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].

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.

Treatment for Postconcussive Syndrome is primarily symptomatic and supportive. It may include medications to manage headaches and mood disorders, such as antidepressants or pain relievers. Cognitive therapy can help address memory and concentration issues, while psychotherapy may be beneficial for emotional symptoms. Lifestyle modifications, such as adequate rest and gradual return to activities, are also important components of management.

The prognosis for PCS varies. Many individuals experience a gradual improvement in symptoms over time, although the duration can differ significantly. Some may recover within a few months, while others might have persistent symptoms for a year or more. Early intervention and a comprehensive management plan can improve outcomes and help patients return to their normal activities.

The exact cause of Postconcussive Syndrome is not fully understood. It is believed to result from a combination of physical damage to the brain, psychological factors, and individual susceptibility. The initial concussion may disrupt normal brain function, leading to the prolonged symptoms seen in PCS.

PCS can affect individuals of any age who have experienced a concussion. However, it is more commonly reported in adults than in children. Certain factors, such as a history of previous concussions, pre-existing psychological conditions, and the severity of the initial injury, may increase the risk of developing PCS.

The pathophysiology of PCS is complex and not entirely understood. It is thought to involve a combination of structural and functional changes in the brain. These may include alterations in neurotransmitter levels, inflammation, and disruptions in neural connectivity. Psychological factors, such as stress and anxiety, may also play a role in the persistence of symptoms.

Preventing Postconcussive Syndrome primarily involves preventing concussions in the first place. This can be achieved through safety measures such as wearing helmets during sports and using seat belts in vehicles. For those who have already experienced a concussion, following medical advice for rest and gradual return to activities can help reduce the risk of developing PCS.

Postconcussive Syndrome is a condition characterized by prolonged symptoms following a concussion. It presents with a variety of physical, cognitive, and emotional symptoms that can significantly impact an individual's quality of life. Diagnosis involves a comprehensive clinical evaluation, and treatment focuses on symptom management and supportive care. While the prognosis varies, many individuals experience improvement over time.

If you or someone you know is experiencing symptoms following a concussion, it is important to monitor these symptoms closely. Common signs of Postconcussive Syndrome include persistent headaches, dizziness, difficulty concentrating, and mood changes. While these symptoms can be distressing, they are often manageable with appropriate care and support. It is important to follow medical advice and allow adequate time for recovery.

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.