Post Concussive Syndrome and Mild to Moderate Brain Injury
There is nothing mild about mild brain injury. Each year approximately 500,000 individuals make emergency room visits and 200,000 hospitalizations occur from Mild Brain Injury, according to a 2003 report by the Centers for Disease Control. The effects of a Mild Brain Injury may not be seen at the time of the original emergency room visit and the subtle cognitive and psychological changes may take days, weeks or even months to be recognized.
According to the ICD-10, Post Concussive Syndrome (PCS) consisting of three of eight symptoms and functional changes consisting of:
headache; dizziness; fatigue; irritability; insomnia; concentration difficulty; memory difficulties and intolerance of stress, emotion and/or alcohol.
The DSM-IV identifies Post Concussive Syndrome as: a history of TBI causing significant cerebral concussion; cognitive deficits in memory and/or attention; and presence of at least three of eight symptoms consisting of:
fatigue; sleep disturbance; headache; dizziness; irritability; affective disturbance; personality change and apathy.
Similar, but different in establishing the criteria for Post Concussive Disorder.
In an article by Corwin Boake, Ph.D. and Harvey S. Levin, Ph.D. et al, Diagnostic Criteria for Post Concussional Syndrome After Mild to Moderate Brain Injury, in The Journal of Neuropsychiatry and Clinical Neurosciences, V.17, N.3, Summer 2005 the authors note the discrepancy in the diagnosis of Post Concussive Syndrome (PCS)using the ICD-10 vs the DSM-IV. The authors found that the prevalance of PCS was substantially higher using the ICD-10 criteria. The article confirms the findings of WHO Task Force which suggested further diagnostic refinement of the DSM-IV and ICD-10.
While the research needs to move forward to establish the criteria for the diagnosis of PCS, the problems of brain injury are very real and immediate. Individuals who present with potentially mild brain injury in emergency departments need to be educated better about the effects of the injury. Many of these individuals are at risk for multiple concussive injuries through sport and recreational activities. Preventing an another injury for the individual may be the key function performed through education. Brain injury professionals continue to work with high school, college and professional sports coaches to establish strategies to protect injuried players from subsequent injuries.
With the recent death of Terry Long, a professional football player, on our minds and the countless daily practice sessions undertaken by both professional and amateur athletes during which an injury to brain can occur, the focus on prevention cannot be discounted. Athletes at any level and, of any age, cannot be sent back into the fray following a bump to the head. Coaches, parents, physicians and fellow players must take heed: “Prevention is protection.”