks, fires, and broken pipes.

Sometimes things that should be helping can cause other problems – a fire hose causing flooding in a nearby room, police cars blocking roads.

Remember that this is all happening on a cellular level. It’s incredibly complex, and it’s not easy to see what’s going on from the outside, which is why it’s taking researchers so long to understand the details.

Usually, the brain regains its normal function within a couple of weeks. However, there may be parts of the injury that do not resolve. This can lead to long term problems, such as post concussion syndrome, or chronic traumatic encephalopathy (CTE), a condition occurring late in life in people who have had repeated brain trauma (such as people who played contact sports).

Though we still have a lot to learn about concussion, we’ve come a long way in the past few years. Understanding what is going on in the brain after a concussion is helping with the development of new treatments.

For example, if there are too many free radicals in the brain, could we use antioxidants (as a patch or oral supplement) to clean things up faster, and maybe avoid long term issues?

Meanwhile, if you get a concussion, see a doctor. Be sure to rest and stay away from computer screens and heavy mental activity for three days. Let your doctor know if new symptoms appear, or if some don’t go away.

More tips here: What Should You Do If You Think You Have Had a Concussion?

22 February 2016

A Better Way To Evaluate Concussions?

James Discoveries & Stats, News 0

A concussion is a form of brain damage. And the brain, as we all know, is a very complex piece of equipment. It’s not easy to tell how bad the damage is.

Some patients may seem fine to start with, but within weeks they may develop serious symptoms that could be with them for years to come.

Sometimes migraine symptoms will develop. But sometimes they won’t. Sometimes recovery will be fairly quick, sometimes not.

Typically, your doctor will give you a neurological examination, checking for vision problems, hearing problems, changed in your coordination or balance. If your doctor is concerned about some serious symptoms, either from the exam or from diagnosis of headaches or nausea, he may request some type of scan, such as a CT or MRI.

The MRI can assess white matter injury in the brain. A mean fractional anisotropy (FA) is one way to assess how much damage has been done. But because everyone’s brain is different to start with, the FA measure doesn’t always give reliable results.

Dr. Joseph Delic at the University of Pittsburgh Medical Center and his team investigated the value of another technique, known as Shannon entropy (SE) analysis, to see if it would give more accurate results. And in the opinion of the study authors, it does.

In fact, someone with a SE below a certain level were 16 times more likely to develop migraine from concussion. Also, the lower the SE the longer the recovery.

If doctors have access to a better way to assess patients with concussion, they will be better able to provide treatment over the long term, and avoid treatment that isn’t needed.

For more, read the information on the study from the Radiological Society of North America: Technique Helps Predict Likelihood of Migraines in Concussion Patients, and this article in ScienceDaily: Technique helps predict likelihood of migraines in concussion patients.

Also see: Is it Concussion or Migraine? and Concussion: Tests and diagnosis

10 September 2014

Is it Concussion or Migraine?

James Information 0

If you’re dealing with headache symptoms, and you suspect you may have had a concussion, it’s natural to ask – is it concussion or migraine?

First, some important background. Many people don’t realize that concussion is a brain injury. It’s important to start here, because there are still those who think that concussion is a minor, temporary injury.

Although some injuries are certainly worse than others, a single concussion can lead to long term problems. For more see Is it a Concussion or a Brain Injury?

So back to our question. Concussion can lead to something known as post-concussion syndrome (PCS). In PCS, although the concussion (read: mild brain injury) may have happened several days or even weeks ago, you start developing symptoms such as dizziness, fatigue, headache, anxiety, and insomnia. (More about post concussion syndrome symptoms here)

Now PCS can indeed look a lot like migraine, and sometimes it is difficult to know the difference. In fact, some might say that PCS is triggering actual migraine attacks.

But more likely when you ask if it is concussion or migraine, you’re asking if the concussion is at the root of the problem, and if you should be looking for treatment that is different from typical migraine treatment.

How to tell if you have PCS: Here are some important clues. First, in order to be diagnosed with PCS, your symptoms must be new. These symptoms usually appear between a few days and four weeks of the concussion. So if you’re having the same symptoms as before, you probably won’t be blaming them on the concussion.

If, however, you had struggled with headaches before the concussion, but your symptoms have changed, you may have PCS. You should see a doctor without delay.

After you have confirmed that your symptoms are new, or that they have changed, your doctor will want to know more about they symptoms you’re experiencing, when they started, how severe they are, and so on.

If you decide after speaking with your doctor that you don’t have PCS, you still need a proper diagnosis for your symptoms. There are various types of headache, and even various kinds of migraine. Getting a specific diagnosis will help you find treatment that will be effective.

For more information, see Post Concussion Syndrome – causes and treatment

2 May 2013

Why some people don’t recognize post-concussion syndrome symptoms

James Information, Tips 5

Sometimes it can be challenging to diagnose post-concussion syndrome symptoms. And without a proper diagnosis, proper treatment can be hard to find.

As we’ve mentioned before, a concussion is actually a form of brain injury. To say “It’s just a mild concussion” as if it won’t have any lasting consequences is a misleading.

Symptoms of post-concussion syndrome (PCS) can vary. The common ones include headache, dizziness, fatigue, insomnia, and anxiety. There are also rarer symptoms such as hearing loss, impaired judgment, and trouble speaking. Here’s more on post concussion syndrome symptoms.

But here’s the problem. First, it’s not easy to just do a test and find out if you have PCS. Yes, your doctor may call for a CT scan, and that may help with he diagnosis. But it may not confirm that you have PCS.

Second, as you may have noticed, many of these symptoms are common in other types of headache. PCS can look very much like migraine, or like tension-type headache.

So how can you help your doctor properly diagnose your symptoms?

First, your doctor will want to know how things have changed and when they changed. Symptoms like these will probably appear within a few days to up to four weeks after your injury. Thankfully, the symptoms usually do go away fairly soon, especially if you can get to a doctor and get them diagnosed early on.

Your doctor will also need to know your medical history. Other conditions and diseases may be impacting your symptoms – things like migraine, depression, insomnia, and so on.

So do pay attention to symptoms and timing as much as you can while you’re preparing for your visit to the doctor. Your doctor will ask you some questions and may call for some tests. Treatment can involve several different things depending on your symptoms.