Postconcussive Subsyndrome (PCCHITS)
in CHIT
The PCCHITs as described here, refers
to physical, cognitive and psychological symptoms
that typically occur concurrently following an alleged
concussive episode. Within the last five years, the
clinical existence of postconcussive syndrome has
obtained further verification and has become more
widely accepted as a legitimate phenomena (Gouvier,
Cubic, Jones, Brantley, & Cutlip, 1992). Brown,
Fann, & Grant (1994) more recently have purported
that there has been sufficient research generated
to establish that postconcussive symptoms do occur
and they have a predictable configuration. These are
typically acute symptoms of nausea and/or vomiting,
dizziness, blurred vision, ringing in the ears, problems
thinking clearly and quickly and complaints of cervicocranial
pain.
The concussive effect to the brain
can occur with or without direct impact to the head
and there may be no documented loss of consciousness.
There may be a transient change in consciousness with
confusion and disorientation. This mild injury to
the brain may not be observable on routine neurological
examination and typically CT and MRI scanning show
no macroscopic findings. The injury underlying the
PCCHITs is microscopic in nature and can occur diffusely
throughout the brain. There is a high preponderance
of involvement in the frontopolar, orbitofrontal and
anterior temporal regions of the brain. These areas
are more susceptible to the effects of acceleration/deceleration,
rotational and coup/contrecoup injury, which is often
the underlying pathophysiologic mechanism of the concussive
episode. The PCCHITs develops primarily as a result
of the disruption of normal brain functioning.
Physiologic Subgroup
Within the PC subsyndrome we distinguish
those patients with focal neuropsychiatric signs from
those with more generalized symptoms and complaints
(Neppe, 1992; Tucker and Neppe, 1994 ). This physiologic
subgroup of patients have more physical symptoms
which predominate, although there may also be secondary
cognitive and psychological features. These patients
complain of posttraumatic headaches, myalgias, photophobia,
dizziness, ringing in the ears, balance problems,
numbness and tingling in the extremities, sleep disturbances
and often atypical disorientations or derealizations
described as spells (Goodwin, 1989).
Cognitive Subgroup
We also see a cognitive subgroupof
PCCHITs patients with primarily intellectual and cognitive
changes upon initial presentation. These patients
typically exhibit measurable deficits in attentional
processes, sustained and focused concentration, memory,
problem solving, cognitive flexibility, speed of information
processing and cognitive stamina. While there may
be concomitant psychological sequelae and physical
symptoms along with pain problems, the chief complaints
by patients are typically cognitive in nature.
Psychologic Subgroup
We also observe a psychologic sub
group of PC subsyndrome with predominantly psychological
changes characterized by susceptibility to developing
anxiety and depressive disorders, increased irritability,
low frustration tolerance, emotional volatility and
a reduced ability to cope and deal with everyday life
stressors. These patients present with a chief complaint
of feeling different since the injury. They are typically
aware of this perceived sense of change and the changes
are also observed by significant others.