A Review of the Postconcussion Syndrome

Objective: This review will focus on aspects of the postconcussion syndrome (PCS), including accompanying symptomatology, neuropsychological changes, brain imaging studies and treatment. Method: In each topic area, those research studies resulting in the most interpretable data are reported. Since there is little research in some aspects of the PCS, some studies of limited merit are described, with their limitations outlined, in lieu of not reporting any study. The section on psychopharmacology largely consists of opinions of recognized clinicians, since there is almost no research on the psychopharmacology of PCS. Results: Mild traumatic brain injury is a relatively frequent occurrence which often results in the postconcussion syndrome (PCS), consisting of complaints of irritability, fatigue, headache, difficulty concentrating, dizziness, and memory problems. Anxiety and depression are also frequently present, especially later in its course. Although the PCS has often been thought to reflect a psychological response to injury, there is considerable recent evidence to suggest that it is primarily a physiologic disturbance. For most individuals, treatment consists primarily of education of the patient and his/her family, along with supportive counseling regarding emerging problems at work or at home. A subgroup of patients, however, may require psychopharmacologic intervention. Conclusion: More research is needed in all aspects of PCS, especially its neurophysiology and pharmacologic treatment. Relationships between neurophysiological changes and behavioral and neuropsychological changes are unknown. New imaging techniques, such as single-photon emission tomography, and positron emission tomography will likely play an important role in understanding the physiology of this disorder.