Skip to main content
SpringerLink
Log in

Post-concussion Syndrome

  • Chapter
  • First Online:
Concussion Management for Primary Care

Abstract

Post-concussion syndrome is a term used for a concussion that follows a longer than expected time for recovery. There is no consensus definition for this syndrome, making scientific study a challenge. A commonly used term to describe this condition is persistent post-concussive symptoms (PPCS). PPCS is likely caused by a combination of physiologic derangement, neurologic alterations, abnormalities of the vestibulo-ocular system, and psychological factors, among others. Evaluation can be done by examining the different systems contributing to symptoms, and focused treatments can be directed at abnormalities in certain areas. Complications of PPCS may include second impact syndrome, chronic traumatic encephalopathy (CTE), and depression/suicide, although these are also widely debated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Psychiatric Association. Task force on DSM-IV. In: Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000. p. xxxvii, 943.

    Google Scholar 

  2. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992. p. xii, 362.

    Google Scholar 

  3. Reichenberg LW. DSM-5TM essentials: the savvy clinician’s guide to the changes in criteria. Hoboken: Wiley; 2014.

    Google Scholar 

  4. McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.

    PubMed  Google Scholar 

  5. Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane S, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Clin J Sport Med. 2019;29(2):87–100.

    Article  PubMed  Google Scholar 

  6. McCrea M, Guskiewicz K, Randolph C, Barr WB, Hammeke TA, Marshall SW, et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J Int Neuropsychol Soc. 2013;19(1):22–33.

    Article  PubMed  Google Scholar 

  7. Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA. 2016;315(10):1014–25.

    Article  CAS  PubMed  Google Scholar 

  8. Marshall CM, Vernon H, Leddy JJ, Baldwin BA. The role of the cervical spine in post-concussion syndrome. Phys Sportsmed. 2015;43(3):274–84.

    Article  PubMed  Google Scholar 

  9. Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941–8.

    Article  PubMed  Google Scholar 

  10. Romeu-Mejia R, Giza CC, Goldman JT. Concussion pathophysiology and injury biomechanics. Curr Rev Musculoskelet Med. 2019;12(2):105–16.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment. Brain Inj. 2015;29(2):238–48.

    Article  PubMed  Google Scholar 

  12. King ML, Lichtman SW, Seliger G, Ehert FA, Steinberg JS. Heart-rate variability in chronic traumatic brain injury. Brain Inj. 1997;11(6):445–53.

    Article  CAS  PubMed  Google Scholar 

  13. Hanna-Pladdy B, Berry ZM, Bennett T, Phillips HL, Gouvier WD. Stress as a diagnostic challenge for postconcussive symptoms: sequelae of mild traumatic brain injury or physiological stress response. Clin Neuropsychol. 2001;15(3):289–304.

    Article  CAS  PubMed  Google Scholar 

  14. Bakhtadze MA, Vernon H, Karalkin AV, Pasha SP, Tomashevskiy IO, Soave D. Cerebral perfusion in patients with chronic neck and upper back pain: preliminary observations. J Manipulative Physiol Ther. 2012;35(2):76–85.

    Article  PubMed  Google Scholar 

  15. Nakamura Y, Nojiri K, Yoshihara H, Takahata T, Honda-Takahashi K, Kubo S, et al. Significant differences of brain blood flow in patients with chronic low back pain and acute low back pain detected by brain SPECT. J Orthop Sci. 2014;19(3):384–9.

    Article  PubMed  Google Scholar 

  16. Freitag P, Greenlee MW, Wachter K, Ettlin TM, Radue EW. fMRI response during visual motion stimulation in patients with late whiplash syndrome. Neurorehabil Neural Repair. 2001;15(1):31–7.

    Article  CAS  PubMed  Google Scholar 

  17. Otte A, Mueller-Brand J, Fierz L. Brain SPECT findings in late whiplash syndrome. Lancet. 1995;345(8963):1513.

    Article  CAS  PubMed  Google Scholar 

  18. Alptekin K, Degirmenci B, Kivircik B, Durak H, Yemez B, Derebek E, et al. Tc-99m HMPAO brain perfusion SPECT in drug-free obsessive-compulsive patients without depression. Psychiatry Res. 2001;107(1):51–6.

    Article  CAS  PubMed  Google Scholar 

  19. Ito H, Kawashima R, Awata S, Ono S, Sato K, Goto R, et al. Hypoperfusion in the limbic system and prefrontal cortex in depression: SPECT with anatomic standardization technique. J Nucl Med. 1996;37(3):410–4.

    CAS  PubMed  Google Scholar 

  20. Schwartz RB, Komaroff AL, Garada BM, Gleit M, Doolittle TH, Bates DW, et al. SPECT imaging of the brain: comparison of findings in patients with chronic fatigue syndrome, AIDS dementia complex, and major unipolar depression. AJR Am J Roentgenol. 1994;162(4):943–51.

    Article  CAS  PubMed  Google Scholar 

  21. Sarmento E, Moreira P, Brito C, Souza J, Jevoux C, Bigal M. Proton spectroscopy in patients with post-traumatic headache attributed to mild head injury. Headache. 2009;49(9):1345–52.

    Article  PubMed  Google Scholar 

  22. Bartnik-Olson BL, Holshouser B, Wang H, Grube M, Tong K, Wong V, et al. Impaired neurovascular unit function contributes to persistent symptoms after concussion: a pilot study. J Neurotrauma. 2014;31(17):1497–506.

    Article  PubMed  Google Scholar 

  23. Su SH, Xu W, Li M, Zhang L, Wu YF, Yu F, et al. Elevated C-reactive protein levels may be a predictor of persistent unfavourable symptoms in patients with mild traumatic brain injury: a preliminary study. Brain Behav Immun. 2014;38:111–7.

    Article  CAS  PubMed  Google Scholar 

  24. Rathbone AT, Tharmaradinam S, Jiang S, Rathbone MP, Kumbhare DA. A review of the neuro- and systemic inflammatory responses in post concussion symptoms: introduction of the “post-inflammatory brain syndrome” PIBS. Brain Behav Immun. 2015;46:1–16.

    Article  CAS  PubMed  Google Scholar 

  25. Meares S, Shores EA, Taylor AJ, Batchelor J, Bryant RA, Baguley IJ, et al. Mild traumatic brain injury does not predict acute postconcussion syndrome. J Neurol Neurosurg Psychiatry. 2008;79(3):300–6.

    Article  CAS  PubMed  Google Scholar 

  26. Lange RT, Iverson GL, Brubacher JR, Madler B, Heran MK. Diffusion tensor imaging findings are not strongly associated with postconcussional disorder 2 months following mild traumatic brain injury. J Head Trauma Rehabil. 2012;27(3):188–98.

    Article  PubMed  Google Scholar 

  27. Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalalgia. 1994;14(4):273–9; discussion 57.

    Article  CAS  PubMed  Google Scholar 

  28. Jensen OK, Nielsen FF, Vosmar L. An open study comparing manual therapy with the use of cold packs in the treatment of post-traumatic headache. Cephalalgia. 1990;10(5):241–50.

    Article  CAS  PubMed  Google Scholar 

  29. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, Barlow K, Boyd L, Kang J, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. 2014;48(17):1294–8.

    Article  PubMed  Google Scholar 

  30. Armstrong B, McNair P, Taylor D. Head and neck position sense. Sports Med. 2008;38(2):101–17.

    Article  PubMed  Google Scholar 

  31. Ernst A, Basta D, Seidl RO, Todt I, Scherer H, Clarke A. Management of posttraumatic vertigo. Otolaryngol Head Neck Surg. 2005;132(4):554–8.

    Article  PubMed  Google Scholar 

  32. Silverberg ND, Iverson GL. Etiology of the post-concussion syndrome: physiogenesis and psychogenesis revisited. NeuroRehabilitation. 2011;29(4):317–29.

    Article  PubMed  Google Scholar 

  33. Collins MW, Kontos AP, Reynolds E, Murawski CD, Fu FH. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):235–46.

    Article  PubMed  Google Scholar 

  34. Feddermann-Demont N, Echemendia RJ, Schneider KJ, Solomon GS, Hayden KA, Turner M, et al. What domains of clinical function should be assessed after sport-related concussion? A systematic review. Br J Sports Med. 2017;51(11):903–18.

    Article  PubMed  Google Scholar 

  35. Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, et al. The sport concussion assessment tool 5th edition (SCAT5): background and rationale. Br J Sports Med. 2017;51(11):848–50.

    Article  PubMed  Google Scholar 

  36. McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport, Zurich, November 2012. J Athl Train. 2013;48(4):554–75.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Makdissi M, Schneider KJ, Feddermann-Demont N, Guskiewicz KM, Hinds S, Leddy JJ, et al. Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. Br J Sports Med. 2017;51(12):958–68.

    Article  PubMed  Google Scholar 

  38. Leddy JJ, Baker JG, Willer B. Active rehabilitation of concussion and post-concussion syndrome. Phys Med Rehabil Clin N Am. 2016;27(2):437–54.

    Article  PubMed  Google Scholar 

  39. Griesbach GS, Hovda DA, Molteni R, Wu A, Gomez-Pinilla F. Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function. Neuroscience. 2004;125(1):129–39.

    Article  CAS  PubMed  Google Scholar 

  40. Griesbach GS, Tio DL, Nair S, Hovda DA. Temperature and heart rate responses to exercise following mild traumatic brain injury. J Neurotrauma. 2013;30(4):281–91.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Darling SR, Leddy JJ, Baker JG, Williams AJ, Surace A, Miecznikowski JC, et al. Evaluation of the Zurich guidelines and exercise testing for return to play in adolescents following concussion. Clin J Sport Med. 2014;24(2):128–33.

    Article  PubMed  Google Scholar 

  42. Leddy JJ, Baker JG, Kozlowski K, Bisson L, Willer B. Reliability of a graded exercise test for assessing recovery from concussion. Clin J Sport Med. 2011;21(2):89–94.

    Article  PubMed  Google Scholar 

  43. Leddy JJ, Kozlowski K, Donnelly JP, Pendergast DR, Epstein LH, Willer B. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010;20(1):21–7.

    Article  PubMed  Google Scholar 

  44. Ellis MJ, Leddy J, Willer B. Multi-disciplinary management of athletes with post-concussion syndrome: an evolving pathophysiological approach. Front Neurol. 2016;7:136.

    PubMed  PubMed Central  Google Scholar 

  45. Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is medicine for concussion. Curr Sports Med Rep. 2018;17(8):262–70.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Silverberg ND, Iverson GL. Is rest after concussion “the best medicine?”: recommendations for activity resumption following concussion in athletes, civilians, and military service members. J Head Trauma Rehabil. 2013;28(4):250–9.

    Article  PubMed  Google Scholar 

  47. Mucha A, Collins MW, Elbin RJ, Furman JM, Troutman-Enseki C, DeWolf RM, et al. A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med. 2014;42(10):2479–86.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ellis MJ, Cordingley D, Vis S, Reimer K, Leiter J, Russell K. Vestibulo-ocular dysfunction in pediatric sports-related concussion. J Neurosurg Pediatr. 2015;16(3):248–55.

    Article  PubMed  Google Scholar 

  49. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med. 2011;39(11):2311–8.

    Article  PubMed  Google Scholar 

  50. Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, et al. Statements of agreement from the targeted evaluation and active management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15–16, 2015. Neurosurgery. 2016;79(6):912–29.

    Article  PubMed  Google Scholar 

  51. Broglio SP, Collins MW, Williams RM, Mucha A, Kontos AP. Current and emerging rehabilitation for concussion: a review of the evidence. Clin Sports Med. 2015;34(2):213–31.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Hugentobler JA, Vegh M, Janiszewski B, Quatman-Yates C. Physical therapy intervention strategies for patients with prolonged mild traumatic brain injury symptoms: a case series. Int J Sports Phys Ther. 2015;10(5):676–89.

    PubMed  PubMed Central  Google Scholar 

  53. Ventura RE, Jancuska JM, Balcer LJ, Galetta SL. Diagnostic tests for concussion: is vision part of the puzzle? J Neuroophthalmol. 2015;35(1):73–81.

    Article  PubMed  Google Scholar 

  54. Gallaway M, Scheiman M, Mitchell GL. Vision therapy for post-concussion vision disorders. Optom Vis Sci. 2017;94(1):68–73.

    Article  PubMed  Google Scholar 

  55. Scheiman M, Cotter S, Kulp MT, Mitchell GL, Cooper J, Gallaway M, et al. Treatment of accommodative dysfunction in children: results from a randomized clinical trial. Optom Vis Sci. 2011;88(11):1343–52.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Thiagarajan P, Ciuffreda KJ. Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury. J Rehabil Res Dev. 2013;50(9):1223–40.

    Article  PubMed  Google Scholar 

  57. Raikes AC, Killgore WD. Potential for the development of light therapies in mild traumatic brain injury. Concussion. 2018;3(3):CNC57.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Bajaj S, Vanuk JR, Smith R, Dailey NS, Killgore WDS. Blue-light therapy following mild traumatic brain injury: effects on white matter water diffusion in the brain. Front Neurol. 2017;8:616.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Sinclair KL, Ponsford JL, Taffe J, Lockley SW, Rajaratnam SM. Randomized controlled trial of light therapy for fatigue following traumatic brain injury. Neurorehabil Neural Repair. 2014;28(4):303–13.

    Article  PubMed  Google Scholar 

  60. Ibrahim MM, Patwardhan A, Gilbraith KB, Moutal A, Yang X, Chew LA, et al. Long-lasting antinociceptive effects of green light in acute and chronic pain in rats. Pain. 2017;158(2):347–60.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Clark J, Hasselfeld K, Bigsby K, Divine J. Colored glasses to mitigate photophobia symptoms posttraumatic brain injury. J Athl Train. 2017;52(8):725–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Barth JT, Freeman JR, Broshek DK, Varney RN. Acceleration-deceleration sport-related concussion: the gravity of it all. J Athl Train. 2001;36(3):253–6.

    PubMed  PubMed Central  Google Scholar 

  63. Treleaven J. Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma. Spine (Phila Pa 1976). 2011;36(25 Suppl):S211–7.

    Article  Google Scholar 

  64. Schneider KJ, Iverson GL, Emery CA, McCrory P, Herring SA, Meeuwisse WH. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med. 2013;47(5):304–7.

    Article  PubMed  Google Scholar 

  65. Seifert T. Post-traumatic headache therapy in the athlete. Curr Pain Headache Rep. 2016;20(6):41.

    Article  PubMed  Google Scholar 

  66. Cushman DM, Borowski L, Hansen C, Hendrick J, Bushman T, Teramoto M. Gabapentin and tricyclics in the treatment of post-concussive headache, a retrospective cohort study. Headache. 2019;59(3):371–82.

    Article  PubMed  Google Scholar 

  67. Pinto SM, Twichell MF, Henry LC. Predictors of pharmacological intervention in adolescents with protracted symptoms after sports-related concussion. PM R. 2017;9(9):847–55.

    Article  PubMed  Google Scholar 

  68. Brooks BL, Sayers P, Virani S, Rajaram A, Tomfohr L. Insomnia in adolescents with slow recovery from concussion. J Neurotrauma. 2019;36(16):2391–9.

    Article  PubMed  Google Scholar 

  69. Hoffman NL, Weber ML, Broglio SP, McCrea M, McAllister TW, Schmidt JD, et al. Influence of postconcussion sleep duration on concussion recovery in collegiate athletes. Clin J Sport Med. 2017.

    Google Scholar 

  70. Howell DR, Oldham JR, Brilliant AN, Meehan WP 3rd. Trouble falling asleep after concussion is associated with higher symptom burden among children and adolescents. J Child Neurol. 2019;34(5):256–61.

    Article  PubMed  Google Scholar 

  71. Oyegbile TO, Dougherty A, Tanveer S, Zecavati N, Delasobera BE. High sleep disturbance and longer concussion duration in repeat concussions. Behav Sleep Med. 2020;18(2):241–8.

    Google Scholar 

  72. Brent DA, Max J. Psychiatric sequelae of concussions. Curr Psychiatry Rep. 2017;19(12):108.

    Article  PubMed  Google Scholar 

  73. Trojian TH, Wang DH, Leddy JJ. Nutritional supplements for the treatment and prevention of sports-related concussion-evidence still lacking. Curr Sports Med Rep. 2017;16(4):247–55.

    Article  PubMed  Google Scholar 

  74. Barlow KM, Esser MJ, Veidt M, Boyd R. Melatonin as a treatment after traumatic brain injury: a systematic review and meta-analysis of the pre-clinical and clinical literature. J Neurotrauma. 2019;36(4):523–37.

    Article  PubMed  Google Scholar 

  75. Barlow KM, Brooks BL, MacMaster FP, Kirton A, Seeger T, Esser M, et al. A double-blind, placebo-controlled intervention trial of 3 and 10 mg sublingual melatonin for post-concussion syndrome in youths (PLAYGAME): study protocol for a randomized controlled trial. Trials. 2014;15:271.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Lavigne G, Khoury S, Chauny JM, Desautels A. Pain and sleep in post-concussion/mild traumatic brain injury. Pain. 2015;156 Suppl 1:S75–85.

    Article  PubMed  Google Scholar 

  77. McCarty CA, Zatzick D, Stein E, Wang J, Hilt R, Rivara FP, et al. Collaborative care for adolescents with persistent postconcussive symptoms: a randomized trial. Pediatrics. 2016;138(4):pii: e20160459.

    Article  Google Scholar 

  78. Mittenberg W, Canyock EM, Condit D, Patton C. Treatment of post-concussion syndrome following mild head injury. J Clin Exp Neuropsychol. 2001;23(6):829–36.

    Article  CAS  PubMed  Google Scholar 

  79. Al Sayegh A, Sandford D, Carson AJ. Psychological approaches to treatment of postconcussion syndrome: a systematic review. J Neurol Neurosurg Psychiatry. 2010;81(10):1128–34.

    Article  PubMed  Google Scholar 

  80. Whittaker R, Kemp S, House A. Illness perceptions and outcome in mild head injury: a longitudinal study. J Neurol Neurosurg Psychiatry. 2007;78(6):644–6.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Echemendia RJ, Gioia GA. The role of neuropsychologists in concussion evaluation and management. Handb Clin Neurol. 2018;158:179–91.

    Article  PubMed  Google Scholar 

  82. Silverberg ND, Panenka WJ. Antidepressants for depression after concussion and traumatic brain injury are still best practice. BMC Psychiatry. 2019;19(1):100.

    Article  PubMed  PubMed Central  Google Scholar 

  83. McAllister TW, Zafonte R, Jain S, Flashman LA, George MS, Grant GA, et al. Randomized placebo-controlled trial of methylphenidate or galantamine for persistent emotional and cognitive symptoms associated with PTSD and/or traumatic brain injury. Neuropsychopharmacology. 2016;41(5):1191–8.

    Article  CAS  PubMed  Google Scholar 

  84. Johansson B, Wentzel AP, Andrell P, Mannheimer C, Ronnback L. Methylphenidate reduces mental fatigue and improves processing speed in persons suffered a traumatic brain injury. Brain Inj. 2015;29(6):758–65.

    Article  CAS  PubMed  Google Scholar 

  85. Quinn DK, Mayer AR, Master CL, Fann JR. Prolonged postconcussive symptoms. Am J Psychiatry. 2018;175(2):103–11.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Bey T, Ostick B. Second impact syndrome. West J Emerg Med. 2009;10(1):6–10.

    PubMed  PubMed Central  Google Scholar 

  87. McLendon LA, Kralik SF, Grayson PA, Golomb MR. The controversial second impact syndrome: a review of the literature. Pediatr Neurol. 2016;62:9–17.

    Article  PubMed  Google Scholar 

  88. Weinstein E, Turner M, Kuzma BB, Feuer H. Second impact syndrome in football: new imaging and insights into a rare and devastating condition. J Neurosurg Pediatr. 2013;11(3):331–4.

    Article  PubMed  Google Scholar 

  89. McKee AC, Stern RA, Nowinski CJ, Stein TD, Alvarez VE, Daneshvar DH, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136(Pt 1):43–64.

    Article  PubMed  Google Scholar 

  90. Randolph C. Chronic traumatic encephalopathy is not a real disease. Arch Clin Neuropsychol. 2018;33(5):644–8.

    Article  PubMed  Google Scholar 

  91. Iverson GL, Keene CD, Perry G, Castellani RJ. The need to separate chronic traumatic encephalopathy neuropathology from clinical features. J Alzheimers Dis. 2018;61(1):17–28.

    Article  PubMed  Google Scholar 

  92. McKee AC, Stein TD, Nowinski CJ, Stern RA, Daneshvar DH, Alvarez VE, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136(Pt 1):43–64.

    Article  PubMed  Google Scholar 

  93. Stein TD, Alvarez VE, McKee AC. Chronic traumatic encephalopathy: a spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel. Alzheimers Res Ther. 2014;6(1):4.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Savica R, Parisi JE, Wold LE, Josephs KA, Ahlskog JE. High school football and risk of neurodegeneration: a community-based study. Mayo Clin Proc. 2012;87(4):335–40.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Janssen PH, Mandrekar J, Mielke MM, Ahlskog JE, Boeve BF, Josephs K, et al. High school football and late-life risk of neurodegenerative syndromes, 1956–1970. Mayo Clin Proc. 2017;92(1):66–71.

    Article  PubMed  Google Scholar 

  96. Asken BM, Sullan MJ, DeKosky ST, Jaffee MS, Bauer RM. Research gaps and controversies in chronic traumatic encephalopathy: a review. JAMA Neurol. 2017;74(10):1255–62.

    Article  PubMed  Google Scholar 

  97. Asken BM, Sullan MJ, Snyder AR, Houck ZM, Bryant VE, Hizel LP, et al. Factors influencing clinical correlates of chronic traumatic encephalopathy (CTE): a review. Neuropsychol Rev. 2016;26(4):340–63.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Iverson GL. Suicide and chronic traumatic encephalopathy. J Neuropsychiatry Clin Neurosci. 2016;28(1):9–16.

    Article  PubMed  Google Scholar 

  99. Cottler LB, Ben Abdallah A, Cummings SM, Barr J, Banks R, Forchheimer R. Injury, pain, and prescription opioid use among former National Football League (NFL) players. Drug Alcohol Depend. 2011;116(1–3):188–94.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Schwenk TL, Gorenflo DW, Dopp RR, Hipple E. Depression and pain in retired professional football players. Med Sci Sports Exerc. 2007;39(4):599–605.

    Article  PubMed  Google Scholar 

  101. Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, et al. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med. 2017;51(12):969–77.

    Article  PubMed  Google Scholar 

  102. Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Harding HP Jr, Matthews A, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007;39(6):903–9.

    Article  PubMed  Google Scholar 

  103. Lehman EJ, Hein MJ, Gersic CM. Suicide mortality among retired National Football League players who played 5 or more seasons. Am J Sports Med. 2016;44(10):2486–91.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA

    Jack Spittler

  2. Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Lindsey Kolar

Authors
  1. Jack Spittler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lindsey Kolar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jack Spittler .

Editor information

Editors and Affiliations

  1. Family and Sports Medicine, Rush University Medical Center, Chicago, IL, USA

    Deepak S. Patel

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Spittler, J., Kolar, L. (2020). Post-concussion Syndrome. In: Patel, D. (eds) Concussion Management for Primary Care . Springer, Cham. https://doi.org/10.1007/978-3-030-39582-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-39582-7_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-39581-0

  • Online ISBN: 978-3-030-39582-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation