Comparison and Contrast of Post Concussive Syndrome and Traumatic Brain Injury
Post Concussive Syndrome (PCS) and Traumatic Brain Injury (TBI) are neurological disorders that are primarily associated. However, they have some differences and similarities. Examining the relationship between the two neurological disorders through comparison and contrast will help better understand the two.
This discussion compares and contrasts post-Concussive Syndrome and Traumatic Brain Injury. The comparison will include the similarities and differences between the two conditions regarding their presentation, pathophysiology, assessment, diagnosis, and treatment.
Presentation
Post-concussive Syndrome is a neurological disorder that occurs when a set of symptoms from a concussion are persistent even after the recovery period of a brain injury. Traumatic brain injury, on the other hand, is a neurological disorder that entails brain dysfunction following an external force, such as a violent blow on the head. It occurs when a sudden trauma causes damage to the brain.
Post Concussive Syndrome symptoms manifest in the physical, cognitive, and psychological aspects. Specific symptoms include dizziness, headaches, sleeping problems, memory loss, concentration problems, and anxiety. Traumatic Brain Injury symptoms, on the other hand, manifest in behavioral, cognitive, and physical aspects. Specific TBI symptoms include abnormal emotions, irritability, depression, hypertonia, persistent headaches, and balance disorder.
PCS is most prevalent among males in all populations, children of 0-4yrs, young adults aged 15-24, and adults above 60yrs, while TBI is most prevalent among children below one year and adults above 65 years. The associated risk factors of Post Concussive Syndrome include road traffic accidents, existing chronic diseases, and high hospital stay (Van der Vlegel et al., 2021), while the associated risk factors of traumatic brain injury include alcohol use and certain sports that can lead to head injuries.
Both PCS and TBI are neurological disorders caused by external brain injuries. Their symptoms also manifest in similar aspects. They also have various similar symptoms such as headaches, fatigue, and sleep problems. The two disorders are related in that Post Concussive Syndrome results from the persistence of symptoms after mild Traumatic Brain Injury.
Pathophysiology
According to Ng and Lee (2019), Traumatic Brain Injury damages the neuronal tissues depending on whether the injury was primary or secondary. Primary injury is directly caused by the damages of the initial external force, while the secondary injury is further cellular and tissue damage following the primary injury.
Both injuries affect the neuronal area/ necrotic cells, compromising blood supply, which potentially causes hematoma and intracerebral hemorrhages. More so, based on the severity and area of the injury, there are disruptions in the connectivity between various parts of the brain, leading to neurological and cognitive symptoms. After that, secondary brain damage may lead to mitochondrial axon degeneration, neuroinflammation, and cell death.
Post Concussive Syndrome, on the other hand, occurs after extreme forces of traumatic brain injury. Consistent symptoms of Post Concussive Syndrome result from damage to the autonomic nervous system. The damage occurs to the white matter track between the vagal nerve and the cortical control centers.
Damage to the autonomic nervous system affects the control of cerebral blood flow, heart rate, and blood pressure; thus, the patient experiences confusion, dizziness, and difficulty concentrating. Heart rate variability also causes a disproportional increase in blood pressure, and heart rate during activities, thus causing fatigue.
Both neurological conditions affect the nervous system by compromising its functionality, contributing to the manifestation of similar symptoms. Both disorders also have similar abnormalities that affect the white matter and other cerebral structures leading to the manifestation of symptoms. Also, in both conditions, the symptoms and outcomes depend on the injury’s extent.
Assessment
To facilitate continuous monitoring, several assessments must be done regarding Traumatic Brain Injury and Post Concussive Syndrome patients. To assess a patient on Post Concussive Syndrome, the nurse enquires about the history of head injuries that would have caused brain injuries, any challenges in sleeping, mood changes, memory loss, and changes in emotions. The patient is also assessed on physical symptoms such as dizziness, fatigue, and headaches.
In Traumatic Brain Injury, however, amnesia resulting from brain trauma can be assessed using the standardized tool, Westmead Post Traumatic American Scale (WPTAS). First, the patient is assessed on the type and extent of TBI involved. A head-to-toe assessment is also crucial in assessing TBI patients, whereby the vital signs and the physical body are assessed. Common assessment findings in this assessment may include awareness and responsiveness problems and changes in consciousness. The findings of TBI can be assessed using the Gaslow Coma Scale (GSC).
Similar assessment characteristics for both PCS and TBI include physical examination, history taking, cognitive assessments, neurological screenings/exams, cranial nerves assessment, and overall mental health assessment. Research by Wang et al. (2018) shows that Bio-fluid based TBI biomarker tests can also be used in the diagnostic testing of both TBI and PCS to show the severity of the injury, including concussions, and also predict the outcomes.
Diagnosis
Traumatic Brain Injury is diagnosed based on clinical presentations, while Post Concussive Syndrome is diagnosed based on the history of clinical presentations. TBI is diagnosed using imaging tests such as MRI and CT scans. Cerebral hemorrhage is ruled out using a non-contract head CT.
MRI is used to identify specific anatomic details, such as identifying diffuse axonal injuries. Suspicion of fracture in the cervical spine is ruled out using an x-ray of the cervical spine. More so, the tool used to diagnose the severity of the injury in TBI is the Gaslow Coma Scale(GCS). In contrast, Post Concussive Syndrome is diagnosed using the presence and severity of its signs. The presence and severity of PCS signs are mainly identified using patient interviews.
The Riverhead PCS questionnaire can be used in the patient interviews to determine the PCS symptoms following a brain injury. The PCS diagnosis includes mild or significant neurological disorder symptoms such as loss of consciousness, confusion, the patient being disoriented, and posttraumatic amnesia (Alvarez and Dalal, 2021). Also, diagnosing TBI requires the onset of symptoms compared to diagnosing PCS, which requires the persistence of TBI symptoms.
Traumatic Brain Injury and Post Concussive Syndrome diagnosis may include similar distinguishing symptoms such as metabolic abnormalities, fatigue, migraines, and anxiety. According to Polinder et al. (2018), the prerequisite of diagnosing both Post Concussive Syndrome and Traumatic Brain Injury is the presentation of symptoms resulting from a history of external brain injuries.
Treatment
The treatment of TBI depends on the severity and damage caused by the brain injury. Severe cases of TBI call for aggressive treatment options such as surgery, while mild cases sometimes only require assessment, monitoring, and general brain injury management. However, PCS treatment depends on the symptoms presented. In TBI, treatment includes patient stabilization, supportive care to unconscious patients, and physical rehabilitation, while specific treatment measures in PCS include low stimulation and rest.
Both treatments of TBI and PCS may require the use of anti-seizure medications to reduce the pressure that has been asserted by the anti-emetics utilized by both injuries. Cognitive impairment caused by both TBI and PCS is treated similarly. Treatment involves both non-pharmacological and pharmacological measures.
It begins with non-pharmacological measures, including patient education, administering rest, lifestyle and environment modification, cognitive behavioral therapy (CBT), cognitive rehabilitation, and good sleep. Also, treatment of TBI may include anti-seizure medications meant to reduce anti-emetic pressure utilized in both injuries.
Conclusion
In conclusion, Traumatic Brain Injury and Post Concussive Syndrome have identifiable differences and similarities, as seen in the discussion above. However, it is worth noting that Post Concussive Syndrome happens after incidences of Traumatic Brain Injury, even though not all cases of TBI evolve into PCS. There is inadequate research on the development of Post Concussive Syndrome. The pathophysiology of Traumatic Brain Injury is less controversial and better understood as compared to that of Post Concussive syndrome.
It, therefore, calls for more research and evidence-based practice publications on the same subject. It is more likely for TBI patients with poor health to develop PCS. Also, having several brain images that make the neurons dysfunctional places a TBI patient at a higher risk of PCS.
References
Alvarez, G., & Dalal, K. (2021). Dual diagnosis of traumatic brain injury and spinal cord injury. Brain Injury Medicine, 337-341. https://doi.org/10.1016/B978-0-323-65385-5.00063-9
Ng, S. Y., & Lee, A. Y. W. (2019). Traumatic brain injuries: pathophysiology and potential therapeutic targets. Frontiers in Cellular Neuroscience, 13, 528. https://doi.org/10.3389/fncel.2019.00528
Polinder, S., Cnossen, M. C., Real, R. G., Covic, A., Gorbunova, A., Voormolen, D. C., Master, C. L., Haagsma J., A., Diaz-Arrastia, R. & Von Steinbuechel, N. (2018). A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Frontiers in Neurology, 9, 1113. https://doi.org/10.3389/fneur.2018.01113
van der Vlegel, M., Polinder, S., Toet, H., Panneman, M. J., & Haagsma, J. A. (2021). Prevalence of post-concussion-like symptoms in the general injury population and the association with health-related quality of life, health care use, and return to work. Journal of Clinical Medicine, 10(4), 806. https://doi.org/10.3390%2Fjcm10040806
Wang, K. K., Yang, Z., Zhu, T., Shi, Y., Rubenstein, R., Tyndall, J. A., & Manley, G. T. (2018). An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert review of Molecular Diagnostics, 18(2), 165-180. https://doi.org/10.1080/14737159.2018.1428089
Comparison and Contrast of Post Concussive Syndrome and Traumatic Brain Injury Instructions
You will research the two areas of content assigned to you and compare and contrast them in a discussion post. NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories below. Consider how each patient would actually present to the office. Paint a picture of how that patient would look, act, what story they would tell. Consider how their history would affect their diagnosis, etc. Evaluation of mastery is focused on the student\'s ability to demonstrate specific understanding of how the diagnoses differ and relate to one another. Address the following topics below in your own words:
Presentation
Pathophysiology
Assessment
Diagnosis
Treatment
Compare and contrast the following diagnoses as assigned:
Student Last Name -Topic
(Find the corresponding first letter of your last name to find your topic assignment for this discussion)
A-E Benign Positional Vertigo and Meniere\'s Disease
F-J - Dementia and Delirium
K-O- Trigeminal Neuralgia and Giant Cell Arteritis
P-T = Post Concussive Syndrome and Traumatic Brain Injury
U-Z = Migraine Headache and Tension Headache
Throughout the Week: Participate in Interactive Dialogue with faculty and students responding to their Part 1 Discussion post moving the discussion forward.
**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.
DISCUSSION CONTENT
Category
Points
%
Description
App Course Knowledge
50
50%
Post contributes unique perspectives/insights applicable to the identified diseases. Demonstrates course knowledge by thorough, thoughtful, specific, evidence-based discussion of similarities and differences between assigned diseases in reference to:
• Presentation (demographics, onset of symptoms, associated risk factors)
• Pathophysiology (knowledge demonstrated in original dialogue)
• Assessment (physical assessment, diagnostic testing)
• Diagnosis
• Treatment
Evidence Based References
20
20%
Discussion post supported by evidence from appropriate sources published within the last five years. Focus of journal articles represents a logical link between the article content and the case study information. In-text citations and full references are provided.
Interactive Dialogue
20
20%
Presents diseases together and responds substantively to at least one peer including evidence from appropriate sources, and all direct faculty questions posted. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (no direct quotes from sources)
90
90%
Total CONTENT Points= 90
DISCUSSION FORMAT
Category
Points
%
Description
Organization
5
5%
Discussion post presented in a logical, meaningful, and understandable sequence. Headings reflect separation of criterion outlined in assignment guidelines.
Grammar, Spelling and APA Format
5
5%
Reflection post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.
* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.
**Direct quote should not exceed 15 words & must add substantively to the discussion
Total FORMAT Points= 10 pts
DISCUSSION TOTAL= 90 out of 100 points