In comparing individuals with previous TBI to those without previous TBI, the former were noted to report more postconcussive symptoms and poorer satisfaction with life. In a study of 586 individuals with TBI (82% of which were concussions), it was noted that 23% had a previous TBI. Examples include preinjury medical or psychosocial factors, difficulty adjusting to the effects of injury, post-TBI development of psychiatric illness (e.g., major depressive disorder or post-traumatic stress disorder), alcohol or substance abuse, embellishing symptoms for personal gain and repeated TBIs. studied the association of persistent symptoms in 33 postconcussive patients, noting that compared with healthy controls, there were no isolated deficits in specific cognitive domains, but there was reduced information-processing efficiency and fatigability, suggesting a possible alteration of the attentional network under increased cognitive stress, even when controlling for comorbid psychiatric symptoms.Įven though there is no conclusive evidence on various factors associated with the persistence of postconcussive symptoms, several have been hypothesized. However, a small percentage of patients, ranging from 5 to 15%, continue to have persistent mood and cognitive symptoms. There is evidence that for most people with concussion and normal structural brain scan the prognosis is good, with spontaneous recovery and no long-term adverse outcomes. The International Collaboration on Mild Traumatic Brain Injury Prognosis (ICoMP) posits that symptoms experienced subsequent to concussions are nonspecific (i.e., typical reactions to the injury stress) and clinicians should be cautious about attributing common postinjury symptoms to a concussion. They can be encountered in nonbrain injuries, general medical illnesses and other neuropsychiatric disorders, thus increasing the risk of misdiagnosis.

Postconcussive symptoms are subjective and nonspecific. Confusion exists in the literature regarding the time duration for the resolution of acute symptoms, with estimates ranging from 1 month to 6 months.

Persistence of symptoms beyond this generally accepted time period has been known by various names such as postconcussion syndrome, persistent postconcussion symptoms and delayed symptom resolution. These symptoms, known as postconcussive symptoms, usually persist from a few days to weeks after injury. Soon after a concussion, the majority of people experience one or more distressing symptoms that may be grouped into three categories: emotional (e.g., depression, anxiety, anger, irritability), cognitive (e.g., inattention, decreased information processing speed, dysexecutive function) and physical (e.g., headache, nausea, vertigo, increased sensitivity to noise or light). We will discuss each in turn, then provide a brief overview of evaluation and management, concluding with directions for the future. Chronic NPS include emotional/behavioral disturbances and cognitive deficits. The acute NPS include postconcussion syndrome and the second-impact syndrome (SIS). The overarching goal of this literature review is to discuss the acute and chronic NPS associated with concussion. Presence of persistent NPS requires a comprehensive medical and psychiatric work-up because they may be caused by factors other than concussion. In some cases, NPS persist for months to years and cause cognitive impairments, emotional disturbances and/or behavioral problems. Neuropsychiatric symptoms (NPS) are common after concussion and are typically transient, often resolving in 7–10 days.

In this review article, henceforth, we will use the term concussion. The United States Department of Defense diagnostic criteria for mTBI include: loss of consciousness for 0–30 min, alteration of consciousness/mental state from a moment up to 24 h, post-traumatic amnesia for up to 24 h, Glasgow coma scale of 13–15 and normal structural imaging scan. mTBI is defined as a complex biological process affecting the brain induced by traumatic biomechanical forces to the head. About 70–80% of all TBIs are mild (mTBI) and the term concussion is often used interchangeably with mTBI.

In 2010, suspected TBI accounted for approximately 2.5 million emergency department visits in the USA. Traumatic brain injury (TBI) is a growing public health problem. First draft submitted: 30 November 2016 Accepted for publication: 16 December 2016 Published online: 2 February 2017

Concussion after effects