This second blow may occur minutes, days or weeks after an initial concussion, and even the mildest grade of concussion can lead to sis. The result is rapid and severe brain swelling and the outcome is often catastrophic. Sis typically involves athletes who return to the field while still suffering postconcussive symptoms after injury but it can also occur in. Summary and agreement statement of the first international conference on concussion in. Second impact syndrome involves two mild head injuries or concussions, mild traumatic brain injuries are also referred to, in close proximity to each other. If the victims concussion remains undetected, or the seriousness of the situation is underestimated, and the individual returns to activity too quickly, they may suffer from something called sis, or second impact syndrome. Typically, the literature suggests that second impact syndrome happens when an athlete has been injured early in a game and then maybe later in the game. Reports of second impact syndrome are few, and some argue that second impact syndrome is simply diffuse cerebral swelling unrelated to the first concussion. It is important to monitor postconcussion symptoms, which include headache, lightheadedness, and impaired consciousness. Second impact syndrome sis occurs when someone sustains a second head injury when the first head injury hasnt fully healed. Gean2 abstract there have been a handful of previously published cases of athletes who were still symptomatic from a prior. A controversial term first described by saunders and harbaugh1 in 1984, second impact syndrome sis consists of two events. Second impact syndrome is a potentially lethal condition in which an individual who has had blunt craniocerebral trauma and whose symptoms have not subsided, sustains a second.
The science behind second impact syndrome and chronic. Second impact syndrome and other concussion complications. Pdf the second impact syndrome robert vink academia. The impact is thought to cause vascular congestion and increased intracranial pressure, which can occur very rapidly and may be difficult or impossible to control. Sis is a controversial phenomenon that allegedly occurs when the brain sustains a second, subsequent impact before a previous injury has had adequate time to heal and recover. One concussion can be dangerous, another one especially soon after the first can be devastating, even fatal. Certain current concussion management guidelines are contingent upon. Second impact syndrome can happen when a second concussion occurs hours, days or even weeks after the first concussion. Second impact syndrome can result from even a mild concussion that occurs days or weeks after the initial incident. Most cases occur in young athletes because their brains are. Second impact syndrome, or sis, happens when the brain swells rapidly shortly after a person suffers a second concussion before symptoms from an earlier concussion have subsided. An uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance robert c. Scott a playford md, in the sports medicine resource manual, 2008.
There are two recorded cases of people over the age of 21 who have had this injury, and all of the rest are below 21. Second impact syndrome if you have had a tbi, take steps to avoid another injury to your brain. Secondimpact syndrome sarah cobb, barbara battin, 2004. Second impact syndrome survivor shows other athletes there. We established criteria for definite, probable, and possible sis and analyzed all published. Secondimpact syndrome sis is a rare condition in which a person receives a second concussion before their first concussion has properly healed. Certain current concussion management guidelines are contingent upon this assumption. Second impact syndrome was first described as occurring when athletes suffering from postconcussive symptoms return to play too early and subsequently sustain a. The severity of the concussion often does not matter. Second impact syndrome concussion and brain injury clinic. Secondimpact syndrome an overview sciencedirect topics. Even with mild tbis, repeated injuries can do longlasting damage to. Concussion and second injury brain complications nicholas m wetjen, md, mark a pichelmann, md, john ld atkinson, md, facs second impact syndrome was first described in 1973 by richard schneider in 2 young athletes who experienced initial concussive syndromes and subsequently died after a. Second impact syndrome sis has been defined as a syndrome occurring when an athlete sustains a second head injury before the symptoms of the initial injury have resolved.
Secondimpact syndrome and a small subdural hematoma. Sportsrelated injuries are among the more common causes of injury in adolescents that can result in concussion and its sequelae, postconcussion syndrome and secondimpact syndrome sis. If an athlete has suffered a concussion, its best if they dont return to their sport until the symptoms of the initial. A rare but catastrophic condition seen in boxing and other headimpact sports, which occurs in 2 phases. Sportsassociated recurrent brain injuries united states. Second impact syndrome forensic science newsletter william a. The dangers and prognosis of secondimpact syndrome. A concussion is an often debilitating and serious injury, which can leave the victim incapacitated for several weeks, months or longer. Recently, however, the scientific evidence behind that definition of second impact syndrome has been criticized. The only difference is that second impact syndrome patients suffer a mild concussive headinjurythatproducescerebralautoregulatoryfailure. Secondimpact syndrome sis is a lifethreatening condition that may manifest in a person who sustains consecutive concussions within a short time period. This deadly second blow may occur days, weeks or minutes after an initial concussion, and even the mildest grade of concussion can lead to sis.
Background second impact syndrome is a devastating injury that primarily affects athletic children and young adults. Primary head injury can be catastrophic, but the effects of repetitive head injuries must also be considered. Six case reports demonstrate that the same mechanism of injuryminor head trauma in a player who still has symptoms from a previous concussioncan cause second impact syndrome in any contact sport. We established criteria for definite, probable, and. Secondimpact syndrome sis is a condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. Ovid and pubmed were searched from years 1946 to 2015 using the terms second impact syndrome,repeat concussion, and catastrophic brain injury. Based on this surveillance system, cdc, in collaboration with participating states, is developing methods to conduct surveillance for sportsrelated second impact syndrome. This event is rare, but when it does happen, it is most often fatal. Saum is one of the lucky few walking and talking survivors of second impact syndrome, a rare phenomenon in which a second concussion occurs before the first one is properly healed. Second impact syndrome sis, a term coined in 1984, describes the situation in which an individual sustains a second head injury before the symptoms from the first head injury have resolved. Second impact syndrome definition of second impact. A concussion is a mild to moderate traumatic brain injury in which a direct blow to the head causes the brain to collide with the skull. What is less clear is the condition that purportedly claimed the deaths of all eight of these athletes.
Second impact syndrome terry ziegler jan 02, 2012 overview zachary lystedt suffered a head injury in an 8th grade football game, but returned to the field and continued playing. Students who experience multiple brain injuries within a short period of time hours, days, or weeks may suffer catastrophic or fatal reactions related to sis. The second impact syndrome carries an exceedingly high mortality, ranging from 50100%, believed to be caused by a disturbed vasoreactivity that results in rapid and profound brain swelling without extraor intracranial spaceoccupying haematomas. The second injury is often minor or incidental, and the result is the.
However, the brains auto regulatory mechanisms compensate for this mechanical and physiologic stress and protect against massive swelling. Hilary pape, in tidys physiotherapy fifteenth edition, 20. Ovid and pubmed were searched from years 1946 to 2015 using the terms second impact syndrome, repeat concussion, and catastrophic brain injury. Second impact syndrome results from acute and often fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. Diffuse cerebral swelling with delayed catastrophic deterioration, a known complication of brain trauma, has been postulated to occur after repeated concussive brain injury in sportsthe second impact syndrome sis. Sportsrelated recurrent brain injuries united states. A patient who sustains an initial concussion may develop cerebral edema, accounting for loss of consciousness, memory impairment, disorientation and headache. Information about the openaccess article second impact syndrome in doaj. Aubry m, cantu r, dvorak j, grafbaumann t, johnston k, kelly j, et al. A controversial term first described by saunders and harbaugh 1 in 1984, second impact syndrome sis consists of two events. With children and mild concussion, we also have another thing thats very controversial in the literature, and thats a disorder referred to as secondimpact syndrome.
Neuropathological or neuroimaging evidence of cerebral. Witnessed second head impact with a subsequent rapid cerebral deterioration. Most cases of second impact syndrome have occurred in young athletes, particularly those who participate in sports such as boxing, baseball, football, hockey, and skiing. Secondimpact syndrome sis occurs when the brain swells rapidly, and catastrophically, after a person suffers a second concussion before symptoms from an earlier one have subsided.
The risk for second impact syndrome should be considered in a variety of sports associated with likelihood of blows to the head, including boxing, football, ice or roller. It is thought to be a disruption in the autoregulation of the brain leading to oedema and an increase in intracranial pressure causing herniation of the brain and, ultimately, death solomon et al. Second impact syndrome sis occurs when an athlete who has sustained an initial head injury, most often a concussion, sustains a second head injury before symptoms associated with the first have. Socalled second impact syndrome was first described as the phenomenon of sudden death from rapidly progressing brain swelling due to a second concussion sustained soon after a first one. Even two mild concussions, if they happen in close enough proximity, can result in sis. Secondimpact syndrome sis occurs when an athlete who sustains a head injury e. The star athlete played the entire game before collapsing on the field. Typically, it involves an athlete suffering postconcussive symptoms following a head injury.
Concussion symptoms, diagnosis and safety guidelines. Second impact syndrome sis is a rare but potentially serious, lifethreatening condition that can develop in a person who suffers from back to back concussions. The second impact syndrome sis has been reported when a second concussion occurs within hours, days, or weeks following a prior concussion. It occurs when a second concussion occurs before symptoms from the first concussion have resolved. Second impact syndrome and a small subdural hematoma. Second impact syndrome directory of open access journals.