[Subjective syndrome after head injury]

DEFINITION AND CLASSIFICATION PROBLEMS: Post-traumatic or post-commotion syndrome is one of the most controversial entities in studying consequences of craniocerebral trauma. Part of this problem arises from impossibility of adequate translation of the term brain concussion. Post-concussion syndrome is a broader concept than post-commotion and includes, if not a whole, than part of the post-contusion syndrome. There are also some other terms in the literature: post-traumatic syndrome, post head injury syndrome, post head injury syndrome or symptoms and the old term post-traumatic encephalopathy. Terminological imprecisions have not been solved yet, but the notion itself is determined by relative standard symptoms often associated with closed craniocerebral trauma, but without precise connection with the severity of the trauma. In the classification of mental disorders and behavior disorders, this syndrome is coded as FO7.2.

In regard to the etiology of this syndrome some authors speak in favor of psychogenic and some of organic etiology, while Levin considers symptoms of post-commotion syndrome to start as organic and persist as psychic. Wechsler classified subjective disorders after head injuries into 4 categories: simulation, traumatic hysteria, traumatic encephalopathy and traumatic neurosis. The author does not deal with the origin of symptoms, whereas the classification itself suggests priority of psychic to organic factors (11). Those who speak in favor of organic etiology, think that axon damage and neuron damage are organic substrate in mild brain injuries, while fibrous degenerations of the cerebral hemisphere and brain stem are the organic base in severe traumas. On the other hand, many scientists primarily point to psychic moments, especially to importance of aggravation and simulation as well as compensation or rental neurosis in persistent post-traumatic syndrome. Most scientists agree that personality characteristics influence the development of post-traumatic syndrome and can predispose aggravation and simulation, whereas these symptoms more often occur in neurotic persons. The latest investigations reveal that classification in regard to etiologic factors--organic and psychogenic--is an anachronism. Long and Novac state that 80% of persons with cerebral trauma spontaneously speak about symptoms of the post-traumatic syndrome, while by targeted evaluation the percentage rises to 90%, so that they think that universality of symptoms points to their common origin.

If the post-traumatic syndrome is though of as a line with organic dementia at one end and traumatic neuroses at the other, then this syndrome can be placed at different positions. Some authors put it close to the neurotic syndrome or regard it to be the neurotic syndrome itself, while others, mostly due to homogenity of the clinical picture, believe that this syndrome has an organic cause.