General
- LOC does not increase the risk for PCS
Multiple definitions of PCS, a combination of definition is as follows:
- Patients having ≥ 3 symptoms including headache, fatigue, dizziness, irritability, difficulty concentrating, memory difficulty, insomnia, and intolerance to stress, emotion, or alcohol,
- Symptoms must begin within 4 weeks of injury
- Symptoms remain for ≥ 1 month after onset of symptoms.
Numbers
- Occurs in 10%-15% of concussed individuals.
- >80% of PCS patients had at least 1 previous concussion
- Average number of previous concussions was 3.4
- Median duration of PCS was 6 months
- 50% of patients were <18 years of age
Clinical features
Sensory and motor:
- Headache (most common)
- Dizziness
- Nausea
- Changes in vision, such as blurred vision, double vision, 'seeing stars' and 'looking through a haze'
- Visual processing problems, such as not taking in what you are seeing
- Difficulties staying awake, sleeping for many more hours than usual and chronic fatigue when awake
- Unusual sensitivity to noise (hyperacusis)
- Unusual sensitivity to bright lights (photophobia)
- Difficulties with balance, coordination and mobility, often resulting in falls, banging into objects and, at times, further traumatic brain injuries
- Speech problems.
Cognition:
- Cognitive difficulties (as long as the GCS score is 15), sometimes described as 'brain fog', which may include problems finding words or numbers, difficulty speaking, slowed responsiveness, short-term memory problems, difficulty concentrating and problems with information processing, such as following conversations, digesting text and finding words
- Difficulties with executive functions, such as organising, planning and multitasking
- Amnesia
- Problems with spatial awareness and proprioception, including the sensation of touching something as if through a layer of numbness.
Emotional:
- Lability, such as unusual laughing or crying (because of being overwhelmed by sense impressions) or irritability
- Depression
- Anxiety.
Additional symptoms that may present in children under 5:
- Changes in normal behaviour after a head injury, such as crying a lot or irritability
- Changes in feeding or sleeping habits
- Loss of interest in people or objects
- Listlessness.
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