Managing Post-Concussive Syndrome
Post-Concussive Syndrome (PCS) is a complex and often prolonged condition that can develop following a mild brain injury or concussion.
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Mild traumatic brain injury — often referred to as a concussion — is the most common type of TBI. Concussions typically result in disruption of brain function, with symptoms such as confusion, headache, and dizziness. Based on the medical evidence, approximately 90 percent of concussion symptoms are transient, and those symptoms typically resolve within 10–14 days. However, some symptoms (physical, cognitive, behavioral, or emotional in nature) may linger for weeks.
Did You Know? ≥15% of Mild TBI Patients Develop PCS
Post-concussive syndrome research confirms that at least 15 percent of mild TBI patients will suffer from PCS, which requires further treatment. PCS is seen most often following prolonged mild TBI but can also follow moderate or severe TBI.
Post-Concussive Syndrome Symptoms — What to Watch For
Individuals experiencing PCS may face a range of physical, cognitive, emotional, and behavioral symptoms that can impact their daily functioning and overall well-being. PCS can persist beyond the acute phase of a concussion or mild TBI.
While the exact mechanisms underlying PCS are not fully understood, it is believed to involve physiological, neurobiological, and psychosocial factors contributing to ongoing symptoms and functional impairments. Symptoms can range in severity, duration, and impact on daily functioning.
Signs of a Concussion you Shouldn’t Ignore
Stewart Cohen: Based on your experience, what are the kinds of symptoms people should be looking for after a concussion?
Dr. Thomas Swirsky-Sacchetti: Well, in the cognitive sphere, it would be confusion — just not being as sharp. People describe this cloudy feeling. The way I describe it to family members: it’s kind of like one of those snow globes. When you shake it up, it gets snowy and blurry — and that’s what actually happens to the brain. It gets blurry. And gradually, that snow settles and it becomes clearer.
So that sense of cloudiness, not being as sharp, memory — short-term memory being impaired — slower processing speed. And then headaches would be more of a physical symptom. Ocular motor issues — getting headaches when reading, or having poor reading comprehension, or slowed reading.
Stewart Cohen: Nausea?
Dr. Thomas Swirsky-Sacchetti: Nausea would be another physical symptom, yes.
Post-Concussion Syndrome Treatment
Mild TBI and PCS are conditions that can have a significant impact on an individual’s cognitive, physical, and emotional well-being. There are a range of treatment options, medical practices, and therapies involved in managing mild TBI and PCS.
When a patient is admitted to the hospital with a concussion or mild TBI, the treatment approach typically focuses on both immediate assessment and ongoing care. Initially, health care providers conduct a thorough evaluation, which includes a neurological examination to assess cognitive function, coordination, and balance. Imaging studies, such as CT scans, may be performed to rule out any complications, such as fractures or bleeding within the brain. Once a diagnosis is confirmed, the primary treatment often involves evaluation, testing, monitoring, and managing symptoms. Often patients are referred to neuropsychologists who, in coordination with neurologists, perform evaluations and testing which can identify cognitive deficits, predict functional outcomes, and monitor patient recovery after TBI.
Patients are usually advised to rest both physically and cognitively because overexertion can exacerbate symptoms. Pain relievers may be prescribed to alleviate headaches, while antinausea medications can address those symptoms. Education about the importance of gradual return to normal activities is important, and if necessary, referrals for additional diagnosis, treatment, and counseling can be made.
Source: Schroeder et al, “Neuropsychological Evaluations in Adults,” American Family Physician 99, no. 2 (2019): 101.
Watch the video below to hear Stewart Cohen of Cohen, Placitella & Roth, P.C., and neuropsychologist Dr. Thomas Swirsky-Sacchetti explain the role of neuropsychological evaluation in diagnosing and understanding post-concussion syndrome.
Stewart Cohen:
My name is Stewart Cohen from the law firm of Cohen, Placitella & Roth in Philadelphia. On behalf of our traumatic brain injury practice, I’m pleased to introduce Dr. Thomas Swirsky-Sacchetti. I’ve been looking forward to this conversation.
Our topic today is neuropsychology and neuropsychologists. What is a neuropsychologist?
Dr. Thomas Swirsky-Sacchetti:
The easiest way to explain it is that, as a psychologist, I’m interested in human behavior. As a neuropsychologist, I’m interested in behavior as it relates to brain function. My job is to assess the brain in a very detailed way.
A neurologist evaluates the nervous system, but typically only has five to ten minutes to assess the brain. In contrast, a neuropsychological evaluation can take an entire day because we’re examining every aspect of how the brain functions.
Stewart Cohen:
Can you tell us a bit about your background and how you became a neuropsychologist?
Dr. Thomas Swirsky-Sacchetti:
I earned my PhD in Counseling Psychology from Temple University and worked at Jefferson Hospital, where I became interested in the connection between mind and body. That led me to pursue additional training and board certification in neuropsychology, which allows me to specialize in evaluating brain function.
Stewart Cohen:
How does a neuropsychologist’s role differ from that of a neurologist?
Dr. Thomas Swirsky-Sacchetti:
We work together, but focus on different things. Neurologists use imaging like CT scans and MRIs to look at the structure of the brain. Neuropsychologists focus on how the brain is functioning.
We use what’s called pattern analysis—looking at strengths and weaknesses across different areas of brain function—to determine which parts of the brain may not be working properly and what that means for diagnosis and recovery.
Stewart Cohen:
How does that differ from a psychiatrist?
Dr. Thomas Swirsky-Sacchetti:
Psychiatrists are generally focused on the biological and chemical aspects of the brain and often prescribe medication to treat emotional or behavioral conditions. Neuropsychologists, on the other hand, focus on how brain function impacts thinking, behavior, and daily life.
Stewart Cohen:
You mentioned that these evaluations can take a full day. What does that process look like?
Dr. Thomas Swirsky-Sacchetti:
Testing is done one-on-one and includes a combination of paper-and-pencil tasks, computer-based assessments, and hands-on activities like puzzles and problem-solving exercises.
We evaluate a wide range of functions, including:
- Intelligence (IQ)
- Memory and attention
- Language skills
- Problem-solving and executive function
- Visual-spatial abilities
- Motor and sensory function
- Emotional and personality factors
We also measure effort, because how hard someone tries during testing affects the validity of the results.
Stewart Cohen:
Do different areas of the brain control different functions?
Dr. Thomas Swirsky-Sacchetti:
Yes. For example, the left side of the brain is generally responsible for language and verbal skills, while the right side is more involved in visual and spatial abilities.
The frontal lobe acts as the brain’s “executive,” responsible for decision-making and problem-solving. The temporal lobe plays a key role in memory, and other regions handle functions like visual processing and spatial awareness.
Stewart Cohen:
How do you evaluate someone who didn’t have prior testing before their injury?
Dr. Thomas Swirsky-Sacchetti:
We use certain measures, like vocabulary and reading ability, that tend to remain stable even after a brain injury. These help us estimate a person’s pre-injury functioning and compare it to their current abilities.
Stewart Cohen:
What are the key areas you focus on when evaluating a brain injury?
Dr. Thomas Swirsky-Sacchetti:
We look closely at memory, attention, and processing speed. In mild traumatic brain injuries, people can often still perform tasks correctly, but they do so more slowly.
We also evaluate executive function—how well the brain processes and organizes information—and emotional functioning, since brain injuries often affect mood and behavior.
Stewart Cohen:
How do these tests help you make a diagnosis?
Dr. Thomas Swirsky-Sacchetti:
We’re looking for patterns. Different conditions—like stroke, multiple sclerosis, or traumatic brain injury—produce different patterns of strengths and weaknesses. By analyzing those patterns, we can make a diagnosis and develop a treatment plan.
Stewart Cohen:
How does your evaluation help guide treatment?
Dr. Thomas Swirsky-Sacchetti:
Our goal is to understand how the injury affects a person’s ability to function in daily life. For example:
- Can they return to work?
- Do they need accommodations?
- What types of rehabilitation or therapy would help?
We also recommend strategies to improve function, whether that’s retraining certain brain functions or finding ways to compensate for areas that are impaired.
Stewart Cohen:
So your role goes beyond diagnosis—you’re helping guide recovery?
Dr. Thomas Swirsky-Sacchetti:
Exactly. We work closely with neurologists and other providers to help patients understand their condition and develop a path forward for recovery and rehabilitation.
The best possible outcomes are achieved when a patient and their family understand the nature and goals of a treatment plan and follow the physician orders regarding treatment and therapy.
Prognosis for PCS
Based on the medical evidence, approximately 90 percent of concussion symptoms are transient, and those symptoms typically resolve within 10–14 days. However, some symptoms (physical, cognitive, behavioral, or emotional in nature) may linger for weeks.
Persistent PCS occurs when symptoms persist beyond three months. Persistent PCS can have lasting effects on cognition, memory, learning and executive function, and people who suffer multiple instances of TBI are at greater risk for PCS. PCS can lead to significant disability, lost earnings, and lost earnings capacity.
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Speak to an experienced brain injury attorney team like Cohen, Placitella & Roth.
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