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Mild head injuries frequently result in the post-concussion syndrome (PCS), a constellation of symptoms that can include headaches, dizziness, nausea, irritability, imbalance and problems with concentration and memory.  The specific etiology of these symptoms is seldom investigated since they are accepted as part of a syndrome diagnosis that is impossible to verify objectively.  Nevertheless, symptoms of vestibular system trauma, estimated to occur in up to 65% of head injuries (Griffiths, 1979), are seldom differentiated from PCS in the evaluation of minor head injury.  Three of the above PCS symptoms, dizziness, imbalance and nausea, are more likely to result from a traumatic vestibulopathy than from a mild brain injury.

While the majority of mild traumatic brain injury (MTBI) patients recover quickly, returning to baseline functioning within 3-6 months, up to 15% of these patients have prolonged recoveries or never recover completely (Levin et.al., 1987).  Existing treatment paradigms have largely failed this population of MTBI patients (Ruff et.al. 1994).  Incomplete recovery in this group has been attributed to a variety of factors, including the residual effects of brain injury (Barth et. al., 1983), chronic pain (Smith-Seemiller et. al., 2003), emotionally-based symptoms (Eysenick, 1991), and outright malingering (Jacobson, 1995).  Seldom has vestibular system pathology been considered as a common explanation for why this minority of MTBI patients remains “miserable” and unable to recover.  The following points summarize my thoughts about the persistent post-concussion syndrome.
 
 
 
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