Skip to main content

Advertisement

SpringerLink
Log in

Post-concussion Syndrome and Neurologic Complications

  • Neurology (D Stephenson, Section Editor)
  • Published:
Current Pediatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review seeks to describe the clinical manifestations of and management approach to post-concussion syndrome and other neurologic sequelae of concussion including post-traumatic headache, concussive convulsions, and chronic traumatic encephalopathy.

Recent Findings

Most children with concussion recover within 1 month but symptoms persist beyond that in patients with post-concussion syndrome. After a limited period of cognitive and physical rest, gradual reintroduction of activities, including aerobic exercise, helps to relieve concussive and post-concussive symptoms. A variety of treatment approaches are utilized to reduce specific symptoms of post-concussion syndrome.

Summary

Clinicians should screen for post-concussive symptoms so that appropriate therapies, medications, and referrals can be offered. With time and targeted interventions, improvement can be expected for patients with post-concussion syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F. Sports- and recreation-related concussions in US youth. Pediatrics. 2016;138(1):1–2. https://doi.org/10.1542/peds.2015-4635.

    Article  Google Scholar 

  2. •• McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838–47. https://doi.org/10.1136/bjsports-2017-097699. This consensus statement provides up-to-date guidelines for concussion management and return to activity.

    PubMed  Google Scholar 

  3. Rose SC, Weber KD, Collen JB, Heyer GL. The diagnosis and management of concussion in children and adolescents. Pediatr Neurol. 2015;53(2):108–18. https://doi.org/10.1016/j.pediatrneurol.2015.04.003.

    Article  PubMed  Google Scholar 

  4. Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, Dewey D. Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics. 2010;126(2):e374–81. https://doi.org/10.1542/peds.2009-0925.

    Article  PubMed  Google Scholar 

  5. • Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ. Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department. JAMA Pediatr. 2013;167(2):156–61. https://doi.org/10.1001/jamapediatrics.2013.434. This retrospective study determined the incidence of post-concussive syndrome, the most common symptoms, and predictors for developing post-concussive symptoms.

    Article  PubMed  PubMed Central  Google Scholar 

  6. • Heyer GL, Schaffer CE, Rose SC, Young JA, McNally KA, Fischer AN. Specific factors influence postconcussion symptom duration among youth referred to a sports concussion clinic. J Pediatr. 2016;174:33–8. https://doi.org/10.1016/j.jpeds.2016.03.014. This retrospective cohort study determined factors that influenced duration of post-concussive symptoms.

    Article  PubMed  Google Scholar 

  7. Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013;132(1):8–17. https://doi.org/10.1542/peds.2013-0432.

    Article  PubMed  Google Scholar 

  8. McCrea M, Guskiewicz K, Randolph C, Barr WB, Hammeke TA, Marshall SW, et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J Int Neuropsychol Soc. 2013;19(01):22–33. https://doi.org/10.1017/S1355617712000872.

    Article  PubMed  Google Scholar 

  9. Morgan CD, Zuckerman SL, Lee YM, King L, Beaird S, Sills AK, et al. Predictors of postconcussion syndrome after sports-related concussion in young athletes: a matched case-control study. J Neurosurg Pediatr. 2015;15(6):589–98. https://doi.org/10.3171/2014.10.PEDS14356.

    Article  PubMed  Google Scholar 

  10. Eisenberg MA, Meehan WP, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133(6):999–1006. https://doi.org/10.1542/peds.2014-0158.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tator CH, Davis H. The postconcussion syndrome in sports and recreation: clinical features and demography in 138 athletes. Neurosurgery. 2014;75:S106–12. https://doi.org/10.1227/NEU.0000000000000484.

    Article  PubMed  Google Scholar 

  12. •• Grool AM, Aglipay M, Momoli F, Meehan WP, Freedman SB, Yeates KO, et al. Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. JAMA. 2016;316(23):2504–14. https://doi.org/10.1001/jama.2016.17396. This prospective cohort study demonstrated that pediatric and adolescent patients who resumed physical activity within seven days of concussion had a decreased risk of persistent post concussive symptoms at 28 days after injury.

    Article  PubMed  Google Scholar 

  13. Leddy JJ, Kozlowski K, Donnelly JP, Pendergast DR, Epstein LH, Willer B. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010;20(1):21–7. https://doi.org/10.1097/JSM.0b013e3181c6c22c.

    Article  PubMed  Google Scholar 

  14. Vidal PG, Goodman AM, Leddy CA, Grady MF. Rehabilitation strategies for prolonged recovery in pediatric and adolescent concussion. Pediatr Ann. 2012;41(9):1–7. https://doi.org/10.3928/00904481-20120827-10.

    Article  PubMed  Google Scholar 

  15. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808. https://doi.org/10.1177/0333102413485658.

    Article  Google Scholar 

  16. • Kuczynski A, Crawford S, Bodell L, Dewey D, Barlow KM. Characteristics of post-traumatic headaches in children following mild traumatic brain injury and their response to treatment: a prospective cohort. Dev Med Child Neurol. 2013;55:636–41. https://doi.org/10.1111/dmcn.12152. This article describes the prevalence of headache types amongst post-traumatic headache and shows that post-traumatic migraine is the most common type.

    Article  PubMed  Google Scholar 

  17. Blume HK, Vavilala MS, Jaffe KM, Koepsell TD, Wang J, Temkin N, et al. Headache after pediatric traumatic brain injury: a cohort study. Pediatrics. 2012;129(1):e31–9. https://doi.org/10.1542/peds.2011-1742.

    Article  PubMed  Google Scholar 

  18. Gioia G, Collins M. Acute Concussion Evaluation (ACE) Physician/Clinician Office Version. In: Heads up: brain injury in your practice. Children’s National Medical Center. CDC; 2006. https://www.cdc.gov/headsup/pdfs/providers/ace-a.pdf. Accessed 8 Nov 2017.

  19. Gawel MJ, Rothbart P, Jacobs H. Subcutaneous sumatriptan in the treatment of acute episodes of posttraumatic headache. Headache. 1993;33(2):96–7. https://doi.org/10.1111/j.1526-4610.1993.hed3302096.x.

    Article  CAS  PubMed  Google Scholar 

  20. Abend NS, Nance ML, Bonnemann C. Subcutaneous sumatriptan in an adolescent with acute posttraumatic headache. J Child Neurol. 2008;23(4):438–40. https://doi.org/10.1177/0883073807309772.

    Article  PubMed  Google Scholar 

  21. • Heyer GL, Idris SA. Does analgesic overuse contribute to chronic post-traumatic headaches in adolescent concussion patients? Pediatric Neurology. 2014;50:464–8. https://doi.org/10.1016/j.pediatrneurol.2014.01.040. This retrospective study demonstrates the high incidence of analgesic overuse in patients with chronic post-traumatic headache.

    Article  PubMed  Google Scholar 

  22. Chan S, Kurowski B, Byczkowski T, Timm N. Intravenous migraine therapy in children with posttraumatic headache in the ED. Am J Emerg Med. 2015;33(5):635–9. https://doi.org/10.1016/j.ajem.2015.01.053.

    Article  PubMed  PubMed Central  Google Scholar 

  23. McBeath JG, Nanda A. Use of dihydroergotamine in patients with postconcussion syndrome. Headache. 1994;34(3):148–51. https://doi.org/10.1111/j.1526-4610.1994.hed3403148.x.

    Article  CAS  PubMed  Google Scholar 

  24. Dubrovsky AS, Friedman D, Kocilowicz H. Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey. Headache. 2014;54(5):878–87. https://doi.org/10.1111/head.12334.

    Article  PubMed  Google Scholar 

  25. Seeger TA, Orr S, Bodell L, Lockyer L, Rajapakse T, Barlow KM. Occipital nerve blocks for pediatric posttraumatic headache: a case series. J Child Neurol. 2015;39(9):1142–6. https://doi.org/10.1177/0883073814553973.

    Article  Google Scholar 

  26. Corwin DJ, Wiebe DJ, Zonfrillo MR, Grady MF, Robinson RL, Goodman AM, et al. Vestibular deficits following youth concussion. J Pediatr. 2015;166(5):1221–5. https://doi.org/10.1016/j.jpeds.2015.01.039.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zhou G, Brodsky JR. Objective vestibular testing of children with dizziness and balance complaints following sports related concussions. Otolaryngol Head Neck Surg. 2015;152(6):1133–9. https://doi.org/10.1177/0194599815576720.

    Article  PubMed  Google Scholar 

  28. Heyer G, Fischer A, Wilson J, MacDonald J, Cribbs S, Ravindran R, et al. Orthostatic intolerance and autonomic dysfunction in youth with persistent postconcussive symptoms: a head-upright tilt table study. Clin J Sports Med. 2016;26(1):40–5. https://doi.org/10.1097/JSM.0000000000000183.

    Article  Google Scholar 

  29. Singh K, Morse AM, Tkachenko N, Kothare SV. Sleep disorders associated with traumatic brain injury: a review. Pediatr Neurol. 2016;60:30–6. https://doi.org/10.1016/j.pediatrneurol.2016.02.013.

    Article  PubMed  Google Scholar 

  30. Gosselin N, Lassonde M, Petit D, Leclerc S, Mongrain V, Collie A, et al. Sleep following sport-related concussions. Sleep Med. 2009;10(1):35–46. https://doi.org/10.1016/j.sleep.2007.11.023.

    Article  PubMed  Google Scholar 

  31. Kostyun RO, Milewski MD, Hafeez I. Sleep disturbance and neurocognitive function during the recovery from a sport-related concussion in adolescents. Am J Sports Med. 2014;43(3):633–40. https://doi.org/10.1177/0363546514560727.

    Article  PubMed  Google Scholar 

  32. Kaufman Y, Tzischinsky O, Epstein R, Etzioni A, Lavi P, Pillar G. Long-term sleep disturbances in adolescents after minor head injury. Pediatr Neurol. 2001;4(2):129–34. https://doi.org/10.1016/S0887-8994(00)00254-X

    Article  Google Scholar 

  33. Tham SW, Palermo TM, Vavilala MS, Wang J, Jaffe KM, Koepsell TD, et al. The longitudinal course, risk factors, and impact of sleep disturbances in children with traumatic brain injury. J Neurotrauma. 2012;29(1):154–61. https://doi.org/10.1089/neu.2011.2126.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schmidt AT, Li X, Hanten GR, McCauley SR, Faber J, Levin HS. A longitudinal investigation of sleep quality in adolescents and young adults after mild traumatic brain injury. Cogn Behav Neurol. 2015;28(2):53–62. https://doi.org/10.1097/WNN.0000000000000056.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Mathias JL, Alvaro PK. Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: a meta-analysis. Sleep Med. 2012;13(7):898–905. https://doi.org/10.1016/j.sleep.2012.04.006.

    Article  CAS  PubMed  Google Scholar 

  36. Felt BT, Cervin RD. Medications for sleep disturbances in children. Neurol Clin Pract. 2014;4(1):82–6. https://doi.org/10.1212/01.CPJ.0000442521.30233.ef.

    Article  PubMed  PubMed Central  Google Scholar 

  37. • Biederman J, Feinberg L, Chan J, Adeyemo BO, Woodworth KY, Panis W, et al. Mild traumatic brain injury and attention-deficit hyperactivity disorder in young student athletes. J Nerv Ment Dis. 2015;203:813–9. https://doi.org/10.1097/NMD.0000000000000375. This study demonstrates that ADHD increases risk of concussion and that patients with ADHD who sustain a concussion are at higher risk of more severe concussion symptoms.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Babikan T, Arsanow R. Neurocognitive outcomes and recovery after pediatric TBI: meta-analytic review of the literature. Neuropsychology. 2009;23(3):283–96. https://doi.org/10.1037/a0015268.

    Article  Google Scholar 

  39. Maillard-Wermelinger A, Yeates KO, Taylor HG, Rusin J, Bangert B, Dietrich A, et al. Mild traumatic brain injury and executive functions in school-aged children. Dev Neurorehabil. 2009;12(5):330–41. https://doi.org/10.3109/17518420903087251.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Babikan T, Satz P, Zaucha K, Light R, Lewis RS, Arsanow RF. The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury. J Int Neuropsychol Soc. 2011;17(05):886–95. https://doi.org/10.1017/S1355617711000907.

    Article  Google Scholar 

  41. Brooks BL, Khan S, Daya H, Mikrogianakis A, Barlow KM. Neurocognition in the emergency department after a mild traumatic brain injury in youth. J Neurotrauma. 2014;31(20):1744–9. https://doi.org/10.1089/neu.2014.3356.

    Article  PubMed  Google Scholar 

  42. Covassin T, Moran R, Wilhelm K. Concussion symptoms and neurocognitive performance of high school and college athletes who incur multiple concussions. Am J Sports Med. 2013;14(12):2885–9. https://doi.org/10.1177/0363546513499230.

    Article  Google Scholar 

  43. Kontos AP, Sufrinko A, Womble M, Kegel N. Neuropsychological assessment following concussion: an evidence-based review of the role of neuropsychological assessment pre- and post-concussion. Curr Pain Headache Rep. 2016;20(6):38. https://doi.org/10.1007/s11916-016-0571-y.

    Article  PubMed  Google Scholar 

  44. Bloom DR, Levin HS, Ewing-Cobbs L, Saunders AE, Song J, Fletcher JM, et al. Lifetime and novel psychiatric disorders after pediatric traumatic brain injury. J Am Acad Child Adolesc Psychiatry. 2001;40(5):572–9. https://doi.org/10.1097/00004583-200105000-00017.

    Article  CAS  PubMed  Google Scholar 

  45. Chrisman SP, Richardson LP. Prevalence of diagnosed depression in adolescents with a history of concussion. J Adolesc Health. 2014;54(5):582–6. https://doi.org/10.1016/j.jadohealth.2013.10.006.

    Article  PubMed  Google Scholar 

  46. Annegers JF, Hauser WA, Coan SP, Rocca WA. A population-based study of seizures after traumatic brain injuries. N Engl J Med. 1998;338(1):20–4. https://doi.org/10.1056/NEJM199801013380104.

    Article  CAS  PubMed  Google Scholar 

  47. McCrory PR, Bladin PF, Berkovic SF. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. Br Med J. 1997;314(7075):171–4. https://doi.org/10.1136/bmj.314.7075.171.

    Article  CAS  Google Scholar 

  48. Perron AD, Brady WJ, Huff JS. Concussive convulsions: emergency department assessment and management of a frequently misunderstood entity. Acad Emerg Med. 2001;8(3):296–8. https://doi.org/10.1111/j.1553-2712.2001.tb01312.x.

    Article  CAS  PubMed  Google Scholar 

  49. McCrory PR, Berkovic SF. Concussive convulsions: incidence in sport and treatment recommendations. Sports Med. 1998;25(2):131–6. https://doi.org/10.2165/00007256-199825020-00005.

    Article  CAS  PubMed  Google Scholar 

  50. McCrory P, Berkovic S. Video analysis of acute motor and convulsive manifestations in sport-related concussion. Neurology. 2000;54(7):1488–91. https://doi.org/10.1212/WNL.54.7.1488.

    Article  CAS  PubMed  Google Scholar 

  51. Tenyi D, Gyimesi C, Horvath R, Kovacs N, Abraham H, Darnai G, et al. Concussive convulsions: a YouTube video analysis. Epilepsia. 2016;57(8):1310–6. https://doi.org/10.1111/epi.13432.

    Article  PubMed  Google Scholar 

  52. Wilson L, Stewart W, Dams-O’Connor K, Diaz-Arrastia R, Horton L, Menon DK, et al. The chronic and evolving neurological consequences of traumatic brain injury. Lancet Neurol. 2017;16(10):813–25. https://doi.org/10.1016/S1474-4422(17)30279-X.

    Article  PubMed  Google Scholar 

  53. •• Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, et al. Clinicopathologic evaluation of chronic traumatic encephalopathy in players of American football. J Am Med Assoc. 2017;318(4):360–70. https://doi.org/10.1001/jama.2017.8334. This article provides evidence for a link between football participation and chronic traumatic encephalopathy. Among a convenience sample of donated football players’ brains, a high proportion had pathologic findings of chronic traumatic encephalopathy and the majority of the donors were reported to have clinical symptoms of this entity prior to their death.

    Google Scholar 

  54. Meehan WP, Landry GL. Tackling in youth football. Pediatrics. 2015;136(5):e1419–30. https://doi.org/10.1542/peds.2015-3282.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurology, Children’s Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Boulevard, Office 10200-11, c/o Ashley Rees-Jones, Philadelphia, PA, 19104, USA

    Sara Fridinger & Donna Stephenson

Authors
  1. Sara Fridinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donna Stephenson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara Fridinger.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Neurology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fridinger, S., Stephenson, D. Post-concussion Syndrome and Neurologic Complications. Curr Pediatr Rep 6, 1–8 (2018). https://doi.org/10.1007/s40124-018-0149-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40124-018-0149-8

Keywords

Search

Navigation