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Understanding Concussion Syndrome
Written By : Bruce Kaler, MD 
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Occupational head injuries are common to most industries. Dangerous settings in the construction and manufacturing trades are obviously more at risk. However offices, transportation and warehouse work have led to significant traumatic brain injuries as well. A slip and fall can happen any place. Car accidents are also part of most every one's life. Most of the head injuries that occur are mild to moderate in severity and do not typically require hospitalization. Nonetheless, concussion or post-concussion syndrome is the source of substantial problems for the workplace, individuals and their families. Between 30 and 80 % of head injuries result in some form of post-concussion syndrome (PCS).

The exact cause of PCS is not well understood but there are some recognizable patterns in symptoms and behavior. To understand what is happening to the brain we can compare a sharp blow to the forearm. There is certainly pain after the accident. The arm may feel unusual and not work well. Nothing is broken and symptoms resolve spontaneously and completely. A similar thing can happen to the brain after direct trauma to the head. After the accident there is pain. The pain is usually substantial and feels deep-seated inside the head. The person feels "funny". Only a momentary lapse in memory or feeling dazed is possible. The brain temporarily may not work quite right exhibiting a wide range of random symptoms. However nothing is broken and it goes away spontaneously. Common symptoms of PCS can include headache, dizziness, fatigue, memory loss, light sensitivity and difficulty concentrating. Behavior can be profoundly to mildly affected. Personality change, irritability or anxiety is not unusual. Other changes can be difficulty regulating emotions, poor coordination, or temporary learning disability. The precise cause of symptoms remains unclear and is a source of disagreement among researchers. We don't understand whether there are actual microscopic changes in brain structure or neurotransmitters, the chemical messengers between brain cells, are somehow altered by the trauma. Imaging studies of the head and neck (CT and MRI) are usually normal. Symptoms of PCS are nonspecific and sometime are seen in other conditions. Women are more likely to have problems than men. Being over forty, having other preexisting medical or behavioral problems increase the risk of developing PCS. It also increases the chance of slower recovery regardless of gender. Depression and post-traumatic stress disorder can complicate recovery. These also tend to confuse the origin of symptoms experienced by the victim. Experts disagree often about which came first moreover, if the trauma was the source rather than the pre-existing condition.

Treatment is largely symptomatic. There is no specific modality that alters the course of PCS. Most symptoms resolve in a matter of two weeks to three months. Medication for pain relief and managing headaches is important. The psychological and emotional impact plays a significant role. Counseling and cognitive behavioral therapy can be very useful for many patients. The frustration of the symptoms and feeling out of control can easily contribute to depression or anxiety. Reassurance for the patient, employer and family members is important. Understanding that there are no dangerous findings and having perspective about the slow improving course can help all involved. Most of these patients reach complete resolution of their symptoms. More than half will resolve in one month while two thirds of PCS patients clear in three months. Physical therapy can improve restoration of normal routine, return to pre-injury work and be adjunctive rehabilitation of the mental status. Fortunately only a small percentage of patients will have long-term (up to one year) problems beyond three months.

Prevention is focused on safe work place environment. Use of good body mechanics while being mindful of your surroundings and co-workers is important. Dangerous industries like construction, law enforcement, warehouse work and manufacturing where falling objects may be more common necessitate use of protective gear such as approved hard hats and goggles. Proper training in use of equipment and tools can be time consuming but worthy investments. Keeping the work environment orderly with adequate space for appropriate tasks is important in the office as well as a rugged construction site.

A concussion is a complicated problem that needs thorough initial evaluation. Seek medical attention for head injures even if they seem mild and no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early and be the reassuring basis for ongoing treatment. Post concussion syndrome can be temporarily debilitating. Even though the patient may have no "red badge of courage" understanding and accommodation are in order for rehabilitation. Transitional duties are helpful for a gradual return to work. Supportive medical attention with a compassionate family and workplace can help facilitate recovery.

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