Postconcussive Syndrome in Emergency Medicine Treatment & Management

  • Author: Eric L Legome, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 7, 2011
 

Emergency Department Care

No specific care is required in the ED. Patients with the symptom constellation consistent with postconcussive syndrome (PCS) require thorough physical and neurological examinations. A CT scan should be obtained if significant concern about intracranial hemorrhage exists, although this injury is rare in the patient presenting late with nonfocal findings at examination.

  • Supportive care may include the use of nonnarcotic analgesics and antiemetics. However, there does not appear to be any medications at discharge that can prevent or hasten the resolution of postconcussive syndrome. Several drugs are under investigation, but none have proven to be clinically useful yet.
  • Several studies have shown that providing patients with an explanation of symptoms as well as expectations may decrease the severity and duration of postconcussive symptoms.
  • Although rare, patients may be admitted if symptoms are severe, the majority can be discharged. Several studies have revealed that patients admitted acutely after a minor head injury (MHI) may have a lower incidence of postconcussive syndrome and its attendant social and psychological morbidity. This finding, however, may be due to active interventions at follow-up.
  • Prompt follow-up care and reassurance may hasten resolution of symptoms. Patients should be referred to a primary care doctor, neurologist, or psychiatrist depending on their symptoms.
  • Follow-up and patient education on what to expect after minor head injuries is useful, as many patients will have symptoms for weeks after discharge.[10]
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Consultations

Rarely is consultation warranted in the ED once the diagnosis is made. Outpatient referral is the cornerstone of treatment. One study suggests that findings of early neuropsychological assessment may determine the prognosis; however, this assessment rarely is performed in the ED.

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Contributor Information and Disclosures
Author

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L 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.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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 

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

References

  1. Heitger MH, Jones RD, Macleod AD, Snell DL, Frampton CM, Anderson TJ. Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability. Brain. Oct 2009;132:2850-70. [Medline].

  2. Dischinger PC, Ryb GE, Kufera JA, Auman KM. Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury. J Trauma. Feb 2009;66(2):289-96; discussion 296-7. [Medline].

  3. Sheedy J, Harvey E, Faux S, Geffen G, Shores EA. Emergency department assessment of mild traumatic brain injury and the prediction of postconcussive symptoms: a 3-month prospective study. J Head Trauma Rehabil. Sep-Oct 2009;24(5):333-43. [Medline].

  4. Bazarian JJ, McClung J, Shah MN, Cheng YT, Flesher W, Kraus J. Mild traumatic brain injury in the United States, 1998--2000. Brain Inj. Feb 2005;19(2):85-91. [Medline].

  5. Faux S, Sheedy J. A prospective controlled study in the prevalence of posttraumatic headache following mild traumatic brain injury. Pain Med. Nov 2008;9(8):1001-11. [Medline].

  6. Dawson KS, Batchelor J, Meares S, Chapman J, Marosszeky JE. Applicability of neural reserve theory in mild traumatic brain injury. Brain Inj. Aug 2007;21(9):943-9. [Medline].

  7. Whittaker R, Kemp S, House A. Illness perceptions and outcome in mild head injury: a longitudinal study. J Neurol Neurosurg Psychiatry. Jun 2007;78(6):644-6. [Medline].

  8. Ma M, Lindsell CJ, Rosenberry CM, Shaw GJ, Zemlan FP. Serum cleaved tau does not predict postconcussion syndrome after mild traumatic brain injury. Am J Emerg Med. Sep 2008;26(7):763-8. [Medline].

  9. Lima DP, Simao Filho C, Abib Sde C, de Figueiredo LF. Quality of life and neuropsychological changes in mild head trauma. Late analysis and correlation with S100B protein and cranial CT scan performed at hospital admission. Injury. May 2008;39(5):604-11. [Medline].

  10. Cunningham J, Brison RJ, Pickett W. Concussive symptoms in emergency department patients diagnosed with minor head injury. J Emerg Med. Mar 2011;40(3):262-6. [Medline].

  11. Rees RJ, Bellon ML. Post concussion syndrome ebb and flow: longitudinal effects and management. NeuroRehabilitation. 2007;22(3):229-42. [Medline].

  12. Meares S, Shores EA, Batchelor J, et al. The relationship of psychological and cognitive factors and opioids in the development of the postconcussion syndrome in general trauma patients with mild traumatic brain injury. J Int Neuropsychol Soc. Nov 2006;12(6):792-801. [Medline].

  13. Yang CC, Tu YK, Hua MS, Huang SJ. The association between the postconcussion symptoms and clinical outcomes for patients with mild traumatic brain injury. J Trauma. Mar 2007;62(3):657-63. [Medline].

  14. Alexander MP. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995;45 (7):1253-60. [Medline].

  15. Barrett K, Ward AB, Boughey A, Jones M, Mychalkiw W. Sequelae of minor head injury: the natural history of post-concussive symptoms and their relationship to loss of consciousness and follow-up. J Accid Emerg Med. Jun 1994;11(2):79-84. [Medline].

  16. Bazarian JJ, Wong T, Harris M, Leahey N, Mookerjee S, Dombovy M. Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Inj. Mar 1999;13(3):173-89. [Medline].

  17. Bernstein DM. Recovery from mild head injury. Brain Inj. Mar 1999;13(3):151-72. [Medline].

  18. Bigler ED. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc. Jan 2008;14(1):1-22. [Medline].

  19. Boake C, McCauley SR, Levin HS, et al. Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury. J Neuropsychiatry Clin Neurosci. Summer 2005;17(3):350-6. [Medline].

  20. Bohnen N, Twijnstra A, Wijnen G. Tolerance for light and sound of patients with persistent post-concussional symptoms 6 months after mild head injury. J Neurol. Dec 1991;238(8):443-6. [Medline].

  21. Chan RC. How severe should symptoms be before someone is said to be suffering from post-concussion syndrome? An exploratory study with self-reported checklist using Rasch analysis. Brain Inj. Dec 2005;19(13):1117-24. [Medline].

  22. Chen JK, Johnston KM, Collie A, McCrory P, Ptito A. A validation of the post concussion symptom scale in the assessment of complex concussion using cognitive testing and functional MRI. J Neurol Neurosurg Psychiatry. Nov 2007;78(11):1231-8. [Medline].

  23. Collie A, Makdissi M, Maruff P, Bennell K, McCrory P. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. J Neurol Neurosurg Psychiatry. Feb 2006;77(2):241-5. [Medline].

  24. de Kruijk JR, Leffers P, Meerhoff S, Rutten J, Twijnstra A. Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest. J Neurol Neurosurg Psychiatry. Aug 2002;73(2):167-72. [Medline].

  25. De Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Rutten J, Twijnstra A. Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. J Neurol Neurosurg Psychiatry. Dec 2002;73(6):727-32. [Medline].

  26. de Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Twijnstra A. S-100B and neuron-specific enolase in serum of mild traumatic brain injury patients. A comparison with health controls. Acta Neurol Scand. Mar 2001;103(3):175-9. [Medline].

  27. Duff J. The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clin EEG Neurosci. Oct 2004;35(4):198-209. [Medline].

  28. Erlanger DM, Kutner KC, Barth JT, Barnes R. Neuropsychology of sports-related head injury: Dementia Pugilistica to Post Concussion Syndrome. Clin Neuropsychol. May 1999;13(2):193-209. [Medline].

  29. Evans RW. Post-traumatic headaches. Neurol Clin. Feb 2004;22(1):237-49, viii. [Medline].

  30. Groswasser Z, Reider-Groswasser I, Soroker N, Machtey Y. Magnetic resonance imaging in head injured patients with normal late computed tomography scans. Surg Neurol. Apr 1987;27(4):331-7. [Medline].

  31. Guerrero JL, Thurman DJ, Sniezek JE. Emergency department visits associated with traumatic brain injury: United States, 1995-1996. Brain Inj. Feb 2000;14(2):181-6. [Medline].

  32. Ingebrigtsen T, Waterloo K, Marup-Jensen S, Attner E, Romner B. Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. J Neurol. Sep 1998;245(9):609-12. [Medline].

  33. Kibby MY, Long CJ. Minor head injury: attempts at clarifying the confusion. Brain Inj. Mar 1996;10(3):159-86. [Medline].

  34. Kraus J, Hsu P, Schaffer K, Vaca F, Ayers K, Kennedy F, et al. Preinjury factors and 3-month outcomes following emergency department diagnosis of mild traumatic brain injury. J Head Trauma Rehabil. Sep-Oct 2009;24(5):344-54. [Medline].

  35. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. Sep-Oct 2006;21(5):375-8. [Medline].

  36. Larrabee GJ. Neuropsychological Outcome, Post Concussion Symptoms, and Forensic Considerations in Mild Closed Head Trauma. Semin Clin Neuropsychiatry. Jul 1997;2(3):196-206. [Medline].

  37. Lee LK. Controversies in the sequelae of pediatric mild traumatic brain injury. Pediatr Emerg Care. Aug 2007;23(8):580-3; quiz 584-6. [Medline].

  38. Levin HS, Amparo E, Eisenberg HM, et al. Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg. May 1987;66(5):706-13. [Medline].

  39. Lewine JD, Davis JT, Bigler ED, et al. Objective documentation of traumatic brain injury subsequent to mild head trauma: multimodal brain imaging with MEG, SPECT, and MRI. J Head Trauma Rehabil. May-Jun 2007;22(3):141-55. [Medline].

  40. Lovell MR, Iverson GL, Collins MW, McKeag D, Maroon JC. Does loss of consciousness predict neuropsychological decrements after concussion?. Clin J Sport Med. Oct 1999;9(4):193-8. [Medline].

  41. McCullagh S, Feinstein A. Outcome after mild traumatic brain injury: an examination of recruitment bias. J Neurol Neurosurg Psychiatry. Jan 2003;74(1):39-43. [Medline].

  42. Mooney G, Speed J, Sheppard S. Factors related to recovery after mild traumatic brain injury. Brain Inj. Nov 2005;19(12):975-87. [Medline].

  43. Olver J. Traumatic brain injury--the need for support and follow up. Aust Fam Physician. Apr 2005;34(4):269-71. [Medline].

  44. Potter S, Leigh E, Wade D, Fleminger S. The Rivermead Post Concussion Symptoms Questionnaire: a confirmatory factor analysis. J Neurol. Dec 2006;253(12):1603-14. [Medline].

  45. Preiss-Farzanegan SJ, Chapman B, Wong TM, Wu J, Bazarian JJ. The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. PM R. Mar 2009;1(3):245-53. [Medline].

  46. Rosenthal M. Mild traumatic brain injury syndrome. Ann Emerg Med. Jun 1993;22(6):1048-51. [Medline].

  47. Satz PS, Alfano MS, Light RF, et al. Persistent Post-Concussive Syndrome: A proposed methodology and literature review to determine the effects, if any, of mild head and other bodily injury. J Clin Exp Neuropsychol. Oct 1999;21(5):620-8. [Medline].

  48. Savola O, Hillbom M. Early predictors of post-concussion symptoms in patients with mild head injury. Eur J Neurol. Mar 2003;10(2):175-81. [Medline].

  49. Stalnacke BM, Bjornstig U, Karlsson K, Sojka P. One-year follow-up of mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction in relation to serum levels of S-100B and neurone-specific enolase in acute phase. J Rehabil Med. Sep 2005;37(5):300-5. [Medline].

  50. Stalnacke BM, Elgh E, Sojka P. One-year follow-up of mild traumatic brain injury: cognition, disability and life satisfaction of patients seeking consultation. J Rehabil Med. May 2007;39(5):405-11. [Medline].

  51. Stulemeijer M, van der Werf S, Borm GF, Vos PE. Early prediction of favourable recovery 6 months after mild traumatic brain injury. J Neurol Neurosurg Psychiatry. Aug 2008;79(8):936-42. [Medline].

  52. van der Naalt J, Hew JM, van Zomeren AH, Sluiter WJ, Minderhoud JM. Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome. Ann Neurol. Jul 1999;46(1):70-8. [Medline].

  53. Voller B, Benke T, Benedetto K, Schnider P, Auff E, Aichner F. Neuropsychological, MRI and EEG findings after very mild traumatic brain injury. Brain Inj. Oct 1999;13(10):821-7. [Medline].

  54. Wade DT, King NS, Wenden FJ, Crawford S, Caldwell FE. Routine follow up after head injury: a second randomised controlled trial. J Neurol Neurosurg Psychiatry. Aug 1998;65(2):177-83. [Medline].

  55. Wood RL. Understanding the 'miserable minority': a diasthesis-stress paradigm for post-concussional syndrome. Brain Inj. Nov 2004;18(11):1135-53. [Medline].

 
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