Post-concussive to organic causes with a psychological basis

Post-concussive
syndrome is considered as a minor traumatic brain injury that usually occurs
after a person gets a shock to the head. In PCS, there is a injury in the white
matter of the brain, which is in the inner part of the brain and consists of
the axons of neurons that create the connections within the brain. It is
considered also as a complex disorder in which many various symptoms can
present such as headaches and dizziness and lasting for weeks and months sometimes.
Symptoms are often caused by mechanical damage to the brain and by a trouble of
the messaging structure within the nerves causing the concussion.
Symptoms of post concussive syndrome in early stage are often due to organic
causes with a psychological basis while the symptoms continuing beyond 3
months are due to a nonorganic cause with psychological basis (Al Sayegh, et al., 2010).

In Post-concussive syndrome, symptoms usually occur within
the first week and sometimes disappear within three months. However, the
symptoms may sometimes persist for a year or more. Post-concussive syndrome
presentations include: headaches dizziness, fatigue, irritability, anxiety, insomnia,
low concentration and memory, ringing in the ears, blurry vision, light and noise
sensitivity, and a decrease in taste and smell, which rarely occurs (Al Sayegh,
et al., 2010).

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Assessment. In
the assessment of people with post concussive syndrome, a clinical made assessment
should be done by doing a GSC. Also Automated
Neuropsychological Assessment Metrics (ANAM) and Immediate Post-Concussion
Assessment and Cognitive Testing (ImPACT) are two assessment tools that can be
used to test cognitive function before injury and after injury and make
comparison according to some studies (Sullivan & Garden, 2011; Wu-chen
& Brady, 2012).

Diagnosis and treatment

1)There is no single test for
post-concussion syndrome. Tests that can be used in diagnosis are CT of brain
or MRI along clinical diagnosis based on presenting symptoms.

2) There is no precise treatment for post-concussion
syndrome. Treatment is made based on the individual symptoms the patient is experiencing
since the types of symptoms and frequency are different for everyone. The
primarily goal after concussion is to efficiently manage symptoms. Treatment
may include prescriptions for pain medications and anti-nausea medication,
and antidepressants on follow up visits if needed. Also, some nonpharmacologic
therapy may be given such as early psychological intervention and cognitive
rehabilitation, physical and occupational therapy. People with Post concussive
syndrome can be advised to get
plenty of sleep at night, have adequate rest during the day,
avoidance of physically demanding activities or
any activities requiring a lot of concentration,
and lastly avoidance of
alcohol or usage of other non-prescribed drugs (Al Sayegh,
et al., 2010; Ayr, et
al., 2009 ).

Traumatic
Brain Injury

Traumatic brain
injury is an injury that happens when an outside mechanical force causes brain damage
and dysfunction. It also results from a forceful blow to the head or body. Traumatic
brain injury can be minor or severe. Mild traumatic brain injury causes by a brief
dysfunction of brain cells whereas a more severe traumatic brain injury can cause
bruising, torn tissues, bleeding and other physical damages to the brain resulting
in long-term complications or even death. TBI can be caused by a focal brain damage due from contact
injury types resulting in contusion, laceration, and intracranial hemorrhage.
It can also be caused by a diffuse brain damage due to acceleration or deceleration
injury types resulting in diffuse axonal injury or brain swelling. The cerebral
injury after TBI is characterized by direct tissue damage that often impaired
regulation of CBF and metabolism causing ischemia (Werner &
Engelhard, 2007).

Traumatic brain injury can have many signs and
symptoms from physical, sensory, cognitive to mental symptoms. The signs and symptoms
include:

Physical symptoms

·        
Loss of consciousness that can happen from several minutes to
hours

·        
Persistent headache or worsening headache

·        
Repeated vomiting or nausea

·        
Convulsions or seizures

·        
Dilating pupils of the eyes

·        
Clear fluids drainage from the nose and ears

·        
Incapability to rouse from sleep

·        
Weakness or numbness in fingers and toes

·        
Loss of coordination

Cognitive or mental symptoms

·        
Deep confusion

·        
Agitation, combativeness or other rare behaviors

·        
Slurred and nonclear speech

·        
Coma and other disorders affecting conscious
(Shedy et al., 2009; Smits, et al., 2011).

Children
can present with those signs and symptoms of change
in eating, continuous crying and inability to be comforted, easy irritability, inability
to pay attention and in sleep habits, sadness or depressed mood, and loss of
interest in their favorite toys or games (Shedy et al., 2009; Smits, et al.,
2011).

Diagnosis and treatment

 Traumatic
brain injuries are usually considered as emergencies. Due to their later consequences
that can worsen quickly without treatment, it is important to do a quick
clinical assessment of the injury and provides treatment as well. Glasgow coma scale is one assessment tool containing a 15-point
test that can use to assess the initial severity of a brain injury. Higher
scores mean less severe injuries. Also, getting a detailed history about the
injury is important factor in the assessment. Imaging tests such as CT of brain
with no contrast and MRI along intracranial pressure monitoring are important
in diagnosis (Werner & Engelhard, 2007).

Treatment depends on the severity of the
injury. For mild traumatic brain injury, no treatment is required other than adequate
rest and otc pain relievers to treat a headache for instance. Treatment is
required unless there are persistent, worsening or new symptoms. If
there is moderate or severe injury, treatments should include to make sure
patients have adequate oxygen and blood supply, maintaining blood pressure, and
avoiding any further injury to the head or neck. Medications such as
diuretics, anti-seizure drugs, and coma inducing drugs can be helpful. Emergency
surgery may require if there is a need to reduce more additional damages to the
brain. Lastly, people who had traumatic brain injury often require having
rehabilitation therapy in their plan of care with different rehabilitation
services such as speech, physical, occupational, nurse, recreational therapists (Werner &
Engelhard, 2007; Shedy et al., 2009; Smits, et al., 2011).

References

Sullivan K, Garden NA. Comparison of the
psychometric properties of 4 post-concussion

         
syndrome measures in a nonclinical sample. J
Head Trauma Rehabil. 2011;26(2):170-6.

Wu-Chen WY, Brady MF. Postconcussive syndrome. In: Ferri’s Clinical Advisor,
         2012. Philadelphia, PA:
Mosby; 2011:815.

Ryan PB, Lee-Wilk T, Kok BC, Wilk JE.
Interdisciplinary rehabilitation of mild TBI and PTSD:  

        
a case report. Brain Inj.
2011;25(10):1019-25.

Sheedy J, Harvey E, Faux S, Geffen G, Shores EA. Emergency department
assessment of mild  

         
traumatic brain injury and the prediction of post concussive symptoms: a
3-month

        
prospective study. J Head Trauma
Rehabil. 2009;24(5):333-43.

Smits M, Houston GC, Dippel DWJ, Wielopolski PA, Vernooij MW, et al.
Microstructural brain

        
 injury in post-concussion
syndrome after minor head injury. Neuroradiology.
 

        
 2011;53(8):553-63.

Al Sayegh A, Sandford D, Carson AJ. Psychological approaches to treatment
of post-concussion

        
syndrome: A systematic review. Journal of Neurology, Neurosurgery,
and

        
Psychiatry. 2010;81(10):1128–1134. PubMed

Ayr LK, Yeates KO, Taylor HG, Browne M.
Dimensions of post concussive symptoms in

       
children with mild traumatic brain injuries. Journal of the
International Neuropsychological

       
Society. 2009;15(1):19–30. PMC free article PubMed

Werner, C & Engelhard, K.
(2007). Pathophysiology of Traumatic Brain Injury. British Journal    

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        9,https://doi.org/10.1093/bja/aem131