Postconcussion Syndrome

Postconcussion Syndrome

No Results

No Results


Postconcussion (postconcussive) syndrome (PCS), a sequela of minor head injury (MHI), has been a much-debated topic. Muddled by conflicting findings regarding symptom duration, an absence of objective neurologic findings, inconsistencies in presentation, poorly understood etiology, and significant methodologic problems in the literature, PCS remains controversial. Depending on the definition and the population examined, 29-90% of patients experience postconcussion symptoms shortly after the traumatic insult. [1, 2, 3, 4]

Minor head injury and concussion are generally used interchangeably in the medical literature; however, it should be noted that the traditional definition of concussion precludes findings of intracranial hemorrhage on CT scan, whereas the definition minor head injury does not (though it does preclude the presence of a skull fracture). A minor head injury typically indicates a blow to the head with a brief period of loss of consciousness (LOC) or posttraumatic amnesia or disorientation. At presentation, the Glasgow Coma Scale (GCS) score ranges from 13-15. However, more recent literature suggests, and many clinicians concur, that a GCS score of 14 or 15 denotes an injury with a significantly less chance of intracranial injury on CT scan than a GCS score of 13.

Although no universally accepted definition of postconcussion syndrome exists, most of the literature defines the syndrome as the development of at least 3 of the following symptoms: headache, dizziness, fatigue, irritability, impaired memory and concentration, insomnia, and lowered tolerance for noise and light. Confusion exists in the literature, with some authors defining it as symptoms of at least 3 months’ duration, while others define it as symptoms appearing within the first week. In this article, the syndrome is loosely defined as symptom occurrence and persistence within several weeks after the initial insult. In defining persistent postconcussive syndrome (PPCS), most authors use greater than one month, and still others use 6 months or a year. However, it generaly applies to ongoing chronic symptoms that continue past expected resolution.

In a study of patients aged 5 to younger than 18 years who presented with acute head injury in pediatric emergency departments, 801 of 2584 patients (31%) experienced PPCS, or acute concussion followed by ongoing somatic, cognitive, and psychological or behavioral symptoms. [5]

The ICD-10 criteria include a history of traumatic brain injury (TBI) and the presence of 3 or more of the following 8 symptoms: (1) headache, (2) dizziness, (3) fatigue, (4) irritability, (5) insomnia, (6) concentration or (7) memory difficulty, and (8) intolerance of stress, emotion, or alcohol.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), postconcussion syndrome is given a diagnosis of either major or mild neurocognitive disorder (NCD) due to TBI. [4] The DSM-5 criteria for neurocognitive disorder due to TBI include the following:

Findings may include headache; cranial nerve signs and symptoms such as dizziness, vertigo, and nausea; psychological and neurovegetative problems such as anxiety, depression, or sleep disturbance; and cognitive impairment such as memory loss and decreased ability to concentrate. [6]

Imaging modalities such as MRI, SPECT, and MEG have been shown to be more sensitive than CT at detecting brain injuries associated with postconcussion syndrome.

Patients with the symptom constellation consistent with postconcussion syndrome require thorough physical and neurological examinations. A CT scan should be obtained if significant concern about intracranial hemorrhage exists.

See Pediatric Concussion and Other Traumatic Brain Injuries, a Critical Images slideshow, to help identify the signs and symptoms of TBI, determine the type and severity of injury, and initiate appropriate treatment.

Debate in the literature exists over which symptoms of postconcussion syndrome are due to organic causes and which have a psychological basis. Researchers have hypothesized that early postconcussion syndrome symptoms are more likely to be organic, whereas PCS symptoms that persist beyond 3 months have a nonorganic, psychological basis. While recent research has shown that psychological factors may be present early, other studies using imaging techniques such as magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) have demonstrated the presence of organic brain injury in patients with persistent PCS at greater than 1 year after injury.

Neuropsychological assessments have pointed toward an organic basis for some of the symptoms of postconcussion syndrome. Patients with PCS have been found to have cognitive deficits in memory, attention, and learning when compared with controls. A prospective study found impaired eye movements in patients with PCS, as compared to controls, that were both persistent and independent of factors such as depression or intellectual ability. [7] Findings from neuropsychological evaluations demonstrate that symptom severity is not necessarily dependent on neurologic status immediately following injury. However, in other series, the length of LOC or posttraumatic amnesia may be correlated with the probability of developing PCS.

Some studies have found certain characteristics such as female sex, noise sensitivity, and anxiety predict development of symptoms. [8] Another study found a simple test in the ED of immediate and delayed memory for 5 words and a VAS for acute headache provided an 80% sensitivity and 76% specificity for the development of PCS. [9] In addition, another study found that higher educational levels, along with mild symptoms and no extracranial symptoms predicted a low likelihood of significant dysfunction from PCS.

More than 1 million instances of minor head injury occur in the United States each year. The overall incidence rate of minor head injury for persons not hospitalized, with data compiled by the National Hospital Ambulatory Medical Care Survey, was 503 per 100,000 population or 1,367,101 visits per year to hospital EDs in the United States. [10]  Depending on the definitions used and population examined, approximately 50% of patients with minor head injury have symptoms of postconcussion syndrome at 1 month and 15% have symptoms at 1 year. The number of patients who sustain minor head injury and do not present for medical care is unknown; therefore, the number of patients with PCS is likely significantly underdiagnosed.

Morbidity is mainly due to the persistence of symptoms, which make it difficult for patients to resume premorbid functions. Between 14 and 29% of children with mild traumatic brain injury will continue to have postconcussion symptoms at 3 months. [11, 12]

Fifty percent of those who experience minor head injury are aged 15-34 years. However, postconcussion syndrome has no predilection for any specific age group. [1, 13]

Approximately 500,000 children a year visit the ED for traumatic brain injuries (TBIs). TBIs are largest cause of ED visits for adolescents. Eighty to ninety percent of these are mild (mTBIs), or concussions, and are not life-threatening, but even a mild TBI can have ongoing effects. Young children are more susceptible to concussion than adults not only because they are more likely to be active and involved in sports but also because their brains are not yet fully developed and therefore are more vulnerable to injury. [14]

According to the University of Pittsburgh’s Brain Trauma Research Center more than 300,000 sports-related concussions occur annually in the United States, and the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19% per year of play. More than 62,000 concussions are sustained each year in high school contact sports, and among college football players, 34% have had one concussion and 20% have had multiple concussions. Estimates show that between 4 and 20% of college and high school football players will sustain a brain injury over the course of one season. The risk of concussion in football players is 3 to 6 times higher in players who have had a previous concussion. [15]

A study conducted by McGill University found that 60% of college soccer players reported symptoms of a concussion at least once during the season and that concussion rates in soccer players were comparable to those of football players. Athletes who suffered a concussion were found to be 4 to 6 times more likely to suffer a second concussion. [16]

True prognosis is difficult to define given that many patients with minor symptoms may not enter the health care system and those that participate in research appear to have more significant symptoms at baseline. In addition, a wide heterogeneity exists in patients enrolled in studies.

Most patients recover fully in less than 3 months, although some small studies suggest persistence of minor cognitive defects for asymptomatic minor traumatic brain injury patients. [17]

Approximately 15% of patients complain of problems more than 12 months after injury. This group is likely to experience persistent and intrusive symptoms that may be refractory to treatment and impose a lifelong disability.

At least one study found the persistence of dizziness as a symptom seemed to portend a longer and more significant symptom complex. [18] Other studies found the depression, pain, and symptom invalidity were correlated with longer and worse symptoms. [19] Another found patients with early clinical symptoms, such as headache, dizziness, and intracranial lesions were more likely to have persistent PCS.

PCS is commonly associated with multiple concussions, but in one series, 23.1% of patients experienced PCS after only 1 concussion (average was 3.3 concussions). Median duration of symptoms in this series was 7 months. [20]

Hiploylee et al found that time to recovery often depended on the number of initial symptoms reported, with each symptom reducing recovery rate by about 20%. They also found that PCS may be permanent if recovery hasn’t occurred withiin 3 years. Those who did not recover were more likely to be noncompliant regarding the recommendation to not return to play. [21]

Butler IJ. Postconcussion Syndrome After Mild Traumatic Brain Injury in Children and Adolescents Requires Further Detailed Study. JAMA Neurol. 2013 Mar 25. 1-2. [Medline].

Sullivan KA, Edmed SL, Cunningham LC. A comparison of new and existing mild traumatic brain injury vignettes: recommendations for research into post-concussion syndrome. Brain Inj. 2013. 27(1):19-30. [Medline].

Barlow KM. Postconcussion Syndrome: A Review. J Child Neurol. 2016 Jan. 31 (1):57-67. [Medline].

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association; 2013.

Zemek R, Barrowman N, Freedman SB, et al. Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED. JAMA. 2016 Mar 8. 315 (10):1014-25. [Medline].

Reuben A, Sampson P, Harris AR, Williams H, Yates P. Postconcussion syndrome (PCS) in the emergency department: predicting and pre-empting persistent symptoms following a mild traumatic brain injury. Emerg Med J. 2014 Jan. 31 (1):72-7. [Medline].

Heitger MH, Jones RD, Macleod AD, Snell DL, Frampton CM, Anderson TJ. Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability. Brain. 2009 Oct. 132:2850-70. [Medline].

Dischinger PC, Ryb GE, Kufera JA, Auman KM. Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury. J Trauma. 2009 Feb. 66(2):289-96; discussion 296-7. [Medline].

Sheedy J, Harvey E, Faux S, Geffen G, Shores EA. Emergency department assessment of mild traumatic brain injury and the prediction of postconcussive symptoms: a 3-month prospective study. J Head Trauma Rehabil. 2009 Sep-Oct. 24(5):333-43. [Medline].

Bazarian JJ, McClung J, Shah MN, Cheng YT, Flesher W, Kraus J. Mild traumatic brain injury in the United States, 1998–2000. Brain Inj. 2005 Feb. 19(2):85-91. [Medline].

Barlow KM. Postconcussion Syndrome: A Review. J Child Neurol. 2014 Oct 20. [Medline].

Dillard C, Ditchman N, Nersessova K, Foster N, Wehman P, West M, et al. Post-concussion symptoms in mild traumatic brain injury: findings from a paediatric outpatient clinic. Disabil Rehabil. 2017 Mar. 39 (6):544-550. [Medline].

Kolias AG, Guilfoyle MR, Helmy A, Allanson J, Hutchinson PJ. Traumatic brain injury in adults. Pract Neurol. 2013 Mar 13. [Medline].

Barry Kosofsky, M.D., Zuhal Ergonul, M.D., Ph.D.; Kenneth Perrine, Ph.D.; Jeffrey Greenfield, et al. Children and Concussions. Weill Cornell Medicine. Available at Accessed: September 24, 2018.

University of Pittsburgh Medical Center. Concussion. Neurological Surgery. Available at 2018; Accessed: September 24, 2018.

Concussion. American Association of Neurological Surgeons. Available at Accessed: September 24, 2018.

Rees RJ, Bellon ML. Post concussion syndrome ebb and flow: longitudinal effects and management. NeuroRehabilitation. 2007. 22(3):229-42. [Medline].

Meares S, Shores EA, Batchelor J, et al. The relationship of psychological and cognitive factors and opioids in the development of the postconcussion syndrome in general trauma patients with mild traumatic brain injury. J Int Neuropsychol Soc. 2006 Nov. 12(6):792-801. [Medline].

Yang CC, Tu YK, Hua MS, Huang SJ. The association between the postconcussion symptoms and clinical outcomes for patients with mild traumatic brain injury. J Trauma. 2007 Mar. 62(3):657-63. [Medline].

Tator CH, Davis HS, Dufort PA, Tartaglia MC, Davis KD, Ebraheem A, et al. Postconcussion syndrome: demographics and predictors in 221 patients. J Neurosurg. 2016 Feb 26. 1-11. [Medline].

Hiploylee C, Dufort PA, Davis HS, Wennberg RA, Tartaglia MC, Mikulis D, et al. Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers. J Neurotrauma. 2017 Apr 15. 34 (8):1511-1523. [Medline].

Faux S, Sheedy J. A prospective controlled study in the prevalence of posttraumatic headache following mild traumatic brain injury. Pain Med. 2008 Nov. 9(8):1001-11. [Medline].

Tator CH, Davis H. The postconcussion syndrome in sports and recreation: clinical features and demography in 138 athletes. Neurosurgery. 2014 Oct. 75 Suppl 4:S106-12. [Medline].

Dawson KS, Batchelor J, Meares S, Chapman J, Marosszeky JE. Applicability of neural reserve theory in mild traumatic brain injury. Brain Inj. 2007 Aug. 21(9):943-9. [Medline].

Whittaker R, Kemp S, House A. Illness perceptions and outcome in mild head injury: a longitudinal study. J Neurol Neurosurg Psychiatry. 2007 Jun. 78(6):644-6. [Medline].

Ma M, Lindsell CJ, Rosenberry CM, Shaw GJ, Zemlan FP. Serum cleaved tau does not predict postconcussion syndrome after mild traumatic brain injury. Am J Emerg Med. 2008 Sep. 26(7):763-8. [Medline].

Lima DP, Simao Filho C, Abib Sde C, de Figueiredo LF. Quality of life and neuropsychological changes in mild head trauma. Late analysis and correlation with S100B protein and cranial CT scan performed at hospital admission. Injury. 2008 May. 39(5):604-11. [Medline].

Ramos-Zuniga R, Gonzalez-de la Torre M, Jimenez-Maldonado M, Villasenor-Cabrera T, Banuelos-Acosta R, Aguirre-Portillo L, et al. Postconcussion Syndrome and Mild Head Injury: The Role of Early Diagnosis Using Neuropsychological Tests and Functional Magnetic Resonance/Spectroscopy. World Neurosurg. 2013 Sep 18. [Medline].

Groswasser Z, Reider-Groswasser I, Soroker N, Machtey Y. Magnetic resonance imaging in head injured patients with normal late computed tomography scans. Surg Neurol. 1987 Apr. 27(4):331-7. [Medline].

Lewine JD, Davis JT, Bigler ED, et al. Objective documentation of traumatic brain injury subsequent to mild head trauma: multimodal brain imaging with MEG, SPECT, and MRI. J Head Trauma Rehabil. 2007 May-Jun. 22(3):141-55. [Medline].

van der Naalt J, Hew JM, van Zomeren AH, Sluiter WJ, Minderhoud JM. Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome. Ann Neurol. 1999 Jul. 46(1):70-8. [Medline].

Ghodadra A, Alhilali L, Fakhran S. Principal Component Analysis of Diffusion Tensor Images to Determine White Matter Injury Patterns Underlying Postconcussive Headache. AJNR Am J Neuroradiol. 2016 Feb. 37 (2):274-8. [Medline].

Mutch WA, Ellis MJ, Ryner LN, Ruth Graham M, Dufault B, Gregson B, et al. Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome. J Neurosurg. 2016 Sep. 125 (3):648-60. [Medline].

Barlow KM, Marcil LD, Dewey D, Carlson HL, MacMaster FP, Brooks BL, et al. Cerebral Perfusion Changes in Post-Concussion Syndrome: A Prospective Controlled Cohort Study. J Neurotrauma. 2017 Mar 1. 34 (5):996-1004. [Medline].

Joyce AS, Labella CR, Carl RL, Lai JS, Zelko FA. The Postconcussion Symptom Scale: utility of a three-factor structure. Med Sci Sports Exerc. 2015 Jun. 47 (6):1119-23. [Medline].

Begasse de Dhaem O, Barr WB, Balcer LJ, Galetta SL, Minen MT. Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery. J Headache Pain. 2017 Dec. 18 (1):60. [Medline].

Bin Zahid A, Hubbard ME, Dammavalam VM, Balser DY, Pierre G, Kim A, et al. Assessment of acute head injury in an emergency department population using sport concussion assessment tool – 3rd edition. Appl Neuropsychol Adult. 2016 Nov 17. 1-10. [Medline].

Khazaei S, Hanis SM, Mansori K, Begasse de Dhaem O, Barr WB, Balcer LJ, et al. Correspondence regarding: Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery. J Headache Pain. 2017 Aug 31. 18 (1):92. [Medline].

Davis GA, Purcell L, Schneider KJ, Yeates KO, Gioia GA, Anderson V, et al. The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale. Br J Sports Med. 2017 Jun. 51 (11):859-861. [Medline].

Yengo-Kahn AM, Hale AT, Zalneraitis BH, Zuckerman SL, Sills AK, Solomon GS. The Sport Concussion Assessment Tool: a systematic review. Neurosurg Focus. 2016 Apr. 40 (4):E6. [Medline].

Reuben A, Sampson P, Harris AR, Williams H, Yates P. Postconcussion syndrome (PCS) in the emergency department: predicting and pre-empting persistent symptoms following a mild traumatic brain injury. Emerg Med J. 2013 Mar 6. [Medline].

Cunningham J, Brison RJ, Pickett W. Concussive symptoms in emergency department patients diagnosed with minor head injury. J Emerg Med. 2011 Mar. 40(3):262-6. [Medline].

Alexander MP. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995. 45 (7):1253-60. [Medline].

Bazarian JJ, Wong T, Harris M, Leahey N, Mookerjee S, Dombovy M. Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Inj. 1999 Mar. 13(3):173-89. [Medline].

Bigler ED. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc. 2008 Jan. 14(1):1-22. [Medline].

Boake C, McCauley SR, Levin HS, et al. Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2005 Summer. 17(3):350-6. [Medline].

Bohnen N, Twijnstra A, Wijnen G. Tolerance for light and sound of patients with persistent post-concussional symptoms 6 months after mild head injury. J Neurol. 1991 Dec. 238(8):443-6. [Medline].

Chan RC. How severe should symptoms be before someone is said to be suffering from post-concussion syndrome? An exploratory study with self-reported checklist using Rasch analysis. Brain Inj. 2005 Dec. 19(13):1117-24. [Medline].

Chen JK, Johnston KM, Collie A, McCrory P, Ptito A. A validation of the post concussion symptom scale in the assessment of complex concussion using cognitive testing and functional MRI. J Neurol Neurosurg Psychiatry. 2007 Nov. 78(11):1231-8. [Medline].

Collie A, Makdissi M, Maruff P, Bennell K, McCrory P. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. J Neurol Neurosurg Psychiatry. 2006 Feb. 77(2):241-5. [Medline].

de Kruijk JR, Leffers P, Meerhoff S, Rutten J, Twijnstra A. Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest. J Neurol Neurosurg Psychiatry. 2002 Aug. 73(2):167-72. [Medline].

De Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Rutten J, Twijnstra A. Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. J Neurol Neurosurg Psychiatry. 2002 Dec. 73(6):727-32. [Medline].

de Kruijk JR, Leffers P, Menheere PP, Meerhoff S, Twijnstra A. S-100B and neuron-specific enolase in serum of mild traumatic brain injury patients. A comparison with health controls. Acta Neurol Scand. 2001 Mar. 103(3):175-9. [Medline].

Duff J. The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clin EEG Neurosci. 2004 Oct. 35(4):198-209. [Medline].

Evans RW. Post-traumatic headaches. Neurol Clin. 2004 Feb. 22(1):237-49, viii. [Medline].

Guerrero JL, Thurman DJ, Sniezek JE. Emergency department visits associated with traumatic brain injury: United States, 1995-1996. Brain Inj. 2000 Feb. 14(2):181-6. [Medline].

Kraus J, Hsu P, Schaffer K, Vaca F, Ayers K, Kennedy F, et al. Preinjury factors and 3-month outcomes following emergency department diagnosis of mild traumatic brain injury. J Head Trauma Rehabil. 2009 Sep-Oct. 24(5):344-54. [Medline].

Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006 Sep-Oct. 21(5):375-8. [Medline].

Larrabee GJ. Neuropsychological Outcome, Post Concussion Symptoms, and Forensic Considerations in Mild Closed Head Trauma. Semin Clin Neuropsychiatry. 1997 Jul. 2(3):196-206. [Medline].

Lee LK. Controversies in the sequelae of pediatric mild traumatic brain injury. Pediatr Emerg Care. 2007 Aug. 23(8):580-3; quiz 584-6. [Medline].

Lovell MR, Iverson GL, Collins MW, McKeag D, Maroon JC. Does loss of consciousness predict neuropsychological decrements after concussion?. Clin J Sport Med. 1999 Oct. 9(4):193-8. [Medline].

McCullagh S, Feinstein A. Outcome after mild traumatic brain injury: an examination of recruitment bias. J Neurol Neurosurg Psychiatry. 2003 Jan. 74(1):39-43. [Medline].

Mooney G, Speed J, Sheppard S. Factors related to recovery after mild traumatic brain injury. Brain Inj. 2005 Nov. 19(12):975-87. [Medline].

Olver J. Traumatic brain injury–the need for support and follow up. Aust Fam Physician. 2005 Apr. 34(4):269-71. [Medline].

Potter S, Leigh E, Wade D, Fleminger S. The Rivermead Post Concussion Symptoms Questionnaire: a confirmatory factor analysis. J Neurol. 2006 Dec. 253(12):1603-14. [Medline].

Preiss-Farzanegan SJ, Chapman B, Wong TM, Wu J, Bazarian JJ. The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. PM R. 2009 Mar. 1(3):245-53. [Medline].

Savola O, Hillbom M. Early predictors of post-concussion symptoms in patients with mild head injury. Eur J Neurol. 2003 Mar. 10(2):175-81. [Medline].

Stalnacke BM, Bjornstig U, Karlsson K, Sojka P. One-year follow-up of mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction in relation to serum levels of S-100B and neurone-specific enolase in acute phase. J Rehabil Med. 2005 Sep. 37(5):300-5. [Medline].

Stalnacke BM, Elgh E, Sojka P. One-year follow-up of mild traumatic brain injury: cognition, disability and life satisfaction of patients seeking consultation. J Rehabil Med. 2007 May. 39(5):405-11. [Medline].

Stulemeijer M, van der Werf S, Borm GF, Vos PE. Early prediction of favourable recovery 6 months after mild traumatic brain injury. J Neurol Neurosurg Psychiatry. 2008 Aug. 79(8):936-42. [Medline].

Voller B, Benke T, Benedetto K, Schnider P, Auff E, Aichner F. Neuropsychological, MRI and EEG findings after very mild traumatic brain injury. Brain Inj. 1999 Oct. 13(10):821-7. [Medline].

Wood RL. Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome. Brain Inj. 2004 Nov. 18(11):1135-53. [Medline].

Eric L Legome, MD Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jon Mark Hirshon, MD, MPH, PhD Professor, Department of Emergency Medicine, University of Maryland School of Medicine

Jon Mark Hirshon, MD, MPH, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Pfizer.

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Jerry R Balentine, DO, FACEP, FACOEP Vice President, Medical Affairs and Global Health, New York Institute of Technology; Professor of Emergency Medicine, New York Institute of Technology College of Osteopathic Medicine

Jerry R Balentine, DO, FACEP, FACOEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, American College of Osteopathic Emergency Physicians, American Association for Physician Leadership, American Osteopathic Association

Disclosure: Nothing to disclose.

Tina Wu, MD Staff Physician, Department of Emergency Medicine, New York University Medical Center, Bellevue Hospital Center

Tina Wu, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Rachel Alt, MD Staff Physician, Department of Emergency Medicine, New York University Bellevue Hospital

Disclosure: Nothing to disclose.

Postconcussion Syndrome

Research & References of Postconcussion Syndrome|A&C Accounting And Tax Services