Ian Purcell MD PhD Monali Patel MD Otoneurology Call 858 223 2172
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Post-Concussive Syndrome/Traumatic Brain Injury

After a concussion or other head injury, dizziness, headache, imbalance, and trouble concentrating can persist for weeks or longer, and they often respond to targeted treatment.

At a glance

Symptoms
Headache, dizziness, imbalance, fatigue, and trouble concentrating
Common causes
Injury to the brain, and often the inner ear, from head trauma
How it's diagnosed
Neurologic and vestibular examination, eye-movement testing, imaging when needed
Treatment
Graded return to activity, vestibular rehabilitation, and headache care

Overview

Post-Concussive Syndrome (PCS) and Traumatic Brain Injury (TBI) are related neurological conditions that can arise after an injury to the head. PCS typically follows a concussion and involves a set of symptoms that persist long after the initial injury. TBI can range from mild to severe and affects brain function, potentially causing long-term complications or disabilities.

Post-Concussive Syndrome/Traumatic Brain Injury
Post-Concussive Syndrome/Traumatic Brain Injury (TBI)

Symptoms

  • Cognitive Impairments: Difficulties with memory, concentration, and executive functions.
  • Physical Symptoms: Headaches, dizziness, fatigue, and noise sensitivity.
  • Emotional and Behavioral Changes: Irritability, anxiety, depression, and mood swings.
  • Sleep Disturbances: Insomnia or sleeping more than usual.

Diagnosis

  • Neuroimaging (MRI or CT Scans): To detect structural changes in the brain post-injury.
  • Neuropsychological Assessments: Evaluate cognitive impairments and help differentiate between PCS and other conditions.
  • Balance Testing: Using tools like the Computerized Dynamic Posturography (CDP) to assess how the injury has affected the vestibular system.

Treatment

  • Medication Management: To address symptoms such as headaches, mood disorders, and cognitive dysfunction.
  • Cognitive Rehabilitation Therapy: Helps patients regain lost cognitive functions and manage daily activities.
  • Physical and Vestibular Therapy: Aids in recovery from balance issues and dizziness.
  • Psychological Counseling: Support for emotional and behavioral challenges.

At our clinic

  • EEG (Electroencephalogram): Monitors brain activity and identifies abnormalities that could influence symptoms.
  • EMG/NCV (Electromyography and Nerve Conduction Velocity): Assesses the impact of TBI on nerve function.
  • Videonystagmography (VNG): Evaluates vestibular health, which is often compromised following head injuries.
  • Vertigo Recording Goggles: Diagnose specific types of balance disorders related to brain injuries.

Living with PCS & TBI:Ongoing management is crucial for living with PCS and TBI, involving:

  • Educational Resources: Helping patients and families understand the condition and its impacts.
  • Lifestyle Modifications: Recommendations to reduce symptoms and support recovery.
  • Support Networks: Connecting patients with community resources and support groups.

Testing that can help

Testing is chosen from your history and examination. These are the tests most often used here.

DizzyDoctor Vertigo Recording GogglesHigh-resolution infrared video goggles used to document eye movements during dizziness and positional vertigo evaluation.Videonystagmography (VNG)A comprehensive eye-movement test battery used to evaluate vestibular and oculomotor function.Computerized Dynamic Posturography (CDP)Balance platform testing that measures how vision, vestibular input, and body sensation contribute to postural control.Electroencephalogram (EEG)Brain-wave recording used when spells, altered awareness, or neurologic symptoms raise concern for seizure activity or other cortical patterns.
Specialty care: Vestibular DisordersVestibular disorders encompass a range of conditions affecting the vestibular system, which is crucial for maintaining balance and spatial orientation.Vestibular MigraineVestibular migraine is a common cause of recurrent vertigo, in which migraine affects the balance system, with or without a headache.Vestibulo-Ocular Reflex (VOR)The vestibulo-ocular reflex keeps vision steady during head movement by moving the eyes opposite to the head.Vestibular RehabilitationVestibular rehabilitation is an exercise-based therapy that retrains the brain to compensate for inner ear problems, reducing dizziness and improving balance.

When to seek urgent care

Call 911 or go to the nearest emergency department if dizziness or imbalance starts suddenly together with any of the following, since these can be signs of a stroke or another emergency:

  • Weakness or numbness of the face, arm, or leg, especially on one side
  • Trouble speaking or understanding speech
  • Double vision or sudden loss of vision
  • A sudden, severe headache
  • Inability to walk or stand
  • Chest pain, fainting, or a seizure

Further reading

This article is for general education and does not replace a medical evaluation. Testing and treatment are chosen for each patient after a full history and examination.