How can I differentiate between Post-Concussion Syndrome and other potential causes of persistent symptoms in my patients?

To differentiate Post-Concussion Syndrome (PCS) from other potential causes of persistent symptoms in patients, a comprehensive clinical assessment is essential, focusing on the characteristic symptom profile of PCS alongside exclusion of alternative diagnoses.

Key differentiating features of PCS include a constellation of sensory, motor, cognitive, and neuropsychiatric symptoms that persist beyond the expected recovery period after a head injury. These symptoms commonly include headache, dizziness, nausea, visual disturbances (blurred or double vision, photophobia), balance and coordination difficulties, speech problems, cognitive impairments such as 'brain fog', memory problems, difficulty concentrating, and executive dysfunction ¹.

Persistent symptoms should be evaluated in the context of the initial injury severity, typically a mild traumatic brain injury with a Glasgow Coma Scale (GCS) score of 13-15, and absence of focal neurological deficits or other structural brain injuries. The presence of focal neurological signs or a history suggestive of more severe injury warrants further investigation ¹.

Other potential causes of persistent symptoms to consider include hypopituitarism, cervical spine injury, psychological conditions, and other neurological disorders. Hypopituitarism can present with fatigue, cognitive symptoms, hormonal deficiencies, and should be suspected if symptoms are disproportionate or atypical for PCS, especially if recovery is delayed; endocrinological investigations are recommended in such cases ¹. Cervical spine injuries may cause neck pain and neurological symptoms and should be ruled out with appropriate imaging if indicated by clinical risk factors ¹.

Psychological factors such as anxiety, depression, or post-traumatic stress disorder can mimic or exacerbate PCS symptoms and should be assessed as part of a holistic evaluation. Persistent symptoms beyond 10 days warrant consideration of multidisciplinary assessment including neuropsychology or clinical psychology (Makdissi et al., 2013; Dwyer and Katz, 2018).

Investigations such as brain imaging or biomarkers have limited utility in predicting PCS but may be used to exclude other pathologies if clinical suspicion arises ¹. Referral to specialists trained in traumatic brain injury management (neurologists, neuropsychologists, endocrinologists) is advised for persistent or complex cases ¹.

In summary, differentiation relies on detailed symptom characterization, exclusion of other causes through clinical and targeted investigations, and multidisciplinary assessment when symptoms persist, integrating both guideline recommendations and evidence from recent literature (Makdissi et al., 2013; Dwyer and Katz, 2018) ¹.