What is PCS and classic vs. non-classic Symptoms?

Last week we briefly talked about what a concussion is and what it isn’t just in sports. No matter how the concussion was sustained the end result is that there are brain areas that are damaged (functionally or structurally) and if not healed and rehabbed properly deficits are very likely to occur. We saw what a brain with CTE looked like as well.
Differences between structural and functional issues: Highway example

Structural:

 
Traffic is bumper to bumper (cars represent nerve signals) on the highway (the highway is the nerve itself). Up ahead the bridge to get off the exit is completely gone and no cars can pass allowing you to get to your destination (the collapsed bridge is the part of the nervous system that isn’t working). 

Functional:

Traffic is bumper to bumper on the highway. Up ahead there is an accident but all exits are clear (the accident is the part that isn’t working) to allow you to still get to your destination.

What is the difference between the two? A structural issue would be a brain after a stroke or if a nerve is completely cut. Whereas the functional issue would be the nerve is still there but it isn’t working the way it should, but other pathways (exits) can be used.

A concussion can lead to both issues but a lot of the issues are from a functional issue where the brain isn’t processing information the way it should and this creates the classic or non-classic symptoms we think of.  Some of these deficits can bee is seen by being sensitive to light or sound,
headaches, or concentration issues (classical symptoms). There are other symptoms that can occur that we may or may not be familiar with when dealing with a concussion. These could be mood changes, gut issues, chronic fatigue, neck/back pain, irritability, dizziness/balance issues, etc (non-classical symptoms). All of these issues can lead to

what we call post-concussive syndrome or post-concussion syndrome. PCS can consist of any of the above-mentioned symptoms and last for days/weeks/months/ or even years if not treated properly. I would say on average, in the office, that most of our TBI or concussion patients sustained their concussion months if not years prior to coming in to see us.

Why is PCS so bad?


PCS in and of itself is just describing signs and symptoms of what is going on in the brain. When we are sensitive to light/sound the normal light/sound that we are experiencing is too much for the injured brain to process and it gets overwhelmed (this is why we squint or shut our eyes real fast). When we have concentration issues it is letting us know that the brain areas for concentration and cognition aren’t working properly. It is very important to be able to look for the symptoms of PCS as this can help us see how the brain is responding to the outside world. If we have a better understanding of what to look for this can in turn help athletes return to play faster or return to work faster (I know returning to work for some of our sounds so exciting, haha). 

What PCS is really telling us is that the brain isn’t responding appropriately to the world around us. If the brain cant sense how strong light or sound is it will be too much for us, if it cant have a clear picture of where we are in space this leads to balance/dizziness issues, or if we move our neck or back and it looses where that body part is this will lead to stiffness or pain in that area. The brain doesn’t like being in pain or being off-balance, so it will do everything it can to get out of it. This leads to us feeling as if light and sound isn’t so bad or that my neck/back pain is better; however, chronically the brain can only compensate for so long without other issues happening. This can be seen when we try and look at an object but every time we do we get dizzy.

The brain recognizes this so when this happens again it will kick in a neck movement to help the eyes go to the desired target. This can be good because it allows us to look at what we want to look at, but if we are constantly moving our heads when we move our eyes this will eventually lead to neck and low back problems. All of this in time will make the PCS issues worse eventually.

This can also be seen years later with people that wake up with pain all of a sudden or if get to stressed can get migraines or headaches very easily. This is letting us know that the compensation mechanism(s) are starting to fail and just normal everyday stimulus is bothering us.

What to do about PCS?

We will be talking about this in a couple of weeks, but the biggest thing to do right now is to be more aware of the classic and non-classic symptoms. Another thing to do is find a healthcare professional that is familiar and knows how to treat PCS. It is important to understand that this may take a couple of weeks or depend on how bad it can be could take months to properly rehab the brain. So the next time someone you knows says that have had a concussion before but my dizziness, pain, or concentration issues aren’t from the concussion you can let them know it very well could be from the concussion.

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