post concussion syndrome

[m_watt]

Approximately 4 months ago I had a biking accident whilst holidaying in Australia, the outcome was fractured ribs, broken wrist, numerous abrasions and severe concussion. I was told I was unconscious for about half an hour, however due to memory loss I do not remember anything of the incident, or much before and after.

The past 4 months have been extremely difficult due to a number of symptoms which I have been suffering. This includes memory loss, sensitivity to light, blurred vision, difficulty concentrating, personality changes and general low depressed feeling. Upon returning to the UK I was diagnosed as having post concussion syndrome and that these were all symptoms.

After a little research I have been unable to find much information within the UK and therefore any type of Practitioner that will be able to advise/treat me. I guess as a starting point I would like to know that I'm going to recover, and when. Also any form of exercises or treatments that would help me would be of great use. Any help or advice would be greatly appreciated.

[CCFNeuroMD JT, MD]

I am happy to address the questions that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a substitute for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.

Your symptoms include cognitive slowing (i.e. memory loss, concentration difficulties), light sensitivity, blurred vision, depressed mood, and changes in personality, onset following a biking injury in which you sustained a concussion with loss of consciousness.  You have expressed your frustration in the paucity of information available on the subject of “postconcussive syndrome” (PCS), and I must admit that part of your difficulty is rooted in the fact that the details of this syndrome remain the subject of debate.  To date, there is no universally accepted definition of PCS, although most of the literature support some version of the following: History of traumatic brain injury (TBI) and presence of  at least 3 of 8 symptoms: (1) headache, (2) fatigue, (3) insomnia, (4) irritability, (5) dizziness, (6) impaired memory (7) impaired concentration, and (8) intolerance of stress, emotion, or alcohol.

Because there is little data available on PCS, it is difficult to offer a prognosis in 100% confidence.  Although many patients tend to improve over the first three months, there have been reports of symptoms persisting as far as a year or more following the initial incident.  Treatment is supportive and is generally approached from a multidisciplinary perspective.  Physical and occupational therapy is often helpful in improving day-to-day function, and there may be a roll for a psychiatrist and/or a neurologist in treatment of symptoms.  

At this point, you are 8 months out from your injury.  I hope the information above is of some help, and I wish you the best of luck with your recovery.

[stonem]

I'm a mild traumatic brain injury survivor and social worker and work a lot with people who have had your type of injury.  It is quite common for people to continue to have problems for a long period of time.  Check out the website www.mybrainconnections.com, a website designed by and for brain injury survivors.  You'll find helpful information as well as a group of people who are struggeling with the issues you're facing at the moment.  The site as an email discussion group and if you join, you'll find lots of folks who can help you find a helpful path.

[ga1687]

Keep in mind that everyone is different.  However, research suggests that most indiviudals will recover from PCS within 4 to 8 weeks.  Given your LOC of 30 minutes and amneisa (PTA) suggest a more significant injury, most likely a grade 3 concussion, that being if your neuroimaging was clear.  

The symptoms you described are consisent with mild TBI.  Most patients we suggest to limit your activities, cognitive and physical, as they may worsen symptoms and prolong recovery.  Increase activites as tolerated.  If possilbe look for a neuropsychologist in your area.  

The problem with mild tbi is that it isn't readily available to see.  It's not like a broken arm, but an injury nonetheless.  Take your time and rest and symptoms should pass within 8 weeks.  If not, find neuropsychologist for evaluation.  As, anti-depressants have been shown useful for mood changes secondary to tbi.  good luck.