eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Postconcussive Syndrome: Follow-up

Author: Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Coauthor(s): Rachel Alt, MD, Staff Physician, Department of Emergency Medicine, New York University Bellevue Hospital; Tina Wu, MD, Staff Physician, Department of Emergency Medicine, New York University Medical Center, Bellevue Hospital Center
Contributor Information and Disclosures

Updated: Feb 6, 2009

Follow-up

Further Outpatient Care

Outpatient care is the cornerstone of treatment of patients with postconcussive syndrome (PCS) and involves multidisciplinary teams that provide testing and treatment, including cognitive rehabilitation, psychotherapy, stress management, vocational counseling, and symptomatic treatment with medications.

  • No treatments have been proven effective, though neurotherapy or quantitative EEG biofeedback is a modality that has been shown in recent studies to improve symptoms of postconcussive syndrome. More controlled studies are needed at this point.
  • A neurologist, physical medicine specialist, primary care physician, or psychologist specializing in these disorders usually coordinates treatment.

Deterrence/Prevention

  • The emergency physician should encourage the use of interventions to decrease the incidence of traumatic brain injury. This approach is particularly important in young adults, who have a higher incidence of head injury than others.
    • Encourage patients to wear a seatbelt.
    • Encourage patients to wear a helmet when riding bicycles or motorcycles, or playing high-risk sports.

Prognosis

  • True prognosis is difficult to define given that many patients with minor symptoms may not enter the health care system and those that participate in research appear to have more significant symptoms at baseline. In addition, a wide heterogeneity exists in patients enrolled in studies.
  • Most patients recover fully in less than 3 months, although some small studies suggest persistence of minor cognitive defects for asymptomatic minor traumatic brain injury patients.5
  • Approximately 15% of patients complain of problems more than 12 months after injury. This group is likely to experience persistent and intrusive symptoms that may be refractory to treatment and impose a lifelong disability.
  • At least one study found the persistence of dizziness as a symptom seemed to portend a longer and more significant symptom complex.6 Other studies found the depression, pain, and symptom invalidity were correlated with longer and worse symptoms.7

Patient Education

  • Educate the patient about the usual self-limited nature of postconcussive syndrome.
  • Education about the usual symptoms may be helpful.
  • Discussions concerning preparation for the graded resumption of vocational and academic routines may lessen postconcussive syndrome persistence.
  • For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education article Concussion.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the benefits of reassurance and providing follow-up care.
    • Patients are likely to experience difficulty with symptoms when neurologic examinations, psychological assessments, and physical examinations reveal limited evidence of or explanation for the persistence of the symptoms.
    • Patients' veracity may be questioned; they may be treated as if they are neurotic or merely seeking compensation.
    • Practitioners may be confused about complaints when objective evidence is not present.
    • Follow-up during recovery may aid in preventing symptom persistence.
  • Failure to provide patients with information regarding the sequelae of minor head injury.
 


More on Postconcussive Syndrome

Overview: Postconcussive Syndrome
Differential Diagnoses & Workup: Postconcussive Syndrome
Treatment & Medication: Postconcussive Syndrome
Follow-up: Postconcussive Syndrome
References
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Further Reading

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Keywords

postconcussive syndrome, concussion, postconcussive symptoms, PCS, minor head injury, MHI, head trauma, loss of consciousness, brain injury, traumatic brain injury 

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Contributor Information and Disclosures

Author

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Rachel Alt, MD, Staff Physician, Department of Emergency Medicine, New York University Bellevue Hospital
Disclosure: Nothing to disclose.

Tina Wu, MD, Staff Physician, Department of Emergency Medicine, New York University Medical Center, Bellevue Hospital Center
Tina Wu, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Senior Vice President, Chief Medical Officer, Medical Director, Attending Physician in Department of Emergency Medicine, Saint Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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