23 - Post-traumatic syndrome, ‘myalgic encephalomyelitis’ and headaches

Summary

Post-traumatic syndrome

The clinical problem

In our opinion, the subjective posttraumatic syndrome, characterised by …, is organic and is dependent on a disturbance in intracranial equilibrium due directly to the blow on the head, We suggest the term postconcussion syndrome for this symptom complex.

Strauss and Savitsky 1934

or

The most consistent clinical feature is the subject's unshakable conviction of unfitness for work, a conviction quite unrelated to overt disability, even if his symptomatology is taken at face value.

Miller 1961

Survivors of severe head injury commonly suffer neurological symptoms, cognitive (Pearce 1994), personality and behavioural changes which are easily related to focal or diffuse brain damage. Their symptoms improve in the first year, but if present at 1–2 years tend to persist indefinitely.

The more difficult problem is in determining the clinical features and outcome of minor head injuries. These patients have complaints and disabilities which are extraordinarily variable, often seeming disproportionate to the injury sustained. They are commonly attributed to the post-traumatic syndrome. Since it has no defining or consistent clinical signs nor biochemical, radiological or pathological accompaniments, it is not a diagnostic entity (Pearce 1994).

A term of convenience, it denotes a variable collection of symptoms that succeed head (and other) injuries. The well-known features are shown in Table 23.1. In most circumstances a knock on the head causes local bruising and abrasions no different from those resulting from a kick on the shin; local pain subsides within days, without sequelae.