Understanding Post Concussion Syndrome

Understanding Post Concussion Syndrome

Post-Concussion Syndrome or PCS is a set of symptoms that may continue for weeks, months, or a year or more after a concussion which is a mild form of Traumatic Brain Injury. If a concussion lasts for more than three months after injury, diagnose the patient. The condition is associates a wide range of symptoms: physical, such as headache, cognitive such as difficulty concentrating, and emotional and behavioural, such as irritability. Many of the PCS-related symptoms are common and exacerbate other disorders, therefore there is considerable risk of misdiagnosis. Headaches that occur after a concussion may feel like migraine headaches or tension like headaches. Most headaches are tension-type headaches, which associates with a neck injury that occurs at the same time of head injury.

CAUSES OF POST CONCUSSION SYNDROME

  • After a Fall
  • Getting into a car accident
  • Experience a blow to the head during impact sports, especially football and boxing
  • Any other reason involving injury to the skull/head

SYMPTOMS OF POST CONCUSSION SYNDROME

Headache
  • Headache
  • Dizziness
  • Vertigo
  • Drowsiness
  • Fatigue
  • Memory Problems
  • Trouble concentrating
  • Anxiety
  • Depression

CONCLUSION

In short, Post-Concussion Syndrome, also known as a post-concussive syndrome or PCS, is a set of symptoms that may continue for weeks, months, or a year or more after a concussion. A diagnosis may be made when symptoms resulting from a concussion last for more than three months after injury. The condition is associated with a wide range of symptoms: physical, such as headache, cognitive such as difficulty concentrating, and emotional and behavioural, such as irritability. Many of the PCS-related symptoms are common or may be exacerbated by other disorders, therefore there is considerable risk of misdiagnosis. So, Headaches that occur after a concussion may feel like migraine headaches or tension like headaches. Most headaches are tension-type headaches, which associates with a neck injury that occurs at the same time of head injury. To conclude, Management of this typically involves treatment addressing specific symptoms.

Go to Blogs or Got to Home

Subdural Hematoma: Simplified

Subdural Hematoma: Simplified

WHAT IS SUBDURAL HEMATOMA?

Undoubtedly, Subdural hematoma is a condition which involves the accumulation of blood between the dura mater and the subarachnoid mater which are the protective layers of the brain. The blood seeps between the dura mater as well as the arachnoid mater, collecting inside the dura mater (brain’s tough outer lining). For the most part, it occurs from rupture of veins which cross the surface convexities of the cerebral hemispheres resulting from a severe injury to the head or skull. Furthermore, the blood may press against the brain increasing the intracranial pressure which damages the delicate tissue of the brain.

So, as it expands in the subdural space, it raises the Intracranial pressure and deforms the brain. As a result of repeated bleeding and organisation causes a progressive increase in size and shows a laminated appearance. Furthermore, this can be seen in all age groups. In Infants, the cause may be a non-accidental injury, motor vehicle accidents in young adults and fall (due to trauma or any other reason) in older persons. In particular, possible causes for this are as follows:

  • Head injury [most common among younger people] 
  • Brain shrinking (atrophy) [most common among older adults] 
  • Being on medicines to prevent blood clots, such as warfarin, aspirin, and other blood thinners 
  • Cerebrospinal fluid [CSF] leaking

PATHOPHYSIOLOGY

It can be classified into the following groups. They are:

  • Acute Subdural Hematoma
  • Sub – Acute Subdural Hematoma
  • Chronic Subdural Hematoma

ACUTE SUBDURAL HEMATOMA

Acute Subdural Hematoma develops following trauma and consists of clotted blood in the frontoparietal region of the Brain. Moreover, it is the most common type of Subdural Hematoma accounting for 24% of cases of severe head injuries and has the highest mortality rate. The Clinical Manifestations appears during the first 3 days after injury. In this case, the usual mechanism in an Acute Subdural Hematoma is a high-speed impact to the skull. So, this sudden impact can strain the blood vessels within the dura, causing them to rip and bleed resulting in brain injury and even death. 

Following this, Acute subdural hematomas frequently arise from the tearing of bridging veins within the dural border cell layer which results in blood flowing into a potential space within the dura mater. To sum up, bleeding continues via a positive feedback mechanism that causes the Cerebrovenous Pressure to increase as the Intracranial Pressure elevates. So, as the Hematoma enlarges, continued dissection of the border cell layer is seen. This continues until blood begins to coagulate, stopping the border cell layer dissection, and pressure within the Acute Subdural Hematoma cavity rises to equal that in the torn bridging vein or veins.

SUB-ACUTE SUBDURAL HEMATOMA

Sub – Acute Subdural Hematoma develops when the clotted blood in the brain liquefies. Furthermore, the Clinical manifestations appear between 4-21 days after injury. For instance, causes of this involve coagulopathies and ruptured intracranial aneurysms. To conclude, subdural hematomas have even been reported to be caused by intracranial tumours.

CHRONIC SUBDURAL HEMATOMA

Chronic Subdural Hematoma develops mainly with brain atrophy and less likely following trauma. So, it is composed of liquid blood. Furthermore, the Clinical manifestations appear after 21 days of the injury. Cortical bridging veins are thought to be under greater tension as the brain gradually shrinks from the skull and even minor trauma or an injury to the skull can cause one of these veins to tear. Slow bleeding from the low-pressure venous system enables large hematomas to form before clinical signs appear.

Moreover, this results from traumatic injury which causes the tearing of the bridging veins traversing from the brain to the draining dural-venous sinuses. So, this results in the accumulation of venous blood within the subdural space over time. 

SIGNS & SYMPTOMS OF SUBDURAL HEMATOMA

ADULTS

  • Slurred Speech
  • Difficulty in walking
  • Headache
  • Confusion
  • Seizures 
  • Loss of consciousness
  • Nausea and vomiting
  • Weakness or numbness
  • Vision problems
  • Dizziness
  • Sleepiness
  • Coma

INFANTS

  • Bulging Fontanelles (The soft spots of the baby’s skull)
  • Separated Sutures (The areas where growing skull bones join)
  • Feeding problems
  • Seizures
  • High-pitched cry
  • Irritability
  • Increased head size (circumference)
  • Increased sleepiness 
  • Persistent vomiting

RISK FACTORS

  • Chronic alcoholism
  • Epilepsy
  • Coagulopathy
  • Arachnoid cysts
  • Anticoagulant therapy 
  • Cardiovascular disease 
  • Thrombocytopenia
  • Diabetes mellitus
  • Very young or very old age
  • Head injury, such as from car crashes, falls etc
  • Playing high-impact sports
  • Previous brain injury
  • Cerebrospinal fluid leak 

Know about more disorders related to the Brain, Click here

Locked-In Syndrome: Causes, Clinical Manifestations & Treatment

Locked-in syndrome is a rare neurological disorder in which all voluntary muscles are completely paralysed except those which control the eye movements. Locked-in syndrome is caused by pons injury, a part of the brainstem containing nerve fibres that transmit information to other brain areas. Sometimes named pseudocoma.

CAUSES

The most common cause of the locked-in syndrome is damage to a particular part of the brainstem known as the pons. The pons has important neuronal pathways between the cerebrum, spinal cord, and cerebellum. In locked-in syndrome, there is an obstruction of all motor fibres flowing from a grey matter in the brain through the spinal cord to the muscles of the body, as well as damage to the centres in the brainstem that are essential for facial control and expression. Damage to the pons most commonly occurs from loss of tissue due to lack of blood flow (infarction) or bleeding (haemorrhage) – it can be caused less frequently by trauma.

Many different factors can cause an infarction, such as a blood clot (thrombosis) or a stroke. Additional conditions that can cause locked-in syndrome include infection in certain areas of the brain, tumours, loss of protective insulation (myelin) surrounding nerve cells (myelinolysis), nerve inflammation (polymyositis), and other disorders such as lateral amyotrophic sclerosis (ALS).

SIGNS AND SYMPTOMS

PARALYSIS OF VOLUNTARY MUSCLES

  • Paralysis of all 4 limbs and torso
  • Bulbar palsy

RESPIRATORY ABNORMALITIES

  • Cheyne-Stokes breathing, apnea, loss of voluntary control of breathing
  • Often requires tracheostomy and mechanical ventilation

PRESERVATION OF THE FOLLOWING FUNCTIONS

  • Normal consciousness, language comprehension, cognition, and ability to make decisions 
  • Vertical eye movements and voluntary blinking 
  • Cutaneous sensation 

DIAGNOSIS

  • CT/MRI of the brain
  • EEG 
  • Lumbar puncture
  • Neuropsychological testing

TREATMENT

IN ACUTE PHASE

  • Supportive therapy (airway, breathing, circulation)
  • Treat the underlying, often life-threatening, disorder

IN THE REHABILITATIVE PHASE

  • Respiration: most patients require tracheostomy and mechanical ventilation
  • Feeding: initially feeding tube; possibly gastrostomy
  • Physiotherapy: passive stretching exercises; skeletal muscle relaxants and/or botulinum toxin for spasticity; frequent position changes to avoid pressure sores
  • Speech: eye-gaze sensor-controlled computer communication programs, computer/internet use; use of speech synthesizers; eyelid blinking to communicate yes/no

Visit home page (click here)