The treatment of Post Concussion Syndrome – A Fuel Delivery Approach

Patients who present with post concussive syndrome can have a multitude of symptoms that can seem unrelated. Symptoms can range widely: headaches, dizziness, tinnitus, nausea, fatigue, lightheadedness, brain fog, memory loss, speech abnormalities, chronic pain, and more. Traditionally, patients are advised to rest and take anti-inflammatory medication and allow the brain time to heal. We now understand that this method is not the most effective, and for many action is required to help the brain heal. 

Concussions and Evaluation of the Autonomic Nervous System

It is fundamental for a brain that has undergone trauma to have proper fuel delivery, or oxygen and nutrients, for the healing process to be effective. This requires efficiency of the autonomic nervous system. This is often a key area of dysfunction we see when concussion patients present with symptoms such as headache, dizziness, fatigue, lightheadedness (especially upon standing), and nausea. Without proper evaluation of the autonomic nervous system, a very crucial aspect of treatment can be missed. 

For athletes, an IMPACT test is the most common resource used to determine return to play. While the IMPACT test does a thorough job and evaluates cognitive deficits related to concussions, it does not evaluate all aspects of brain function that can be involved such as eye movement centers, balance centers, and autonomic centers. All of these aspects of brain function are predominantly localized to various brainstem regions. 

Concussion and Treatment of the Autonomic Nervous System

To understand how to treat concussions in the most effective manner, we must understand the necessity of monitoring the autonomic nervous system. If we are going to stimulate the brain, we must account for proper fuel delivery to the brain. It is important for concussion recovery that we not only provide stimuli to the nervous system but that we provide the appropriate amount of stimuli. 

During treatment at CNFC, our doctors are always monitoring components of autonomic function to help us understand how much stimuli/rehab a patient can handle. We are closely monitoring heart rate and oxygen saturation. If a patient exceeds how much stimuli they can handle, we will often see an increase in heart or and/or a decrease in oxygen saturation. We can also monitor pupil size. Pupil size is a function of the autonomic nervous system. When a patient has become fatigued we can see the pupils dilate and constrict, this is called hippus. Other signs/symptoms we may monitor for are sweating, skin color change, nausea, lightheadedness, excessive salivation, dry eyes, and more. 

We feel it is of utmost importance that the autonomic nervous system be evaluated and taken into consideration in an effective treatment plan for patients dealing with concussions and post concussive syndrome. 

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DISCLAIMER: This information is intended to be informational and informative solely based on the clinical experience of our doctors at CFNC. Our goal is to increase awareness of these conditions for treatments and research. This is not intended to be medical advice, if you are experiencing any of these symptoms or conditions please contact your healthcare provider.