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Concussions and Second Impact Syndrome

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susan_harr6 years ago

Second Impact Syndrome (SIS) is a rare condition in which a person suffers a second concussion before the first concussion has healed. This has been known to happen in high-impact sports like football and boxing. Athletes under the age of 25 are at the greatest risk for SIS.

First and Second Impact

The National Institutes of Health (NIH) define a concussion as a traumatic brain injury (TBI) that may result in a bad headache, altered levels of alertness, or unconsciousness. It can occur when the head hits an object or a moving object strikes the head. Concussions definitely deserve proper attention, but they usually don’t result in lasting injuries. Yet, if a person suffers a second impact before the brain is properly healed, the effects can be fatal.

“Second impact syndrome occurs when “an athlete suffering post-concussive symptoms following a head injury. If, within several weeks, the athlete returns to play and sustains a second head injury, diffuse cerebral swelling, brain herniation, and death can occur,” Western Journal of Emergency Medicine.

The average time from second impact to brainstem failure can occur in two to five minutes. Symptoms of second-impact syndrome include:

  • Dilated pupils
  • Loss of eye movement
  • Unconsciousness
  • Respiratory failure
  • Death

Effects of Second Impact on the Brain

According to the Traumatic Brain Injury Information Center at the University of Nebraska-Lincoln:

  1. A second blow to the head, even if it is a minor one, can result in a loss of auto regulation of the brain's blood supply. 
  2. Loss of autoregulation leads to brain swelling. 
  3. Brain swelling results in increased intracranial pressure and leads to herniation of the brain.
  4. Once herniation and brainstem compromise occur, ocular movement and respiratory failure are likely to result.

Preventing SIS

Since SIS frequently occurs in a sports setting, the coach and parents are the player’s first line of defense. Coaches should have in place “return-to-play guidelines” that include a check up from a doctor or physician. Players may be reluctant to report concussions for fear of being taken out of a game or season, but it is important to note that not all concussions will lead to SIS.

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