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.