Post-concussion syndrome, persistent symptomatic concussion, related sequelae, and treatment of mild closed head injury

Concussion, particularly sport-related concussion, has recently seen a revival of academic and clinical interest. While most concussions are self-limited and resolve over 7–10 days, there is a small subset of patients who experience prolonged symptoms. These prolonged symptoms are often refractory to treatment. Once the symptoms of a concussion become protracted they can prove to be very difficult to treat. This constellation of symptoms is most commonly referred to as post-concussive syndrome (PCS) but several synonymous terms exist in the literature, most notably post-concussive disorder, persistently symptomatic concussion, and difficult concussion. While there has been an explosion of research regarding acute concussion, more chronic injuries are just now being investigated as a distinct entity. To be frank, we simply do not know enough about the PCS to accurately describe the risk factors, common features, or ideal treatment for PCS. At this time, treatment is largely anecdotal and derived from a combination of successful treatment paradigms used in acute concussion and more severe traumatic brain injuries. Fortunately PCS is beginning to also see an upsurge in attention that will hopefully provide valuable insight into the pathophysiology needed to treat it more effectively. For now, an active and comprehensive rehabilitation program focusing on the persistent symptoms and managed from an experienced concussion clinic is the best course of action.