{
"topic": "Post-Concussion Syndrome",
"slug": "post-concussion-syndrome",
"category_id": 15726,
"passage_count": 14,
"source_chars": 12491,
"enough_material": true,
"references": [
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
4356
]
},
{
"title": "Signs and Symptoms in Pediatrics",
"author": "Henry M. Adam,Jane Meschan Foy",
"pages": [
596
]
},
{
"title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
"author": null,
"pages": [
72
]
},
{
"title": "Pediatric Clinical Practice Guidelines and Policies",
"author": "American Academy of Pediatrics (AAP);",
"pages": [
1351
]
},
{
"title": "PPE: Preparticipation Physical Evaluation",
"author": "American Academy of Family Physicians, American Academy;American Academy of Pediatrics;American College of Sports Medicine;American Medical Society for Sports Medicine, American Medical;",
"pages": [
84
]
},
{
"title": "Cover",
"author": "Vitalsource Download",
"pages": [
8408
]
},
{
"title": "Pediatric Board Study Guide",
"author": null,
"pages": [
234
]
},
{
"title": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition",
"author": "American Academy of Pediatrics",
"pages": [
1321
]
}
],
"passages": [
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4356",
"text": "Concussion is a form of **traumatic brain injury** (TBI) caused by sudden acceleration, deceleration, or rotational forces to the brain, which can occur with a blow to the head, neck, face, or body. The resulting pathophysiologic state is associated with a constellation of signs and symptoms that, for **sport- related concussions (SRCs)** , typically selfresolve within 7-10 days. A minority of children can experience **persistent postconcussion symptoms** (PPCS) that extend beyond 28 days and limit functional ability, cause social isolation, reduce school attendance and performance, and can lead to anxiety, mood alteration, and lower quality of life. Accurate diagnosis and appropriate management of concussion is needed to safely return children to school and sports and to avoid the potential for worse outcomes. ## **DEFINITION/TERMINOLOGY**"
},
{
"source": "Signs and Symptoms in Pediatrics, p. 596",
"text": "Irritability and Fussiness A special concern is for children who sustain concussions from sports-related injuries. Th e American Academy of Neurology defi nes concussion as \u201ca trauma-induced alteration in mental status that may or may not involve loss of consciousness.\u201d Th e term _post-concussive syndrome_ refers to the constellation of acute symptoms, which can be somatic (headache, dizziness, blurriness), emotional (irritability, anxiety), and cognitive (concentration and memory diffi culties). Th e term _second impact syndrome_ has been proposed for an athlete who has sustained a concussion, sustains a second head injury before symptoms associated with the fi rst have fully cleared, and is at risk for a catastrophic outcome such as permanent disability or death.[5] To manage these injuries, a concussion grading scale has been developed with return-to-play guidelines that include physical and cognitive rest and rehabilitation.[6]"
},
{
"source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 72",
"text": "Children with concussion after head trauma can have significant symptoms and prolonged recovery despite normal head imaging. Concussion\u2014or more accurately, mild traumatic brain injury\u2014is defined as a brief alteration in brain function with or without loss of consciousness caused by a blow or jolt to the head. Children and adolescents with concussions may have significant and long-lasting symptomatology, including headaches, dizziness, amnesia, confusion, difficulty concentrating, nausea, and vomiting. Older grading systems based on the _initial_ signs and symptoms of injury are not predictive of subsequent outcomes and are no longer used by most experts."
},
{
"source": "Pediatric Clinical Practice Guidelines and Policies, p. 1351",
"text": "_Moffatt, MD, FAAP; and Council on Sports Medicine and Fitness_ ABSTRACT. Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion\u2019s definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is"
},
{
"source": "PPE: Preparticipation Physical Evaluation, p. 84",
"text": "The absolute number of concussions an individual can sustain and continue to participate in contact sports has not been defined.[12] High school athletes with a history of concussions who have no physical, medical, or cognitive difficulties are generally allowed to participate in all sports. Sustained attention and cognitive function deficits following a Cervical Cord Neurapraxia 75 mild concussion may persist long after the injury, limiting medical eligibility.[50] The evidence available regarding concussion recovery in children is sparse.[51] Providers treating young athletes with a history of multiple concussions may adopt a more conservative medical eligibility or RTP strategy. When repeated concussions occur with lesser force, are more severe, take longer to fully recover, or show changes in baseline brain function, withholding medical eligibility for contact or collision sports or \u201csports with high risk\u201d should be considered."
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4356",
"text": "Signs and symptoms of concussion can be classified into five categories, including somatic, vestibular, cognitive, emotional, and sleep related (Table 729.1). Acutely, headache is the most commonly reported symptom, followed by dizziness, difficulty concentrating, and confusion. Sleep disturbance, anxiety, and mood- related symptoms are more likely to occur several weeks post- injury. Brief loss of consciousness occurs in less than 5% of SRCs and is not associated with injury severity or time to recover. The most reliable predictor of recovery is initial symptom burden; children who experience greater symptom load and severity are at increased risk of PPCS. However, several noninjury\u2013 related factors can also affect recovery, including female sex, history of migraines, history of prior concussion, poorer preinjury child adjustment, family dysfunction, neurodevelopmental disorder (e.g., learning disability, attention- deficit/hyperactivity disorder [ADHD]), and psychiatric illness (e.g., anxiety, depression)."
},
{
"source": "Cover, p. 8408",
"text": "Long-term management is symptom-based and unique to each child, most often requiring a multidisciplinary team of medical providers and therapists. Common conditions resulting from brain injury requiring medical attention and multidisciplinary care include spasticity/dystonia, attention-deficit/hyperactivity disorder, seizures, sleep disturbance, cognitive dysfunction, mood disorders, headaches, and fatigue. Children with TBI are also at higher risk for developing endocrine abnormalities, especially in the initial year following injury. ## **OUTCOMES** ## **Mild TBI** While children with mild TBI may have a longer time to complete recovery when compared to adults, the overall prognosis of concussive injuries is good."
},
{
"source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 72",
"text": "The International Conference on Concussion in Sport has suggested that measures of recovery must be included in the determination of injury severity as well as in determining when someone who has sustained a concussion is ready to resume activities such as work and school attendance and return to sports participation. To limit the duration of symptoms in children after concussions, rest (including the concept of cognitive rest) should be encouraged and strict return-to-activity guidelines should be followed. This involves a gradual increase in both physical and mental activities. 50 SECTION I \u2022 Care of the Acutely Ill Child  **----- Start of picture text -----**
C
B
A Rhinorrhea, otorrhea,
or ear hemorrhage
Longitudinal (A) and
transverse (B) fractures
of petrous pyramid
of temporal bone,
and anterior basal
skull fracture (C)
**----- End of picture text -----**
Battle\u2019s sign: postauricular hematoma"
},
{
"source": "Pediatric Board Study Guide, p. 234",
"text": "- Also known as a mild traumatic brain injury - The signs and symptoms of pediatric concussions are variable - Cognitive - Amnesia: May be retrograde or anterograde - Confusion - Difficulty concentrating - Disorientation - Persistent crying - Neurologic - Headache - Dizziness ## **Epidemiology and mechanism of pediatric concussions** - Major cause across all age groups for pediatric visits to emergency care - Arises from either a direct or transmitted blow to the head, face, or neck - Subsequent injury to the brain is the result of an interplay of pathophysiologic processes, induced by biomechanical forces, without evidence of structural brain injury on standard neuroimaging - Gait abnormalities - Sensitivity to light/noise - Slurred speech - Fatigue - Behavioral - Increased sleep - Emotional lability - Gastrointestinal - Nausea - Vomiting - Refusal to feed"
},
{
"source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 1321",
"text": "of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes. (8/10, reaffirmed 8/14)"
},
{
"source": "Berkowitz's Pediatrics, p. 1244",
"text": "depressed fractureconcussion is defined as a , fragments symptoms (eg, headache), physical signs (eg, LOC, amnesia), behav-ioral changes, cognitive impairment, or sleep disturbances. Some of these minor and subtle neurologic sequelae can last for months after the injury (ie, postconcussion syndrome). Most resolve within a relatively short period, typically 7 to 10 days; however, with more severe trauma the symptoms can last longer. Laboratory Tests A complete blood cell count and serum electrolyte panel should be performed for all pediatric patients with significant head trauma. Bedside glucose monitoring should be performed in any child with a head injury with an altered level of consciousness. Toxicology eval-uation may be indicated in the adolescent who appears to be intox-icated or has an altered level of consciousness. The infant or child with an intracranial hemorrhage should undergo screening coag-ulation studies (ie, prothrombin time, activated partial thrombo-plastin time) as well as a type and"
},
{
"source": "Pediatric Clinical Practice Guidelines and Policies, p. 1351",
"text": "every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents. (11/18) **http://pediatrics.aappublications.org/content/142/6/e20183074**"
},
{
"source": "Berkowitz's Pediatrics, p. 586",
"text": "hydrocephalus, necessitating placement of a ventriculoperitoneal shunt catheter; and persistent vegetative or severely impaired mental state. Penetrating head injuries can result in infections (eg, meningitis, abscess) and vascular injuries (eg, aneurysm, arteriovenous malformations). Sequelae such as postconcussion syndrome may result from less severe head trauma. Some of the characteristics of this syndrome include dizziness, headache, irritability, memory deficits, impaired behavior, and impaired cognitive development. These may persist for months after the head injury and sometimes are permanent. The child with postconcussion syndrome may warrant formal neurobehavioral testing. ## **Prevention**"
},
{
"source": "Pediatric Board Study Guide, p. 234",
"text": "- Emotional lability - Gastrointestinal - Nausea - Vomiting - Refusal to feed ## **Risk factors for a concussion** - An individual\u2019s risk for a concussion is multifactorial with no single element being absolutely predictive. - Boys are reportedly more affected than girls due to their predilection for more injuries/inclusion in more sports-related activities. - Girls are more likely to report symptoms of concussion. - History of ADHD or learning problems raises the lifetime risk. - History of prior concussion raises the risk for future concussion. ## **Risk factors for prolonged concussion symptoms** - An individual\u2019s risk for prolonged symptoms is multifactorial with no single element being absolutely predictive - Prior history of concussion-like symptoms - Known history of intracranial abnormalities - \u2013 Psychiatric disorders, headache disorders - Family and social stressors ## **Management** - Diagnosis is typically clinical."
}
]
}