Post-Concussion Syndrome After Mild Brain Injury

The purpose of this study was to investigate the relationship between Post-Concussion Syndrome (PCS) and posttraumatic stress disorder (PTSD) in a population of motor vehicle accident survivors. The authors anticipated finding more PCS in MTBI individuals with concurrent PTSD than in TBI patients without PTSD. Their hypothesis was that the additional cognitive load of anxiety and intrusive symptoms of PTSD influenced MTBI patients' experience of PCS.

The population was divided into two groups, one group of 46 with MTBI, and one group of 59 with no TBI. Assessment for PTSD and PCS was done for both groups six months post-trauma. A clinical psychologist conducted the assessment using the PTSD module from the Composite International Diagnostic Interview (CIDI). The authors also administered a postconcussive symptom checklist requiring patients to report the presence or absence of postconcussive symptoms consisting of: dizziness, fatigue, headaches, irritability, sensitivity to light, sensitivity to sound, concentration deficits and visual disturbances.

MTBI patients with chronic PTSD reported more concentration deficits, dizziness, fatigue, headaches, sensitivity to sound and visual disturbances than MTBI patients not suffering from PTSD. Additionally, the presence of concentration deficits, dizziness, fatigue, headaches, irritability, and visual disturbances was significantly linked with the severity of PTSD. The authors surmise that their findings add to the growing body of literature linking psychological and neurological factors to PCS:

"It is possible that the heightened anxiety and cognitive load experienced by PTSD patients resulted in greater demands on their cognitive resources, and this may have contributed to PCS. This interpretation is indicated by the finding that persistent PCS were associated with the severity of intrusive, avoidance, and arousal symptoms. Intrusive and avoidance symptoms cannot be readily attributed to neurological factors. Accordingly, this finding suggests that the degree of posttraumatic stress experienced by MTBI patients contributed to persistent PCS. The presence of this pattern in the MTBI sample but not in the non-TBI sample indicates that heightened posttraumatic stress compounded the neurological effects of the MTBI. This pattern accords with Rutherford's (1989) view that PCS is mediated by an interaction of psychological and neurological factors. This study did not obtain neuropsychological data, and the role neurological factors could be more rigorously indexed in future studies by investigating the role of cognitive deficits in the relationship between PCS and PTSD after MTBI."

The authors conclude:

"These findings point to the importance of PTSD in the development and maintenance of PCS. Considering the potential impairment caused by both PTSD and PCS, these findings indicate that rehabilitation of MTBI individuals needs to recognize that effective management of PCS may be facilitated by addressing the symptoms associated with PTSD."

1. Bryant RA, Harvey AG. Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury. Journal of Nervous and Mental Disease 1999;187(5):302-305.
2. Peters L, Andrews G, Cottler LB, Chatterji S, Janca A, Smeets, RMW. The composite international diagnostic interview post-traumatic stress disorder module: Preliminary data. International Journal on Methods ofPsychiatric Research 1996;6:167-174.