![]() The most recent concussion guidelines recommend 24-48 hours of rest after a concussion. The challenge for clinicians is to determine whether prolonged symptoms after concussion reflect a prolonged version of the concussion pathophysiology versus a manifestation of a secondary process such as premorbid clinical depression, a cervical injury, or migraine headaches. The differential diagnosis of PCS includes depression, somatization, chronic fatigue, chronic pain, cervical injury, vestibular dysfunction, ocular dysfunction, or some combination of these conditions. It is a term used to describe a constellation of nonspecific symptoms (eg, headache, fatigue, sleep disturbance, vertigo, irritability, anxiety, depression, apathy, and difficulty with concentration and exercise) that are linked to several possible causes that do not necessarily reflect an ongoing injury to the brain. PCS is not a single pathophysiological entity. Persistence of symptoms beyond the generally accepted time frame for recovery is called “post-concussion syndrome.” In some cases, concussion symptoms are prolonged. Recent research that accounts for vestibular-oculomotor problems that often accompany SRC suggests that recovery time for adolescents after SRC may take 3 to 4 weeks, which is longer than the commonly reported 7 to 14 days. ![]() The majority (75%–90%) of sports-related concussions (SRC) in adults resolve in a short (7–10 days) period, although the recovery time frame may be longer in children and adolescents. The macrophysiological insult to the brain affects the autonomic nervous system (ANS) and its control of both cerebral blood flow (CBF) and rhythm of the heart. This complex pathophysiological process includes metabolic, physiological, and microstructural injury to the brain that produces excitatory neurotransmitter release, abnormal ion fluxes, increased glucose metabolism, lactic acid accumulation, and inflammation. A concussion is a brain injury that involves a complex pathophysiological process induced by biomechanical forces. The most recent concussion guidelines have recommended only an initial period of rest of 24-48 hours before reintroducing a gradual return to school and social activities that do not result in significant exacerbation of symptoms. ![]() The old-school thought of rest until asymptomatic is slowly disappearing. Long-term rest/immobility has been shown to have negative impacts on human health, and the appropriateness of long-term rest after a concussion has been questioned as to the preferred treatment after a concussion. This vulnerable state can be inferred to exist in humans after concussion from the rare but devastating (and controversial) phenomenon of second impact syndrome, from data that concussion risk increases after having had one or more concussions and from retrospective data suggesting that high levels of physical and/or cognitive activity soon after concussion delay recovery. This is due to research based on animal physiological concussion studies suggesting that the concussed human brain is in a vulnerable state that places it at an increased risk of more debilitating injury should it sustain more trauma or experience undue stress before the metabolic balance has been restored. ![]() Rest has been the mainstay of the treatment for concussion.
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