THE POSTCONCUSSION SYNDROME - 130 YEARS OF CONTROVERSY

Controversial best describes the postconcussion syndrome. This controversy is expressed in the many terms proposed since the lectures of Erichsen in 1866 for the sequelae of usually mild head injury: spinal concussion, railway spine, railway brain, traumatic neurosis, nervous shock, traumatic hysteria, traumatic hysteroneurasthenia, spinal anemia, vasomotor symptom complex, litigation neurosis, compensation neurosis, accident neurosis, Erichsen's disease, Friedmann's disease, traumatic neurasthenia, the posttraumatic concussion state, the posttraumatic psychoneurotic state, traumatic encephalopathy, posttraumatic cerebral syndrome, posttraumatic syndrome, posttraumatic nervous instability, postconcussion syndrome, postconcussive syndrome, postconcussional syndrome, posttraumatic stress syndrome, and the persistent postconcussive syndrome. This article will selectively review definitions, historical aspects, causation, symptoms and signs, testing, prognosis, medicolegal aspects, and treatment. Other articles in this issue of Seminars review epidemiology, pathophysiology, neuropathology, posttraumatic headache, testing, and neuropsychologic testing. Areas of current controversy will be illustrated by some of the responses of neurologists in a recent nationwide survey we have conducted by mail, ''The Physician Survey on the Postconcussion and Whiplash Syndromes,'' of family physicians, neurologists, neurosurgeons, and orthopedists.1 Although the results may be biased because of a low response rate (21% of neurologists surveyed), the survey is the best information currently available on this topic. According to the survey results, neurologists see an average of five patients per month with postconcussion syndrome, and 7.1% of the neurology respondents had personally had a postconcussion syndrome with a mean duration of 1 month.