When brain injury symptoms persist

By Amy Lavin, RN, MSN, APNP, Family Health Nurse Practitioner,
Ministry Medical Group Woodruff

 
Each year an estimated 1.7 million traumatic brain injuries occur in the U.S. Nearly 75 percent of traumatic brain injuries are diagnosed as concussion. These concussions are often a result of falls, motor vehicle accidents, and sports injuries. While many patients completely recover, others have lingering symptoms that may impact their life for weeks, months, or even years.

A concussion is a mild traumatic brain injury that is caused by a bump, blow, or jolt to the head that may change how the brain functions. Concussions can also occur from a blow to the body that causes the head and brain to move quickly back and forth. Loss of consciousness isn’t required for a diagnosis of concussion. Signs and symptoms of a concussion usually fall into four categories: cognitive, physical, emotional, and sleep. Difficulty thinking clearly, headache, nausea, balance problems, irritability, sadness, and sleeping more or less than usual are some of the symptoms that may be present in a concussion. Some of these symptoms may appear right away and go away within a few days. However, for some patients these symptoms may last longer.

Post-concussive syndrome (PCS) refers to persistent concussive like symptoms that result following a traumatic brain injury. Anywhere from 30 to 80 percent of patients with mild to moderate brain injury will experience some symptoms of PCS. Symptoms start within a few days after the head injury and usually persist after three months. Fifteen percent of patients will have symptoms one year later. Usually patients do not exhibit neurologic deficits on examination, but report headache, fatigue, dizziness, impaired memory, difficulty concentrating, insomnia, irritability, as well as lowered tolerance of stress or alcohol. Several other associated symptoms are known to exist in patients with PCS.

• Diagnosis of PCS

Studies have shown that in concussion there is damage to the neurons, or microscopic parts of the brain that make connections within the brain. There are often very small hemorrhages and swelling in the brain. This damage may result in problems in how the brain processes information which may lead to the clinical signs and symptoms of PCS. Unfortunately, common tests in the clinical setting typically do not identify this physical damage. Newer, more sophisticated imaging technologies are more effective in capturing the damage that occurs in concussion. Unfortunately, this equipment often isn’t readily available and is quite expensive.

Upon presentation, a person with PCS usually demonstrates a normal neurological exam, but reports the more subjective symptoms. Neuropsychological testing may reveal difficulties in concentration, memory, language, and executive tasks. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the first, most-widely used, and most scientifically validated computerized concussion evaluation system. ImPACT provides neurocognitive assessment tools and services that are used by medical doctors, psychologists, athletic trainers, and other licensed healthcare professionals to assist them in determining an athlete’s ability to return to play after suffering a concussion. It involves assessment of the athlete before the athletic playing season begins as well as after the injury and may help determine if the athlete is ready to return to play.

• Risk Factors and Predictors of PCS

Concussions resulting from car collisions, falls, assaults and sports injuries are commonly associated with post concussive syndrome. However, the severity of the type of injury does not predict whether a person will develop post concussive syndrome. Screening patients in the emergency department for immediate memory problems, delayed memory problems, as well as severity of injury-related headache may also predict which patients are at risk for PCS. A past medical history that includes having headaches, a prior traumatic brain injury, or a prior psychiatric illness such as depression or anxiety may predict the development of persistent PCS.

• How to Manage PCS

Medical providers typically develop an individualized treatment plan to alleviate the patient’s symptoms. Treatment plans often include prescriptions for pain medications, anti-nausea medications and anti-depressants. Non-pharmacologic therapy may include early psychological intervention, cognitive rehabilitation as well as physical and occupational therapy.

Tips to aid recovery following a concussion include: get plenty of sleep at night, rest during the day, avoid physically demanding activities or activities that require a lot of concentration, and do not drink alcohol or use other non-prescribed drugs. Adequate rest is vitally important as it helps the brain to heal. Slowly and gradually returning to work or school is advised. If symptoms return or a patient develops new symptoms as activity increases, it is a sign that the patient needs to cut back on activity level.

For more information on Ministry Medical Group services available in Woodruff, please call 715.356.8920, or visit ministryhealth.org.