Traumatic brain injury (TBI) might lead to severely debilitating long-term sequelae in the absence of an early diagnosis and adequate treatment, one of the most important forms being a concussion, defined as a traumatic event during which various pathophysiological processes (primarily mechanical forces exerted on brain tissue) lead to brain injury, but without evidence on imaging studies [1]. Various symptoms appear shortly after the initial injury, including headaches, amnesia, and loss of consciousness, whereas emotional instability, sleep disturbances, and cognitive impairment (reduced reaction time is a key finding) can be present as well [1]. Postconcussive syndrome (PCS) is still an incompletely defined disorder that several authors describe as prolongation of symptoms after a concussion [2] [3]. The majority of patients recover from a concussion within a period of days to weeks, but PCS is estimated to occur in approximately 10% of cases [4]. Notable findings in PCS include persistent emotional instability, difficulty sleeping, anxiety, dizziness, irritability, visual disturbances, sensitivity to noise, and inability to maintain concentration, in addition to complaints mentioned previously [2] [3] [5] [6]. Depression may also be a long-term adverse effect of concussion and is an important constituent of PCS [1] [7].

• Fatigue

  Headaches, dizziness, fatigue, emotional instability, anxiety, sleep disturbances and an overall decreased quality of life are described as the most important complaints. [symptoma.com]

  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. [doi.org]

  Symptoms In general, the most commonly accepted definition is that postconcussive syndrome consists of someone having suffered from mild TBI and then goes on to suffer from the following: Headache, dizziness, malaise, fatigue, or decreased tolerance to [verywell.com]

  CLINICAL FINDINGS: Post-concussion syndrome lies within the confines of somatic symptoms (headaches, dizziness, and fatigue), cognitive symptoms (memory and concentration problems) and affective symptoms (irritability, emotional lability, depression, [noninvasiveicp.com]

• Asymptomatic

  PCS) participants were different from matched normal control (NC) subjects, and from the 21 MTBI patients who were asymptomatic, at 4 months. [ncbi.nlm.nih.gov]

  Once asymptomatic, ImPACT was repeated and demonstrated a return to baseline. She was returned to sport per a graduated return-to-play protocol without complications and played the full season. [amssm.org]

  Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. J Neurol Neurosurg Psychiatry. 2006 Feb. 77(2):241-5. [Medline]. de Kruijk JR, Leffers P, Meerhoff S, Rutten J, Twijnstra A. [emedicine.com]

• Chronic Fatigue Syndrome

  Keywords Traumatic Brain Injury Chronic Fatigue Syndrome Mild Traumatic Brain Injury Mild Head Injury Minor Head Trauma These keywords were added by machine and not by the authors. [doi.org]

  PCS also shares symptoms with chronic fatigue syndrome, fibromyalgia, and exposure to certain toxins. [en.wikipedia.org]

• Intravenous Drugs

  SH: Negative for tobacco, alcohol, or intravenous drug use. Meds: Advil PRN. Allergies: NKDA. Physical Exam: VITALS: BP 99/64 HR 53 RR 12 Temp 98.8 GENERAL: Healthy-appearing athletic female in no acute distress. HEENT: EOMI, PERRLA. [amssm.org]

• Nausea

  Three days later, she presented to the athletic training room clinic with complaints of frontotemporal headache, nausea, dizziness, photosensitivity, and phonosensitivity. She also endorsed feeling slowed down, irritability, and drowsiness. [amssm.org]

  She had a brief convulsion immediately after the fall, was unresponsive for less than 1 minute, and awakened with a severe generalized headache and nausea but no vomiting. [doi.org]

  Your Doctor may prescribe certain medications to help ease your symptoms, such as painkillers (for headaches), anti-depressants or anti-nausea medication. [sportsinjuryclinic.net]

  Repeated vomiting or nausea. Slurred speech. The people checking on you should take you to an emergency department right away if you: Look very drowsy or cannot be awakened. [braininjspecialists.com]

• Vomiting

  She denied nausea, vomiting, vision changes, weakness, or new trauma. History: PMH: 8 concussions and right orbital fracture, per above. PSH: None. FH: No significant hx. SH: Negative for tobacco, alcohol, or intravenous drug use. Meds: Advil PRN. [amssm.org]

  She had a brief convulsion immediately after the fall, was unresponsive for less than 1 minute, and awakened with a severe generalized headache and nausea but no vomiting. [doi.org]

  In relatively mild cases, potential symptoms of this form of brain injury include headaches, muddled thinking or confusion, nausea, vomiting, short-term memory loss, short-term loss of consciousness and unusual sleepiness or difficulty waking up after [recoveryranch.com]

  Repeated vomiting or nausea. Slurred speech. The people checking on you should take you to an emergency department right away if you: Look very drowsy or cannot be awakened. [braininjspecialists.com]

• Benign Paroxysmal Positional Vertigo

  In patients with Visual Motion Sensitivity (VMS), BNO can improve both subjective visual perception and objective performance with sensorimotor tasks. [19] Considerations: [11] It is important to clear patients of Benign Paroxysmal Positional Vertigo [physio-pedia.com]

  BPPV (Benign Paroxysmal Positional Vertigo) is always screened for and promptly treated when found. If gaze stability is impaired, a peripheral source such as labyrinthine concussion without fracture may be to blame. [jlgh.org]

• Mood Swings

  Cognitive and psychological symptoms of the post-concussion syndrome can include forgetfulness, lack of concentration, slowed reaction times, difficulty taking on new information as well as anxiety, depression and mood swings. [sportsinjuryclinic.net]

  Personality changes are common, and rapid mood swings alternate with waxing and waning energy levels. Taken individually, such impairments might not amount to much. However, such impairments usually appear in groups or clusters. [headinjury.com]

  You may also have mental health problems like anxiety, depression, and mood swings. [cancercarewny.com]

  Some patients will describe a feeling of restlessness, mood swings, aggression, decreased libido, anger, lack of ability to tolerate stress, impulsiveness, and loss of social judgment. [autoaccident.com]

• Sexual Dysfunction

  dysfunction, and substance abuse* Reviews disease- and organ system-specific issues associated with 20 medical specialties, including epidemiology and risk factors; the effects of the psychiatric disorder on medical disorders and, conversely, the effects [books.google.com]

• Headache

  Headaches, dizziness, fatigue, emotional instability, anxiety, sleep disturbances and an overall decreased quality of life are described as the most important complaints. [symptoma.com]

  She complained of 2 months of constant throbbing bilateral frontotemporal headaches – worse with exercise – and difficulty concentrating in class. Her headaches would occasionally wake her from sleep and were usually relieved by Advil. [amssm.org]

  We recorded middle latency auditory evoked potentials (MLR) and slow vertex responses (SVR) in 20 individuals with prolonged cognitive difficulties, behavior changes, dizziness, and headache after concussion. [ncbi.nlm.nih.gov]

  Headache is one of the most common complaints in patients with traumatic brain injury. By definition, headache that develops within 1 wk after head trauma (or within 1 wk after regaining consciousness) is referred to as posttraumatic headache (PTH). [doi.org]

  Headaches can be treated with pain medication, and anti-emetics may be useful for dizziness. A combination of medication and therapy can be beneficial for symptoms of depression. [verywell.com]

• Dizziness

  Headaches, dizziness, fatigue, emotional instability, anxiety, sleep disturbances and an overall decreased quality of life are described as the most important complaints. [symptoma.com]

  We recorded middle latency auditory evoked potentials (MLR) and slow vertex responses (SVR) in 20 individuals with prolonged cognitive difficulties, behavior changes, dizziness, and headache after concussion. [ncbi.nlm.nih.gov]

  On exam, she was tender to palpation over the right inferior orbit and had worsening headache and dizziness with vestibular testing. [amssm.org]

  The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. [doi.org]

  Headaches can be treated with pain medication, and anti-emetics may be useful for dizziness. A combination of medication and therapy can be beneficial for symptoms of depression. [verywell.com]

• Irritability

  Notable findings in PCS include persistent emotional instability, difficulty sleeping, anxiety, dizziness, irritability, visual disturbances, sensitivity to noise, and inability to maintain concentration, in addition to complaints mentioned previously [symptoma.com]

  The prevalence of headache, irritability, fears, sleep disorders, learning difficulties, as well as concentration and memory problems did not differ significantly between children with mild traumatic brain injury and the control group when the results [ncbi.nlm.nih.gov]

  She also endorsed feeling slowed down, irritability, and drowsiness. On exam, she was tender to palpation over the right inferior orbit and had worsening headache and dizziness with vestibular testing. [amssm.org]

  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. [doi.org]

• Insomnia

  Irritability, depression, anxiety, or emotional lability Subjective concentration, memory, or intellectual difficulties Insomnia Reduced alcohol tolerance Most experts agree that symptoms should begin no later than 4 weeks after the head injury. [verywell.com]

  The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. [ncbi.nlm.nih.gov]

  Some common symptoms, such as apathy, insomnia, irritability, or lack of motivation, may result from other co-occurring conditions, such as depression. [en.wikipedia.org]

  Common symptoms seen in patients with this condition include: Dizziness Headache Slurred speech Nausea Other symptoms may include: Anxiety Sound and light sensitivity Insomnia In order to confirm the diagnosis, a physician will often perform a brain scan [tsrinjurylaw.com]

  There are many different ways of defining PCS, but it is usually considered present if three or more symptoms (such as insomnia, headache, and dizziness) are present for at least three months. [healthofchildren.com]

• Cognitive Impairment

  Various symptoms appear shortly after the initial injury, including headaches, amnesia, and loss of consciousness, whereas emotional instability, sleep disturbances, and cognitive impairment (reduced reaction time is a key finding) can be present as well [symptoma.com]

  Multiple foci of low white matter FA and high MD are present in cognitively impaired mild TBI patients, with a distribution that conforms to that of diffuse axonal injury. [doi.org]

  Prolonged cognitive impairment after injury is not unique to brain trauma. Persistent postconcussive syndrome after mild brain trauma, uncomplicated by focal injury, is biologically inseparable from other examples of the posttraumatic syndrome. [ncbi.nlm.nih.gov]

Physicians must bear in mind the importance of an early diagnosis of concussion and proper initiation of therapy, particularly in younger athletes. For this reason, a meticulous clinical workup is recommended. Firstly, a detailed patient history must cover all the details regarding the event that led to brain injury (time, description of the mechanism of injury, and severity of impact) and evaluate the presence of associated symptoms [1]. The Sport Concussion Assessment Tool 2 (SCAT2), comprising of a series of self-evaluating questions, a Glasgow coma scale grading (GCS), cognitive assessment, as well as examination of balance and coordination, is a comprehensive tool that can be of significant benefit in assessing individuals in whom a concussion is suspected [1]. The subjective nature of this test, however, is a major limitation [2]. In addition to findings obtained during the interview with the patient, a complete physical and neurological examination is also important. Clinical criteria should be supported by various tests, the most important being the treadmill test that determines whether symptoms appear or become exacerbated with exercise [2] [8]. If patients are unable to perform strenuous activities after TBI due to the reappearance of symptoms, the diagnosis of PCS is highly likely [2] [8]. The role of imaging studies in identifying additional injuries to other structures (eg. the cranium) is quite important but is of little benefit for PCS due to the absence of macroscopic changes in the brain after a concussion.

1. McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med 2009;19(3):185-200.
2. Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012;4(2):147-154.
3. WHO (World Health Organization) International Statistical Classification of Diseases and Related Health Problems. 2010. [October 3, 2013]. (10th Revision. [Online version.]). http://apps.who.int/classifications/icd10/browse/2010/en.
4. Willer B, Leddy JJ. Management of concussion and post-concussion syndrome. Curr Treat Options Neurol. 2006;8(5):415-426.
5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Arlington, VA: American Psychiatric Publishing; 2013.
6. 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. 2009;66(2):289-96;296-297.
7. Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol. 2006;21(4):303-310.
8. Leddy JJ, Kozlowski K, Donnelly JP, Pendergast DR, Epstein LH, Willer B. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010;20(1):21-27.