What are the diagnostic criteria for Post-Concussive Syndrome (PCS)?

From the Guidelines

Postconcussive syndrome (PCS) is diagnosed when symptoms persist for more than 4 weeks after a concussion or mild traumatic brain injury, with a combination of physical, cognitive, and emotional or behavioral symptoms. The diagnostic criteria for PCS typically include the presence of symptoms such as headache, dizziness, fatigue, sleep disturbance, neck pain, slowed thinking, difficulties with attention, concentration, memory, or executive functions, and changed emotional responsivity, irritability, quickness to anger, disinhibition, or emotional lability 1. These symptoms should represent a change from baseline functioning and cannot be better explained by another medical condition, substance use, or psychological disorder.

Key Diagnostic Considerations

• The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), defines recovery from concussion as expected within the first 2 to 3 weeks, and persistent symptoms as those lasting for more than 4 weeks after injury 1.
• The World Health Organization (WHO) established a definition of the presence of 3 or more symptoms after a head injury, but does not specify a minimum duration of these symptoms to make the diagnosis 1.
• The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition defines postconcussion syndrome as 3 months’ duration of 3 or more symptoms, including fatigue, disordered sleep, headache, vertigo/dizziness, irritability or aggressiveness, anxiety or depression, personality changes, and/or apathy 1.

Clinical Diagnosis and Management

• There is no specific laboratory test or imaging study that can definitively diagnose PCS; it remains primarily a clinical diagnosis based on symptom presentation and history of head trauma.
• Management typically involves a multidisciplinary approach including rest, gradual return to activities, cognitive rehabilitation, medication for specific symptoms, and psychological support.
• Early intervention and appropriate management can help reduce the duration and severity of symptoms, though most cases resolve spontaneously within 3-6 months after injury.

Recent Guideline Recommendations

• The Danish Health Authority commissioned a set of National Clinical Guidelines to evaluate and summarize the evidence for the effectiveness of nonpharmacological interventions in adults experiencing persistent postconcussion symptoms (PPCS) 1.
• The guideline recommends a systematic approach to diagnosis and management, including early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of neck and spine, oculomotor vision treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment 1.

From the Research

Diagnostic Criteria for Post-Concussive Syndrome (PCS)

The diagnostic criteria for Post-Concussive Syndrome (PCS) are not strictly defined, but several studies provide insight into the symptoms and factors that contribute to the condition.

• Symptoms of PCS may include headaches, dizziness, cognitive difficulties, somatosensory issues, sleep disruption, impaired cognition, photo- and phonophobia, fatigue, and emotional symptoms such as anxiety and depression 2, 3, 4.
• The condition can be conceptualized as two multidimensional disorders: early-phase posttraumatic disorder and late-phase posttraumatic disorder, with the latter being highly influenced by psychosocial factors 2.
• Risk factors for the development of PCS include a high early symptom burden, history of multiple concussions, psychiatric conditions, longer duration of unconsciousness or amnesia, and younger age 2, 4.
• A thorough clinical evaluation, including a history, physical examination, and additional tests as clinically indicated, is necessary to diagnose PCS and identify underlying symptom generators 5, 3.
• Differential diagnoses should consider comorbid and premorbid conditions, as well as other possible contributing factors, such as headache disorder, cervical injury, anxiety, depression, somatization, vestibular dysfunction, and visual dysfunction 2, 4.