The Arnold Law Firm

Persistent Post Concussive Symptoms

Persistent cognitive deficits are more disabling over the lifetime of the person with a brain injury than are physical problems. A person with brain injury may also have social or mood problems that limit his or her interactions with others

Studies show well-motivated young men are at the lowest risk of developing post-concussive syndrome, and males with higher education and good social support had the best chance of recovery after mild traumatic brain injury. Women and patients over age 55 or those who have prolonged amnesia are at a higher risk of developing post-concussive syndrome

Patients who suffer post-concussive syndrome for more than one year are classified as persistent post-concussive syndrome

Persistent post-concussive syndrome symptoms are generally considered chronic when they last more than six months and permanent when they persist more than a year. Chronic and, in particular, permanent symptoms are often viewed with distrust from the public, insurance companies and even clinicians. Those patients with long-term symptoms are accused of exaggerating symptoms or malingering in order to increase a claim. Compounding this perception are patient labels such as "accident neurosis," "personality disorder" or "function disorder."

In spite of these negative views, most studies indicate that few patients are malingering or exaggerating symptoms for personal gain. (See Somatization)

Studies show predictors of persistent post-concussive syndrome include female sex, low socioeconomic status, serious other illnesses, alcohol abuse or prior mild traumatic brain injury. Treatment for post-concussive syndrome must be individualized. Supportive care is fundamental with the judicious use  of psychotherapy, psychoactive medications and neuropsychologic exercises.

It is critical to identify the patient with a mild traumatic brain injury who harbors significant intracranial pathology since the outcome is worse if the patient suffers neurologic deterioration, while chances of returning to a normal lifestyle are maximized if the intracranial injury is promptly identified and treated.

Although the presence of clinical demonstrable neurological abnormality increases the likelihood of subsequent deficits in mild traumatic brain injury, their absence does not guarantee full recovery. Studies have show symptoms at discharge from the hospital are not predictive of symptoms at three months.

For children, detailed neuropsychological testing of mildly injured children has revealed persisting deficits even after five years. Furthermore, deficits arising from repeated injuries are cumulative.

Patients with mild traumatic brain injury can exhibit persistent emotional, cognitive, behavioral and physical symptoms, alone or in combination, which may produce a functional disability. These symptoms generally fall into one of the following categories:
  1. Physical symptoms of brain injury -- nausea, vomiting, dizziness, headache, blurred vision, sleep disturbance, fatigue, lethargy or other sensory loss -- that can't be accounted for by peripheral injury or other causes.
  2. Cognitive deficits -- attention, concentration, perception, memory, speech, executive functions -- that can't be completely accounted for by emotional state or other causes.
  3. Behavioral changes -- irritability, anger, dis-inhibition, unexplained laughing and crying -- that are not a psychological reaction to physical or emotional stress or other causes.

Some patients may not become aware of, or admit, the extent of their symptoms until they attempt to return to normal functioning.