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Overlapping Concussion Syndrome

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Other Names

  • OCS



  • Overlapping Concussion Syndrome (OCS) is a new term in concussion assessment.
  • It is used to describe a patient who is currently in the recovery phase for a concussion, without resolution of all symptoms, and has suffered a secondary concussion.
  • This secondary injury can result in prolongation of recovery.
  • This is not to be confused with SIS or PCS.
  • Patients with OCS have an increased number of symptoms as compared to patients with a standard concussion.
  • After the second injury, patients with OCS have similar symptom scores to those with PCS. [1]


  • According to the current body of literature, the pathophysiology of OCS is unknown.
  • It is known that the symptoms of each concussion can compound and worsen with an increased number of impacts.[2]
  • Patients who do not recover fully from concussions but return to everyday life and sport are at risk for a secondary injury and may have prolonged symptoms.
  • Metabolic dysfunction caused by secondary impact before primary concussion symptoms resolve can last up to 45 days after secondary injury occurs. [3] [4]

Risk Factors

  • Patients who have recently been concussed are at risk for OCS.
  • More research is needed on the risk factors specific to OCS.
  • See Concussions (Main) for risk factors for concussions.

Differential Diagnosis

  • Concussion
  • Post Concussion Syndrome
  • Second Impact Syndrome

Clinical Features

  • History
    • Patients with OCS will have a history of a recent previous concussion.
    • The differences in examination history between a patient with a standard concussion and OCS, is unknown.
    • Patients with OCS may also experience symptoms of PCS.
  • See Concussions (Main) for other clinical features of concussion
    • It is unknown how OCS differs in signs and symptoms from a standard concussion.


  • The evaluation of OCS should be similar to the evaluation of a standard concussion.
  • See Concussions (Main) for further explanation.


  • Grading concussions based on symptoms or loss of consciousness is not recommended


  • Patients with OCS may experience increased or worsening symptoms as opposed to a standard concussion.
  • Patient with OCS may experience prolonged symptoms and recovery. [1]
  • Gender may play a role in recovery time for patients with OCS.
    • It has been suggested that females recover slower than males. [1]

Return to Play

  • If a patient is diagnosed with OCS, Return to Play (RTP) protocol should be modified based on individual circumstances.
  • Patients may need to restart the RTP protocol at the level which their symptoms are not exacerbated.

Return to Learn

  • If a patient is diagnosed with OCS, Return to Learn (RTL) protocol should be modified based on individual circumstances.
  • Ensure patient receives modifications that are appropriate to their current symptoms level. Additional modifications may need to be made for patients with OCS.

See Concussions (Main) for further explanation on RTP and RTL protocols.

See Also


  1. 1.0 1.1 1.2 Wang DH, Kostyun RO, Trojian T, Solomito MJ. Overlapping Concussion Syndrome: Defined in a Pediatric Population. Connecticut Medicine. 2017;81(7).
  2. Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Graham R, Rivara FP, Ford MA, et al., editors. Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Washington (DC): National Academies Press (US); 2014 Feb 4. 5, Consequences of Repetitive Head Impacts and Multiple Concussions.
  3. Leddy J, Baker JG, Haider MN, Hinds A, Willer B. A Physiological Approach to Prolonged Recovery From Sport-Related Concussion. J Athl Train. 2017;52(3):299-308. doi:10.4085/1062-6050-51.11.08
    • However, the pathophysiology of OCS specifically, is unknown.
  4. Vagnozzi R, Signoretti S, Tavazzi B, et al. . Temporal window of metabolic brain vulnerability to concussion: a pilot 1H-magnetic resonance spectroscopic study in concussed athletes—part III. Neurosurgery. 2008; 62 6: 1286– 1295.
Created by:
Haley Chizuk on 5 August 2020 17:36:45
Last edited:
31 August 2020 16:36:57