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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 41 The consequence of multiple small-scale head injuries turns out to be more than the sum of its parts. Some evidence shows structural changes in the brain that include a thinning cortex, a shrunken hippocampus, and deterioration of some motor pathways, all of which can contribute to inattention, memory loss and poor memory retention, depression, anxiety, and many other symptoms, depending on which part of the brain sustains the most damage. Some scientists equate the changes seen with multiple small head injuries to those seen in a condition that some boxers (including Mohammed Ali) live with: pugilistic Parkinsonism. In other cases, multiple head injuries may contribute to another brain disorder called chronic traumatic encephalopathy (CTE). CTE is diffi cult to diagnose in a living person, but it was identifi ed posthumously in many professional football players who committed suicide, including Dave Duerson, Ray Easterling, Terry Long, Junior Seau, and Andre Waters. Far more common than CTE, however, is PCS. POSTCONCUSSION SYNDROME Although it is a startlingly common condition, PCS has no universally agreed-upon defi nition. It is considered to be a sequel of minor head injuries, and is marked by the absence of objective neurological fi ndings. Symptoms can persist for months or years after injuries. Experts suggest that anywhere from 29–90 percent of head-trauma patients develop PCS. SYMPTOMS AND DIAGNOSIS The US Centers for Disease Control describe PCS as a collection of signs and symptoms that occur in four distinct categories. PCS is typically diagnosed when three or more of these signs or symptoms are present for three weeks or more after a head injury. In the short run, it is necessary to rule out internal brain bleeds for concussion patients, but PCS must also be differentiated from depression, fi bromyalgia syndrome, and posttraumatic stress disorder. This becomes especially diffi cult when we realize these conditions can be present simultaneously, and any one of them can make the symptoms of the others worse. DEMOGRAPHICS The vast majority of PCS patients are young men between the ages of 15 and 34—often those who engage in contact or high-risk sports. Women are certainly vulnerable as well, but they experience fewer head injuries overall compared to men. Dealing with PCS is also an issue for many service members returning from Iraq and Afghanistan; various types of brain injuries have become the signature wound of the wars in the Middle East. COGNITIVE Poor concentration Memory loss Poor retention PHYSICAL Headaches Blurred or double vision Dizziness and vertigo Sensitivity to light and sound Balance problems Fatigue, poor stamina Hearing loss, tinnitus Changes in taste or olfaction MOOD Irritability Depression Anxiety Anger, sadness Rapid mood swings SLEEP More sleep than normal Less sleep than normal Insomnia