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"Post Concussion Syndrome"

Post Concussion Syndrome is a very unhealthy medical condition...

Post-concussion syndrome is a fairly common medical condition occurring after a head injury. It consists of several physical, cognitive and psychological symptoms occurring after a head trauma and can result in significant social and occupational disability. Clinical features are, epidemiology, aetiology and the best treatment of the condition.

Individuals sustaining mild traumatic brain injuries often report a constellation of physical, cognitive, and emotional/behavioral symptoms referred to as post concussion symptoms (PCS). The most commonly reported post concussion symptoms are headache, dizziness, decreased concentration, memory problems, irritability, fatigue, visual disturbances, sensitivity to noise, judgment problems, depression, and anxiety. Although these PCS often resolve within one month, in some individuals.

PCS can persist from months to years following injury and may even be permanent and cause disability. When this cluster of PCS is persistent in nature, it is often called the post concussion syndrome or persistent PCS. Both physiological and psychological etiologies have been suggested as causes for persistent post concussion symptoms and this has led to much controversy and debate in the literature. Most investigators now believe that a variety of pre-morbid, injury-related, and post-morbid neuropathological and psychological factors contribute to the development and continuation of these symptoms in those sustaining mild traumatic brain injury (MTBI).

Post-concussion syndrome (PCS) associated with mild traumatic brain injury (MTBI) can cause long-lasting disabilities. Magnetic resonance imaging (MRI) evaluation in these patients may demonstrate structural lesions that correlate with functional deficits on neuropsychological testing. However, little is known about the significance of the relationship between structural lesions on MRI, functional deficits on neuropsychological evaluation and outcome in patients with MTBI.

Traumatic Brain Injury

Every year, millions of people in the U.S. sustain head and brain injuries. More than half are bad enough that people must go to the hospital. The worst injuries can lead to permanent brain damage or death.

Half of all traumatic brain injuries (TBIs) are due to motor vehicle accidents. Military personnel are also at risk. Symptoms of a TBI may not appear until days or weeks following the injury. Serious traumatic brain injuries need emergency treatment.

Treatment and outcome depend on the injury. TBI can cause a wide range of changes affecting thinking, sensation, language, or emotions. TBI can be associated with post-traumatic stress disorder. People with severe injuries usually need rehabilitation.

Head injury

A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.

Head injury is classified as either closed or open (penetrating).

  • A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
  • An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.

There are several types of brain injuries, including:

  • Concussion, the most common type of traumatic brain injury, in which the brain is shaken
  • Contusion, which is a bruise on the brain

Every year, millions of people have a head injury. Most of these injuries are minor because the skull provides the brain with considerable protection. The symptoms of minor head injuries usually go away on their own. More than half a million head injuries a year, however, are severe enough to require hospitalization.

Learning to recognize a serious head injury, and implementing basic first aid, can make the difference in saving someone's life.

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In patients who have suffered a severe head injury, there are often other organ systems injured. For example, a head injury is sometimes accompanied by a spinal injury.

Causes of Head Injuries

Common causes of head injury include traffic accidents, falls, physical assault, and accidents at home, work, outdoors, or while playing sports.

Some head injuries result in prolonged or nonreversible brain damage. This can occur as a result of bleeding inside the brain or forces that damage the brain directly. These more serious head injuries may cause:

  • Coma
  • Chronic headaches
  • Loss of or change in sensation, hearing, vision, taste, or smell
  • Paralysis
  • Seizures
  • Speech and language problems

Symptoms of Head Injuries

The symptoms of a head injury can occur immediately or develop slowly over several hours or days. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. The head may look fine, but complications could result from bleeding or swelling inside the skull.

When encountering a person who just had a head injury, try to find out what happened. If he or she cannot tell you, look for clues and ask witnesses. In any serious head trauma, always assume the spinal cord is also injured.

The following symptoms suggest a more serious head injury -- other than a concussion or contusion -- and require emergency medical treatment:

  • Changes in, or unequal size of pupils
  • Convulsions
  • Distorted features of the face
  • Fluid draining from nose, mouth, or ears (may be clear or bloody)
  • Fracture in the skull or face, bruising of the face, swelling at the site of the injury, or scalp wound
  • Impaired hearing, smell, taste, or vision
  • Inability to move one or more limbs
  • Irritability (especially in children), personality changes, or unusual behavior
  • Loss of consciousness, confusion, or drowsiness
  • Low breathing rate or drop in blood pressure
  • Restlessness, clumsiness, or lack of coordination
  • Severe headache
  • Slurred speech or blurred vision
  • Stiff neck or vomiting
  • Symptoms improve, and then suddenly get worse (change in consciousness)

First Aid for Head Injuries

Get medical help immediately if the person:

  • Becomes unusually drowsy
  • Behaves abnormally
  • Develops a severe headache or stiff neck
  • Loses consciousness, even briefly
  • Vomits more than once

For a moderate to severe head injury, take the following steps:

  1. Call 911.
  2. Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.
  3. If the person's breathing and heart rate are normal but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person's head, keeping the head in line with the spine and preventing movement. Wait for medical help.
  4. Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person's head. If blood soaks through the cloth, do NOT remove it. Place another cloth over the first one.
  5. If you suspect a skull fracture, do NOT apply direct pressure to the bleeding site, and do NOT remove any debris from the wound. Cover the wound with sterile gauze dressing.
  6. If the person is vomiting, roll the head, neck, and body as one unit to prevent choking. This still protects the spine, which you must always assume is injured in the case of a head injury. (Children often vomit once after a head injury. This may not be a problem, but call a doctor for further guidance.)
  7. Apply ice packs to swollen areas.

For a mild head injury, no specific treatment may be needed. However, closely watch the person for any concerning symptoms over the next 24 hours. The symptoms of a serious head injury can be delayed. While the person is sleeping, wake him or her every 2 to 3 hours and ask simple questions to check alertness, such as "What is your name?"

If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, as with anyone with a head injury, closely watch the child for 24 hours after the incident.

Over-the-counter pain medicine, such as acetaminophen, may be used for a mild headache. Do NOT take aspirin, ibuprofen, or other anti-inflammatory medications because they can increase the risk of bleeding.

DO NOT for Head Injuries

  • Do NOT wash a head wound that is deep or bleeding a lot.
  • Do NOT remove any object sticking out of a wound.
  • Do NOT move the person unless absolutely necessary.
  • Do NOT shake the person if he or she seems dazed.
  • Do NOT remove a helmet if you suspect a serious head injury.
  • Do NOT pick up a fallen child with any sign of head injury.
  • Do NOT drink alcohol within 48 hours of a serious head injury.

When to Contact a Medical Professional for Head Injuries

Call 911 if:

  • There is severe head or facial bleeding
  • The person is confused, drowsy, lethargic, or unconscious
  • The person stops breathing
  • You suspect a serious head or neck injury, or the person develops signs or symptoms of head trauma

Prevention of Head Injuries

  • Always use safety equipment during activities that could result in head trauma. These include seat belts, bicycle or motorcycle helmets, and hard hats.
  • Obey traffic signals when riding a bicycle. Be predictable so that other drivers will be able to determine your course.
  • Be visible. Do NOT ride a bicycle at night unless you wear bright, reflective clothing and have proper head lamps and flashers.
  • Use age-appropriate car seats or boosters for babies and young children.
  • Make sure that children have a safe area in which to play.
  • Closely watch all young children.
  • Do NOT drink and drive, and do NOT allow yourself to be driven by someone whom you know or suspect has been drinking alcohol or is otherwise impaired.


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