Our Medical Advisors
||Bill Levinger, MD
Head injury survivor
||Hugh R. MacMahon, MD
Neurology, Sea, WA
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About Post Concussion Syndrome, PCS.
PCS is a specific set of neuropsychological (thinking, behavioral, and
emotional) disorders caused by traumatic brain injury, aka concussion.
results from actual, physical, damage, or injury to the brain caused
by an external force. A brain subjected to such violent forces can
be torn or sheared, crushed, or displaced, or simply destroyed. It
can bleed, swell, and occasionally, it might even shut down. The
resultant condition is known as traumatic brain
Leading causes of TBI are motor vehicle
accidents, work place injuries, acts of violence, falls, sports and recreational
injuries. TBI can occur without any outward physical evidence of
injury or trauma. Examples of such invisible injury include, whiplash and
shaken babies. It is the damage to delicate brain as
opposed to outward injury that distinguishes brain injury from superficial
head injury. See Concussion
in Sports. and Shaken
Concussion Syndrome. TBI impairs the ability
to think, do, and know. Memory mood and attention are the top three
complaints of brain injury patients. Intellectual dullness, and mental
rigidity are apparent signs of brain injury. Personality changes are common,
and rapid mood swings alternate with waxing and waning energy levels. Taken
individually, such impairments might not amount to much. However,
such impairments usually appear in groups or clusters. In many cases the
impairments are widespread and disrupt many brain systems. The overall
effect can be profoundly disabling. See TBI
Checklist for a more complete listing of PCS impairments.
Debate. For well over a century the validity and voracity
of symptoms following mild brain injury have been at the center of a great
debate among doctors. This collection of symptoms has come to be
called post concussion syndrome, chronic brain syndrome, and post traumatic
syndrome to name a few. Definitions of these disorders vary widely,
and carry different meaning among individual doctors. Case in point;
mild or minor head injury,
MHI is not necessarily synonymous with
mild traumatic brain injury,
MTBI nor is it clear whether either
term implies "concussion."
Thinking and behavioral disorders such as:
memory, mood, attention, concentration, depression, fatigue, and
increased mental effort constitute the major sources of disability following
MHI. The difficulty of distinguishing between the primary neurological
damage, and secondary psychosocial problems is often difficult and can
stir controversy, especially where "normal" neurological findings are noted.
Although the controversy surrounding PCS is
not new it gained added momentum in the 1860's. A growing school
of thought emerged that gave credence to the disorder. Prominent
scientists offered theories concerning causality, but without
hard evidence of structural damage to the brain, such theories were quickly
discredited. However, the flood of patients bringing such complaints
continued to grow in proportion to the increases in mechanized transport.
During the 1860's there was an ever increasing amount of railway travel
with a high incidence of collisions and sudden stops. Increasingly, doctors
embraced the opinion that the post traumatic disorders resulting from these
injuries occurred from mechanical damage to the brain and spinal cord.
The scientific atmosphere at the time was increasingly
influenced by prominent psychiatrist such as Freud and Charcot, and terms
such "hysteria" and "functional" were gaining popularity. Social
and political changes along with legislation providing for Worker's Compensation
had a profound influence. Malingering was considered a common cause
of otherwise unexplainable railway injuries among both passengers and workers.
Over the next century the sentiment in both the scientific community and
general public was clearly biased against any organic explanation for PCS.
In the 1960's the advent of diagnostic imaging
devices such as CT Scans, MRI's and PET Scans gave new credence to theories
of organic injury of the brain. However, in the best cases such scans
have shown only slight, diffuse abnormalities in a small number of
cases. It is thought that the newer quantitative EEG's, or brain
mapping with increased sensitivity from computer analysis may provide
Emergency Medicine Journal - Jay D. Fisher MD FAAP, Editor Pediatric
Emergency Services, University Medical Center, Las Vegas, NV url: http://www.pediatric-emergency.com/headtrauma.htm
helmets for children!
underestimate the risks of children sustaining a brain injury
while riding on wheels
In fact, a fall
from as little as 2 feet can result in a Brain injury!