Post-Concussion Symptoms: What to Expect After a Year

Can there be residual effects a year after a concussion?

The incident occurred at the end of November 2019 when my eldest daughter, who was seven years old at the time, fell on the school playground.
She hit the back of her head on the sharp edge of the steps of the platform, resulting in a laceration that required sutures.
After returning home, she continued to experience headaches, so we immediately went back to the hospital for an X-ray, which revealed a skull fracture, necessitating transfer to a larger hospital.
During her treatment, she experienced nosebleeds and blood-tinged sputum.
After being discharged, she occasionally still had headaches.

Now, more than a year later, her headaches have become more frequent, and the number of nosebleeds has also increased, with both nostrils bleeding simultaneously.
I would like to know if there could still be any long-term effects after more than a year, or if I should take my child to see a different specialist.
Thank you.

Youyou, 20~29 year old female. Ask Date: 2021/03/05

Dr. Cai Zongzhang reply Neurology

Concussion symptoms should not last for a year; it is recommended to consult a pediatric neurologist and an otolaryngologist for evaluation.

Reply Date: 2021/03/05

More Info

It sounds like your daughter has been through a very challenging experience following her concussion and skull fracture. Post-concussion syndrome (PCS) can indeed lead to a variety of symptoms that may persist long after the initial injury. It’s not uncommon for individuals, especially children, to experience ongoing issues such as headaches, dizziness, and even changes in mood or behavior after a concussion.
In your daughter's case, the fact that she is experiencing increasingly frequent headaches and episodes of nosebleeds more than a year after the injury is concerning and warrants further evaluation. While some children do recover fully from concussions, others may experience lingering symptoms that can last for months or even years. The symptoms can vary widely from person to person and may include:
1. Headaches: These can be tension-type headaches or migraines, and they may become more frequent or severe over time.

2. Cognitive Difficulties: Issues with concentration, memory, and processing information can occur.

3. Emotional Changes: Increased irritability, anxiety, or depression can be common.

4. Sleep Disturbances: Difficulty falling asleep or staying asleep can also be a symptom.

5. Physical Symptoms: Dizziness, balance problems, and sensitivity to light or noise may persist.

The nosebleeds your daughter is experiencing could be related to several factors. After a head injury, the nasal passages can become more susceptible to bleeding due to trauma, dryness, or even increased pressure in the head. However, frequent nosebleeds should be evaluated by a healthcare professional to rule out any underlying issues, such as a bleeding disorder or structural problems in the nasal passages.

Given that your daughter has had ongoing symptoms for over a year, it would be advisable to consult with a healthcare provider who specializes in brain injuries, such as a neurologist or a pediatrician with experience in post-concussion syndrome. They can perform a thorough evaluation, which may include imaging studies like an MRI or CT scan, to assess for any complications from the initial injury and to determine the best course of treatment.

Treatment for post-concussion syndrome often involves a multidisciplinary approach, including:
- Medication: To manage headaches and other symptoms.

- Physical Therapy: To help with balance and coordination issues.

- Cognitive Behavioral Therapy (CBT): To address emotional and cognitive symptoms.

- Rest and Gradual Return to Activity: It's essential to allow the brain to heal, which may involve a temporary reduction in physical and cognitive activities.

In summary, it is possible for your daughter to experience lingering effects from her concussion, and her current symptoms should not be ignored. Seeking a comprehensive evaluation from a specialist will help ensure that she receives the appropriate care and support for her recovery. Early intervention can make a significant difference in managing symptoms and improving her quality of life.

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