Although many head injuries in accidents involving motor vehicles seem to be trivial, they often result in a persistent set of subjective disabilities and complaints, that have been called the post-concussion syndrome (PCS). They include memory loss, concentration difficulties, headache, fatigue, irritability, anxiety, and depression. Although the consistency of this cluster suggests an organic cause, PCS symptoms are by no means specific for brain injury. The most frequent evidence cited in favour of a organic cause to PCS is neurological test results. The author and his colleagues have reported tests on 55 patients with persistent PCS. Remarkably, all of them were involved in litigation, or were pursuing or receiving disability payments. More than half reported depression and insomnia. Considering the Dot Counting test and the Portland Digit Recognition test together, 26 patients had poor performance on at least one of these measures of cooperation, showing that motivational factors could have adversely affected test scores. These results and personality test results suggest that the predominant causes of persistent complaints in the PCS patients were functional rather than organic. These conclusions are contrary to those expressed by most neuropyschologists questioned in a recent survey.
Abstract