POST-CONCUSSION SYNDROME

"It's a gigantic number [200,000 concussions suffered yearly by Canadians]. We think it is a significant public health issue."
"It is profoundly disruptive no matter what stage in life you are. If you're a kid, then it prevents you from going to school and learning... If you're in the working population, you can't work."
"The mental health issue of PCS [post-concussion syndrome] are very severe in many people."
"We're starting from almost zero. We don't even understand where in the brain concussion occurs. ... It's not surprising that treatments are not available."
Dr. Charles Tator, neurosurgeon, concussion researcher, Toronto Western Hospital

Illustration by Thinkstock

There just isn't a lot out there for people having more persistent symptoms."
"It can be a difficult system to navigate."
"You're seeing lots of concussion clinics popping up here and there, and there may be claims made. We really want to recommend to people to be cautious and to understand that it's complex. Further research is certainly needed to try and decipher what's happening in people when symptoms are more persistent."
Dr. Lesley Ruttan, neuropsychologist, Toronto Rehabilitation Institute

Someone suffering from a concussion will not necessarily experience loss of consciousness. An estimated 95 percent of people don't pass out at all. At the fourth International Conference on Concussion in Sport which took place in 2012 in Zurich, Switzerland, Dr. Tator was among scientists attending who helped to draft a new consensus statement on the management of sport concussion. But it doesn't have to be involvement in a sport leading to concussion, there are other impacts on the head as simple as a fall that can lead to concussion.

The injury now described in the new definition of concussion is that of a disturbance in mental functioning which is held to be caused by a sudden movement of the brain within the skull. That situation can result from a direct blow to the head, the face or the neck. An indirect blow occurring elsewhere on the body which results from sufficient force to shake the brain is recognized as an additional factor. There are no dependable statistics available on concussion frequency, let alone the physiological damage the brain receives. Not a lot of research funding is directed toward establishing those details.


When it has been confirmed by a medical examination that a concussion has taken place the standard advice is to try exercise, meditation and cognitive behavioural therapy to determine whether any of those can resolve symptoms. In the direct aftermath of concussion diagnosis the individual is advised to rest. Headaches, light- and sound-sensitivity, nausea, dizziness, memory lapses are all symptoms of post-concussion, and some people find themselves a year later just emerging from the condition, while some never do. In the same token some people see their condition normalized in fairly short order.

It is a poorly understood syndrome, and a fairly invisible one since those who suffer from PCS appear normal on the exterior. Others, even those close to the sufferer, sometimes find it difficult to understand what PCS sufferers are going through, at times. Modern science is not yet capable of assessing the effects on the brain, since no blood test or scanner can be depended upon to detect it, nor a drug or therapy alleviate and treat it.

Women appear more susceptible than men for uncertain reasons. Perhaps thinner neck muscles resulting in less stability for the head could be involved, or possibly a genetic link to susceptibility. Multiple concussions can factor into the equation but remains an unknown. Data show that 20 percent of people with PCS have had one concussion only. Yet less significant 'sub-concussive' hits acquired over the span of years with no evident symptoms may also be involved.

It is  unknown whether post-concussion syndrome is a biochemical injury or whether structural alterations in the brain have occurred, but go undetected. The mechanisms leading to the injury once they are understood will lead to better diagnostics and treatments. "We need a lot of both fundamental research and clinical research", stated Dr. Tator. "But it's not cancer, it's not heart disease. We're not a Canadian favourite (for the allocation of research funding). We're way down the list (of priorities)."