I know there isn't really an answer to this question but does anyone have any good theories or understanding of why someone develops PCS after a concussion and why someone else doesn't?

I know its not necessarily related to the severity of the impact or injury as mine was relatively tame and was my first one whereas some have pretty serious collisions and recover fairly quickly.

Curious to what some of your theories are.

The experts do not know the answer to this question except that some researchers believe genetics may play a part. Some people are more prone to trigger improper functions of neurofibrillary Tau tangles. They are the cause of many dementia related diseases.

Plus, there is agreement that you cannot compare any two concussions. The brain is complex and the angle of the concussion along with the force and duration plus the metabolic condition of the brain all combine to create an immeasurable number of possible combinations.

Impacts with a rotational component often result in more damage.

Can't predict it, just like any illness , it just happens to some and not to others.

If there is a family history of some illness or condition, then there might be a clue to pay attention to. That will give a heads up, but not always, lifestyle , risk factors all play a part.
Hitting your head is just a bad luck roll of the dice for some.

In my case, I'm fairly confident that my history of concussions had a lot to do with it. I sustained at least 4 before my most recent (Oct 2015), and I aggravated my last one before it was healed by a strenuous 5K run. Boom - PCS!

Like others said, it's not exactly known and hence why controversy shrouds this hell syndrome. A family GP gave me a recent clinical literature review on PCS which said cohort studies tend to consistently find female gender and increasing age are risk factors. They also talk about increasingly finding that sport related concussions have better natural recovery than those caused by MVA, falls and assaults (things more traumatic and unsuspecting). They also talk about the likelihood of PCS stemming from structural/biochemical changes to the brain from injury as well as psychogenic origins. There's also the debate of PCS persisting if the individual is more of an intellectually stimulated sort. (At least we can consider ourselves smart!

This is all speculative science of course.. but thought I'd share what I've found from a reputable source

https://www.washingtonpost.com/natio...bc3_story.html

"All people carry the APOE gene, which has many variations. A 2010 study found that athletes carrying three of the gene’s four minor variations were 10 times as likely as those who did not to have reported a concussion and more than eight times as likely to have suffered brain injury as a result."

http://www.huffingtonpost.com/ainiss...b_4394209.html

"On a positive level, the APOE gene, which has three variations -- APOE ε2, ε3, and ε4 -- helps control the distribution of fats and cholesterol in the body. But it also seems to control the way that neurons are repaired -- or aren't -- after a head injury. "If you have the wrong form," Stern explains, "it does something crazy in the brain.""

"The APOE ε4 has been specifically linked to concussions and mild traumatic brain injury and is also associated with increased risk of Alzheimer's disease. One study found that there was lower cognitive performance in older football players possessing it. But, most importantly, APOE ε4 has some strange linkage to chronic traumatic encephalopathy, or CTE. This is the degenerative brain disease that's seemingly linked to head trauma and is found in many retired football players."

Since there are many comparisons between PCS, CTE, and Alzheimer's Disease, here is some more information.

You might want to consider this information from the National Institute on Aging: https://www.nia.nih.gov/alzheimers/p...ics-fact-sheet

APOE ε4 occurs in about 40 percent of all people who develop late-onset AD and is present in about 25 to 30 percent of the population. People with AD are more likely to have an APOE ε4 allele than people who do not develop AD. However, many people with AD do not have an APOE ε4 allele.

A quality genetic test costs about $400. If genetic testing is sought, be sure to ask if the test can identify APOE ε4 with a high level of accuracy.

I think I developed it because I hit my head in the same place as a teenager - insult to injury. I believe that concussions are accumulative. I do wonder how much the psychological condition of the person has to do with developing it, e.g. if you're depressed or stressed does the concussion exaggerate it? I've also read that people of higher intellect are more prone to it or maybe they just notice it more! I don't think anyone really knows, to most doctors the brain is a mystery.

My personality is partly my biggest enemy with this concussion. I notice a lot. I have a high iq and an eye for fine detail. I can be prone to stress. I can be prone to think about things too much. Basically, it's the perfect storm and my injury has affected me in the worst way; it's taken away my ability to tolerate screens and concentration. My job was graphic design. My entertainment was a big part of my interests. So I've had to adapt, which has and is a hard thing to do.

It's an injury which is perfectly designed for my maximum disruption. Which I dare say makes it worse.

Ya I feel you Doozer. I wonder if the fact that I've always had a little bit of health anxiety and get stressed out when I am sick has been a factor. I remember during the early stages of my injury I actually went on this site and saw people/stories of this becoming permanent or something that takes a really long time to go away and the thought of that scared the **** out of me. I then would get really stressed and anxious at how the fact that I wasn't recovered yet as time went on and the constant worry that I was going to develop PCS. I wonder if this worry and stress about developing PCS is actually what made me develop PCS in the end...