Brain damage or compensation neurosis? The controversial post-concussion syndrome

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Abstract
Neuropsychological evaluations were performed on 55 consecutive patients with persisting post-concussion syndrome (PCS). All were in litigation or were pursuing/receiving financial compensation for their injuries. No PCS patients who were not in litigation or compensated were referred over the 2-year span of the study. Many patients had deficits on neuropsychological testing. However, 15% of the patients were shown to be unconsciously or consciously motivated to do poorly on the Portland Digit Recognition Test (PDRT) and 33% fell below the cut-offs suggesting poor motivation reported by previous investigators. Only 28% of the PCS patients performed at or above the levels of patients with documented brain damage, established by previous investigators. When an additional measure of cooperation was considered (the Dot Counting Test), 48% of all patients had questionable motivation during testing. The average MMPI-2 profile of the entire PCS group suggested the presence of somatization and functional overlay. The PCS group's average MMPI-2 T scores on scales Hs and Hy were well above the average MMPI T scores of patients with proven brain damage reported by previous investigators. These results suggest that the predominant causes of persisting PCS after minor or mild head injury in many patients are likely to be functional rather than organic.