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Post Concussion Syndrome

 Poster: A snowHead
Poster: A snowHead
Mrs Z had a nasty tumble at speed at New Year and recovery has been very slow. She doesn't remember exactly what happened or whether or not she actually passed out.

Her damaged knee ligaments are still a minor problem but the biggest issue for her is what her GP has diagnosed as PCD.
She feels dizzy if she moves her head too quickly or looks up. She has a pain around the jawline on her left hand side and suffers frequent headaches.
She has been told that it will recover in time, but we are almost 3 months from the accident and it is still causing her distress.

Anyone here had it or got any words of wisdom or suggestions?
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Concussion is often seen as it is portrayed in the cinema - In reality it is nothing like that. It is a brain injury and can take many months to recover. I have seen that some are more susceptible to it than others. Sympathies, but I suspect that time will be the only healer.
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Well, the person's real but it's just a made up name, see?
I'm not sure I'd trust a GP to make such a diagnosis. I would demand a referral.
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@Ray Zorro,What was the post made of?
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@Ray Zorro, commiserations to Mrs Z. I think asking nicely for a referral to a neurologist might be a better option than demanding one wink.
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Quote:

commiserations to Mrs Z. I think asking nicely for a referral to a neurologist might be a better option than demanding one

+1

Time probably is the only healer but in her place I think I would like an expert opinion. I have been close to three people recovering from severe neurological damage. One small boy thrown by a "hit and run" driver, one cyclist who had inter-cranial (is that the word?) bleeding after an RTA and a big op, and one more elderly friend who had a severe brain aneurysm and was in neurological intensive care for weeks.

All made a brilliant recovery but oh my, it did take a long time and the third, a very good friend, still has some balance problems. The first time he insisted on going out on his bike he fell off right outside the gate and his wife forbade him to cycle on the road again until he was a lot better - they did New Forest tracks instead.

I'd personally like an expert opinion on what best to do - for example whether to persist at the things that are difficult, like turning head quickly, or looking up, or whether to avoid those things wherever possible. My friend skis but his powers of recovery are shot - if he starts to wobble he's gonna fall. But his was a life threatening medical emergency - it's absolutely astonishing how he's recovered. He's a stubborn bug, which probably helps.
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@Hells Bells, I would always demand in a nice way of course. If it was a minor complaint not responding to treatment then yes ask nicely, but this is a head injury and the symptoms, which are causing "distress", have persisted for 3 months. I would want a specialist's opinion 2 months or more ago.
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If the GP is reluctant it would only cost a few hundred quid to see a neurologist privately.
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I suffered a concussion a couple of years ago, and also was told by my GP that I was suffering from post concussion syndrome, for me was lack of concentration, not absorbing new information and headaches. Took about 6 months to go away fully, and I found that if I pushed myself I would get nowhere, so just had to rest plenty, and avoid doing stuff that taxed my brain for a while. GP also advised avoiding things like alcohol and caffeine. My GP seemed perfectly capable of making the diagnosis, and I did not feel the need for anything further.
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Thanks all. Referral onwards to a specialist was never mentioned as a possibility so that is something worth considering.
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@Ray Zorro, I did a bit of Googling, and I'm sure you have too. I've been looking at advice from Headway (Brain injury Association), their advice is that this should resolve around 2 weeks after the injury, and that you should discuss referral if it hasn't resolved. Did Mrs Z have any scans to her head or were they more concerned with the knee? Some good general advice on their website, and more specialist stuff, including advice for GPs should you need it. https://www.headway.org.uk/minor-head-injury-and-concussion.aspx?gclid=CjwKEAjwiq-oBRC9gvHCsvDdn2cSJACV3DFRkbzYM1pg86Lk-sXgGA68s42ge-PgFFYQvi8F_a8P9BoCgI7w_wcB
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And love to help out and answer questions and of course, read each other's snow reports.
Sorry to hear of Mrs Z's ongoing problems. Head injury can be classified as major or minor. Although there are gradations between these, Major = loss of consciousness of many minutes onwards, often associated with skull fracture, brain swelling etc and Minor = minimal loss of consciousness with no detectable structural damage. Recovery from the first takes months to years and may be incomplete, recovery from the second may take upto a few weeks and should be complete. If the original injury resulted in no or only brief loss of consciousness (and no skull fracture, objective neurological deficit etc) then 3 months is a slow recovery. It could still be a slowly recovering concussion but you need to think about BPPV (positional vertigo caused by displacement of the part of the gravity detecting mechanism of the inner ear) and disordered joint position sense from the neck (essentially a variant of whiplash injury). A neurological opinion would do no harm but if it is BPPV or a neck issue (and often the two coexist) she should see someone with an interest in balance disorders (some ENT surgeons, some audiological physicians, some neurologists and some physiotherapists). Doing nothing also works eventually in the great majority of cases, it may just takes longer.
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@Hells Bells, thanks for the research, that is a helpful looking website. She had the accident the day that we were leaving the resort and the next day she was sick so we went to Frimley and they gave her a CT scan - and reported no internal bleeding (but that was all they said).

@stiffdrink, Thanks for your post - a lot of what you said resonated with Mrs Z. She reminded me that she has an almost constant ear ache on her left side.
She has one more week of school and then the Easter holidays so she will see what she can sort out then.
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 You know it makes sense.
You know it makes sense.
This should be taken seriously. Pm me and I'll recommend someone to see her
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Otherwise you'll just go on seeing the one name:
This is a good old thread resurrect, but it showed up doing a search for concussion, as it seems that I have also been diagnosed with the PCS syndrome following a tumble earlier in the season, and a lot of symptoms are taking a long time to clear.

Have folk had any experience of this since these posts from 9(!) years ago, and out of interest. @Ray Zorro did your wife fully recover in the end - it seems it can take a while!?
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 Poster: A snowHead
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@skibomb, I missed the original thread (before my time here) but I'm a neurologist and there is some well-intentioned but misleading information here.

I know you're just looking for some insights and support and this can be a very supportive and insightful place for a lot of things, but this isn't where you should turn for medical information. By all means get a second opinion, either through the NHS or privately, and find a doctor who can make time to answer all of your questions. Concussion symptoms can take a very, very long time to resolve - and at the same time, not everything that looks like a concussion is just a concussion. Only an expert clinician who knows your case and has examined you in person can sensibly weigh in.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
When googling for a condition I might have, I generally always look at the treatment. PCS is generally not treated, and either gets better on its own or not. Therefore, having a label that says PCS does not really help, and in fact may cause insurance issues.

Looking after yourself after a bang in the head involves avoiding further bangs to the head, and not drinking excessive alcohol or taking drugs.

If you get a scan, and nothing is visible, best just to apply the treatment yourself and assume that the diagnosis is "no firm diagnosis"
If there is no recurrence after 5 years it would not need to go on medical underwriting for insurance purposes for most medical insurance.

Remember, medical underwriting is not usually done by medics. It is done by administrators, with a little bit of medical knowledge, and a lot of administration procedures.

Oh, and one tip "wear a helmet"! - a helmet is one piece of ski kit I do update whether it needs it or not.


Last edited by Obviously A snowHead isn't a real person on Mon 26-02-24 21:42; edited 1 time in total
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Thanks @diaphon Not looking for medical information - I used the word "experiences", as it's always interesting to hear those. Peer experiences and support can sometimes be just as helpful as the formal medical pathways (although NHS and private pathways can be challenging to navigate - my nearest BUPA neurologist doesn't have availability until July apparently!)
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Bigtipper wrote:

Oh, and one tip "wear a helmet"! - a helmet is one piece of ski kit I do update whether it needs it or not.


Let's not start that debate again Toofy Grin
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skibomb wrote:
Thanks @diaphon Not looking for medical information - I used the word "experiences", as it's always interesting to hear those. Peer experiences and support can sometimes be just as helpful as the formal medical pathways (although NHS and private pathways can be challenging to navigate - my nearest BUPA neurologist doesn't have availability until July apparently!)


I know, and this is the frustration - it is so hard to get in to see someone that patients have no choice but to ask around on their own and piece together what information they can. I don't blame you at all, in fact I completely sympathize!

But book that appointment for July. It will be here before you know it, and in the meantime of course you should research and try to improve your symptoms. I hope it's a helpful appointment when it finally does roll around.
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You need to be quite careful with your definitions. Concussion is a brain injury, which can be very mild or much more significant. The organic brain injury (i.e. the physical knock taken by the brain) can cause all the sorts of things you would expect.

Post concussion syndrome is a bit more complex. It isn't that well understood, but the best explanation is that it is probably a psychological reaction added to the original brain injury, so a combination of the mind and the neurological injury, rather than the damaged brain by itself, causing the symptoms. PCS does happen, but most concussions are "just" concussions, and most brain injuries are "just" brain injuries.

PCS isn't just a description of the symptoms someone suffers after a concussion, it's a condition in its own right.

If it looks like concussion/brain injury, the normal starting point is to assume it's a pure brain injury until that can be ruled out. Only then would you start to think about something like PCS.

[url=]https://www.ncbi.nlm.nih.gov/books/NBK534786/[/url]

Disclaimer! I am not a doctor, but I am a personal injury lawyer and I have seen numerous medical reports from neuropsychologists on PCS patients explaining the condition. I would of course defer to someone who knows more what they're talking about...

From my experience of dealing with people with head injuries, I would say it can take longer than you think to recover, and that can be frustrating and worrying, and can lead to the feeling that the underlying injury must be worse than it actually is. Take your time, and do what the doctors tell you, even if it feels like it isn't doing any good. It might take time, but with time and whatever treatment is offered, most people do recover.
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PS - Wow, just noticed the age of the OP! And listen to @diaphon
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Aware that this is about PCS and not concussion, but where we all take part in a sport where this can potentially be a risk, its worth us all knowing what it is and what to look for.

Both my boys play rugby and the RFU is now pretty hot on this as you might imagine. There are some really good resources over at the England RFU Headcase Website which are worth a look at for what to do and what to look for if someone in your group or anywhere may have had a head injury. There is a 2 page PDF which has a quick guide to what to look for in the first 48 hours after a suspected concussion, and the key is that the person who has had the injury is often the least able person to assess whether they are OK or not.
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concussion is a common occurance in DH mtb racing/riding. Myself and loads of my mates have all suffered it.
Foggy brain, forgetfulness, losing track mid sentence. Always seems to get better with time. 1 particular friend who raced world cup came off riding full bore in a world cup. He still has memory issues from that 6 years ago.
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Richard_Sideways wrote:
There is a 2 page PDF which has a quick guide to what to look for in the first 48 hours after a suspected concussion, and the key is that the person who has had the injury is often the least able person to assess whether they are OK or not.


This is a fantastic resource, and as skiers and snowboarders this is really something we should all read. Excellent public awareness campaign.
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Richard_Sideways wrote:
Aware that this is about PCS and not concussion, but where we all take part in a sport where this can potentially be a risk, its worth us all knowing what it is and what to look for.

Both my boys play rugby and the RFU is now pretty hot on this as you might imagine. There are some really good resources over at the England RFU Headcase Website which are worth a look at for what to do and what to look for if someone in your group or anywhere may have had a head injury. There is a 2 page PDF which has a quick guide to what to look for in the first 48 hours after a suspected concussion, and the key is that the person who has had the injury is often the least able person to assess whether they are OK or not.


I have an involvement with Twickenham stadium and a few years ago attended a talk by Dr. Simon Kemp who has been the RFU's medical director for many years and also works with World Rugby on the subject of concussion protocols. He strongly recommended the Headcase website and I think he was involved in putting it together.

He said that ten years ago, HISs were carried out on the pitch and took less than a minute. The five questions at the end of page 2 of the PDF under the heading of "awareness" were a major part of the assessment. Apparently they also asked "What is the name of the Prime Minister?" You would have to be pretty sharp to keep up with that one in recent years.

Now the players have to come off the pitch. Video evidence is reviewed and with seventeen match cameras there is normally something available. As well as balance tests they are also given cognitive reasoning tests. The the whole process usually takes about ten minutes. The final decision is taken away from the player and there has to be an independent doctor whose opinion overrides the opinions of the team doctors.

One statistic that surprised me is that in only ten per cent of concussion cases is the victim unconscious.

I used to follow boxing but I do wonder how they get away with it as the referees seem to do some very rapid HIAs.
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I suffered badly with PCS for a few years.

I was an avid rugby player, playing to a reasonably high level as well. This was early to mid 2010s and the HIA procedures very much still in their infancy. I suffered several back head knocks including one that landed me in hospital over night.

Even though I took the required time out each time I was not feeling myself. I became short tempered, easily irritated, sometimes hazy often with that feeling of "being a million miles away". I also developed migraines which I'd suffer from probably once a month (before then, I don't think I'd ever had one). I was diagnosed with post concussion syndrome. It was genuinely quite a dark and lousy period of my life.

My symptoms lasted probably over 12 months since diagnosis. I don't know the lasting effects, I occasionally get headaches from really strenuous sporting endeavours and I don't know if that is linked to my head knocks.

You only get one head and brain. Look after it. Take the rest and time needed to allow it to heal.
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Some great input and interesting experiences :thumbsup:

Fridge03 wrote:
You only get one head and brain. Look after it. Take the rest and time needed to allow it to heal.


Thanks for sharing - very good advice I reckon!
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I had some brain injury stuff going on a few years ago. I had multiple TIAs , all from a vertebral artery dissection. Not ideal. After a few weeks off work; going back to work was really tough. I had bouts of dizziness etc. Anyway, my family doctor recommended I saw a vestibular physiotherapist; he described a TIA as a brain injury and that I should look upon it as being like post concussion syndrome. It took a while to get in as there were only two specialists in Calgary and one was away with some team or other. Anyway, it was the best thing. I explained my issues and he examined me etc. and told me my eye tracking was slightly out, and that was likely the cause of the dizziness. Its not an unusual problem for anyone with any kind of brain type injury. He told me he thought he could cure it in 4 weeks. Cue 4 weeks of very tough eye tracking exercises , but the end I was doing up to 1.5 hrs total a day. But whether it was placebo or it cured me. It was pretty amazing. We also did some other physio, like balance and gentle neck movements. IF you can find someone who is qualified and really knows what they are doing I would recommend it
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But I would also get a referral to specialist. In case there is something else
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I’ve seen tons of head injuries and will sometimes refer to the head injury specialist sports doc and rehab physio. Never referred to a neurologist though as I’m not sure what they could do? Scans are usually pointless as if you have a skull fracture/ bleed it is generally obvious.
Definitely take it easy, older people get scanned more as they can have chronic bleeds, don’t do it again for a while and see the doctor / ot if not improved. Sadly we can’t often do much. The odd patient finds painkillers or add meds helpful.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Each person is different but….



http://youtube.com/v/A54akeuZZ-o

And

https://www.pinkbike.com/news/video-tahnee-seagraves-struggle-with-concussion-in-how-we-eoll-episode-3.html
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Last year, I suffered a concussion with symptoms like headaches and dizziness, which made daily activities challenging.
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@rokoko, what happened?…..details would be interesting….
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