Ani (fictitious name of a patient) was 19-years-old when she was involved in a mild "fender-bender" type of motor vehicle accident.While driving in a traffic congested California freeway, she was rear ended by a driver talking on the cell phone.Since the damage to the car was so minor and there was no need for medical services, they decided to just exchange insurance information andproceeded to drive off.Ani was a student at the local college and she needed to get to school.The first sign that something was wrong was when she began experiencing difficulty navigating her way around to the school. She had driven this path on numerous occasions, there was no reason for her to get lost and nervous. She attempted to call her mother, but could not remember her phone number. She became dizzy, confused, began experiencing pain in her neck and head.She wondered whether the accident could have caused her difficulties….but it was so minor.... What did she have??? As the days went by, Ani's health deteriorated, to a point, where her mother finally took her to see her family doctor who referred her to a neurologist and a neuropsychologist for proper diagnosis and treatment.Subsequently, Ani was diagnosed with Post Concussive Syndrome (PCS).

WHAT IS A CONCUSSION AND POSTCONCUSSIVE SYNDROME?

A blow to the head or sudden jerky motion of the neck, as in a "whiplash" type injury (head does not need to hit something or be hit); can disrupt normal function of the brain.This type of brain injury is called a Concussion or Mild Traumatic Brain Injury. Concussions are not life threatening and in most cases, there are no lasting effects from injury to the brain.Eight out of ten patients with a mild head injury show some sings of the syndrome during the first 3 months after the accident. However, 15% of patients with mild head injury continue to experience symptoms of PCS 1 year after the injury.

The brain is made up of millions of long, thin nerve fibers. Some of these fibers can stretch, snap, or break as a consequence of a head injury.Like any other part of the body, the brain also has blood vessels that can tear and bleed.This happens soon after the injury, it often stops on its own and heal like any cut will.Moreover, due to the microscopic size of these nerve fibers, modern technology has yet to visualize them. Therefore, CT/MRI scans of the brain of a patient with PCS are typically normal. Snapped nerves and broken blood vessels are the cause of symptoms after a head injury

WHAT ARE THE SIGNS AND SYMPTOMS OF POST CONCUSSIVE SYNDROME?

Following a Concussion, a wide variety of cognitive (thinking abilities), physical, and psychological symptoms occur, typically in stages.The symptoms may not develop until days or even weeks after the injury.Few patients will experience all of the symptoms, but even one or two can be unpleasant.Some patients find that at first, PCS makes it hard to work, attend classes, get along at home, or reach short-term goals.Most patients with PCS don't develop symptoms until days or even weeks after the accident, but the syndrome can begin sooner.

IEarly Stage

• Headaches
• Nausea and Vomiting
• Dizziness
• Drowsiness
• Blurred or Double Vision

II. Late Stage

·Continual Headaches

·Dizziness

·Irritability and Anger

·Anxiety,Depression

·Insomnia

·Fatigue

·Short-term Memory Loss

·Attention and Concentration Problems

·Planning and Organizing Difficulties

·Decision Making and Problem Solving

·Disorientation

·Confusion

·Ringing in Ears

·Change in Behavior (impulsive)

·Change in Personality

WHAT IS THE COURSE OF RECOVERY?

The recovery process depends on several factors; 1) age (longer if older than 30), 2) severity of symptoms, 3) the location of the injury (area in the brain injured), 4) mental and physical health before the accident (if you had emotional or medical challenges before the injury,it may take longer for you to recover),5) any prior head injuries (the accumulated effects of brain injury influences the course of recovery), and 6) alcohol or drug use (interferes with healingprocess).The most rapid recovery happens the first 6 months after mild head injury, and most patients will be back to normal after 3 months. The best way to cope with these difficulties is to pace yourself, get all the rest you need,resume activities and responsibilities gradually, a little at a time, and most important of all, be PATIENT (the brain has a mind of its own, it will get better in its own time).If symptoms get worse or new symptoms develop, this is a sign to cut back on activities.Symptoms are your body's way of giving you information.Just as a broken bone prevents you from using it, so does PCS, it is your brain's way of telling you need to rest.Ignoring the symptoms often makes the symptoms worse and recovery longer. Whenever in doubt, consult with a doctor specialized in diagnosing and treating brain disorders (i.e., neurologist or neuropsychologist).

Stay Healthy,

Dr. Haygoush Kalinian