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Thursday, January 10, 2013

A case of second impact syndrome

If you regularly read this blog, you know that concussions (aka mild traumatic brain injuries) are the result of the brain slamming against the inside of the skull. This can be caused either by rapid deceleration of the entire body or by direct impact to the head. Either way, the brain has a bruise that must heal. If an individual receives a second injury before the first has completely healed, this can result in ‘second impact syndrome’ (SIS), a devastating and often fatal neurological condition.

Doctors at the Indiana University School of Medicine, led by Elizabeth Weinstein, document the unfortunate case of a seventeen-year-old high school football player with SIS. This is the first time that doctors have brain CT scans both before and after the second injury.

After the first concussion, caused by a helmet-to-helmet crash during a game, the patient noticed immediate symptoms (dizziness, headache). A CT scan performed four days later was normal, as was the assessment of the boy’s mental and physical condition. 

The next day (day five after the initial injury), the patient returned to football training. After participating in ‘hitting drills' he collapsed, eventually falling into a coma. At the emergency room, a second CT showed extensive brain damage. That was three years ago, and the patient has regained only limited verbal, motor or cognitive skills.

It can be difficult enough to diagnose concussion, let alone figure out when a patient is sufficiently recovered to resume contact activities. Ordinarily, a normal CT scan can clear a player to return to practice. According to this case study, that’s not a sufficient test. This new data is not going to make the task of coaches and sports doctors any easier. 

Image by Patrick J. Lynch, medical illustrator, 2/2/2008.

Weinstein, E., Turner, M., Kuzma, B., & Feuer, H. (2013). Second impact syndrome in football: new imaging and insights into a rare and devastating condition Journal of Neurosurgery: Pediatrics, 1-4 DOI: 10.3171/2012.11.PEDS12343.

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