Second impact syndrome (SIS), or repetitive head injury syndrome, describes a condition in which individual experiences a second head injury before complete recovery from an initial head injury. Recently SIS has gained increased attention as many cite athletes sustaining a concussion and returning to the sport early as being particularly at risk.
Full Answer
What is second impact syndrome?
So-called “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.
How can second impact syndrome be prevented?
Preventing second impact syndrome. Obviously the most sensible approach to prevention of SIS is to prevent the first concussion from happening by following rules for safety and using well maintained appropriate sports equipment. consistently and correctly.
Can you play sports with second impact syndrome?
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. If an athlete has suffered a concussion, it’s best if they don’t return to their sport until the symptoms of the initial head injury are gone.
What happens after the second impact with SIS?
With SIS, the events that occur after a second impact may start with the athlete appearing stunned with no loss of consciousness.
What is the treatment for second impact syndrome?
Unfortunately, treatment for second impact syndrome is limited and requires hospitalization with neurosurgical management. Identification of head injuries and utilization of proper return-to-play protocol is the best way to promote a safe return to sport.
What is 2nd impact syndrome?
Second impact syndrome (SIS), also known as repetitive head injury syndrome, describes a condition in which individual experiences a second head injury before complete recovery from an initial head injury.
How can second impact syndrome be prevented?
Being aware of what the condition is prior to a first concussion is one of the best ways to prevent SIS, because it allows patients and their care teams to make informed decisions about how to protect themselves and their brain after an initial TBI. Time and rest are the best solutions.
What is the second impact in driving?
The second impact (also known as second collision and human collision) is the impact suffered between a vehicle occupant and the vehicle during a collision. The first impact is the impact between the vehicle and another object. There is also a third impact between the internal organs and the frame of the body.
How is second impact syndrome caused?
Second impact syndrome occurs when an athlete returns to sport too early after suffering from an initial concussion. The athlete does not need to receive a strong second blow to the head to set the effects in motion.
How common is second impact syndrome?
Epidemiology. Though the incidence of second impact syndrome is unknown, the condition is rare; very few cases have been confirmed in medical literature.
Can you survive second impact syndrome?
In most diagnosed second-impact syndrome cases, the approximate mortality rate lies near 50 percent, but the probability of permanent disability is close to 100 percent. Non-fatal SIS patients may live with permanent conditions including: Coma or Brain Death (persistent vegetative state) Mental/Cognitive Impairment.
How long does second impact syndrome last?
Pathophysiology of Second Impact Syndrome After the initial phase, a state of altered cerebral metabolism occurs and may last ten days,16 involving decreased protein synthesis and reduced oxidative capacity.
How long are you at risk for second impact syndrome?
Concussion is believed to alter cerebral metabolism, reducing the ability of the brain to respond appropriately to the stress incurred by subsequent concussions. Hence, there is a window of vulnerability for approximately 10-15 days after an initial head injury.
What are the different types of impacts in an MVA?
The three types of impact that occur (in succession) are those involving the vehicle, the body of the vehicle occupant, and the organs within the body of the occupant.
When does the second collision occur?
The second collision happens when the occupants inside the vehicle move in the same direction and the same speed as the car until they come into contact that stops the forward motion.
What happens when you get a second concussion?
Second impact syndrome (SIS) occurs when two concussions happen in a relatively short period of time and the second concussion is inflicted before the first has fully healed. This causes the brain to “lose its ability to self-regulate pressure and blood volume flowing” and causes rapid and severe brain swelling.
What is second impact syndrome?
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. This event is rare, but when it does happen, it is most often fatal. The few who do not die from such an event are usually left severely disabled for life.
How does a concussion affect the second impact?
When a concussion patient whose symptoms have not yet resolved sustains a second impact, they may not even lose consciousness at the moment of the impact, but they may look stunned. They may even complete a play in a game and make it to the sideline themselves, but then collapse within a minute or two. The patient’s condition then worsens rapidly with loss of consciousness, loss of eye movement, dilated pupils, then respiratory failure. This can all take place within a few minutes.
What happens when the brain loses its ability to regulate cerebral spinal fluid pressure?
Death or lifelong disability occurs because the brain suddenly loses its ability to regulate cerebral spinal fluid pressure, leading to severe swelling of the brain and possible herniation of the brain. The impact of the second event does not have to be strong to trigger second impact syndrome. A minor blow to the head, chest or back ...
Can a second impact cause brain damage?
The impact of the second event does not have to be strong to trigger second impact syndrome. A minor blow to the head, chest or back that snaps the head enough to cause the brain to move inside the skull can trigger the usually lethal damage.
What is second impact syndrome?
So-called “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. Recently, however, the scientific evidence behind that definition of second impact syndrome has been criticized.
Can you die from a second concussion?
A true “second impact syndrome” death is the rare exception rather than the rule after a second concussion. There is, however, an increased risk of a second concussion from an injury sustained soon after a first concussion. This may be due to slower reaction times, dizziness, headache, and other concussion symptoms related to incomplete healing ...
Recognizing Second Impact Syndrome
Second impact syndrome is an often-life-threatening condition that takes place because the already injured brain is unable to regulate the amount of blood going to the brain. As the cerebral blood flow increases, the brain experiences swelling (a.k.a. cerebral edema). This swelling can result in intracranial pressure and lead to cerebral bleeding.
Preventing Second Impact Syndrome
The most important step for preventing second impact syndrome is making sure players do not return to play until they are fully healed and have been cleared to play by a physician.
What is second impact syndrome?
Second impact syndrome (SIS), or repetitive head injury syndrome, describes a condition in which individual experiences a second head injury before complete recovery from an initial head injury. Recently SIS has gained increased attention as many cite athletes sustaining a concussion and returning to the sport early as being particularly at risk. Though it is a relatively rare condition, physicians should be aware of SIS, and educate patients who have experienced or are at risk of experiencing a head injury, as the syndrome is often deadly. The term second impact syndrome entered the medical lexicon in 1984 when Saunders and Harbaugh wrote an article describing a case report of a football player who died four days after suffering a head injury after he returned to play on the day of his death. He collapsed and died after a presumed second head injury.
When did the term "second impact syndrome" come into use?
The term second impact syndrome entered the medical lexicon in 1984 when Saunders and Harbaugh wrote an article describing a case report of a football player who died four days after suffering a head injury after he returned to play on the day of his death.
What is second impact syndrome?
What is it? “Second impact syndrome” is a rare but life-threatening condition that can occur when an athlete suffers a second head injury prior to healing from an initial head injury, such as a concussion .
How long after a concussion can you return to football?
They may be at risk for several weeks , however, if they return to sport before full recovery. Symptoms may include headache, confusion, nausea, sensitivity to light or sound, poor concentration, visual problems, drowsiness or any other differences from normal. Symptoms of post-concussion syndrome can often be vague and non-specific, so it is important to be examined by a qualified physician, such as a sports medicine doctor, prior to return to play. Returning to sport too early following concussion leaves an athlete at risk to develop second impact syndrome should they receive a second head injury. This is a medical emergency and requires urgent medical attention at the nearest emergency room. Worrisome findings include loss of consciousness or coma, seizures, nonmoving pupils, vomiting and headache.
How to prevent concussions?
Once symptom-free, a custom-made “return to play” protocol may be started, beginning with light cardio exercise.
What should be done after a concussion?
Once free from concussion symptoms while at rest, a gradual increase of level of effort should be performed under the guidance of a qualified medical professional. The athlete should also have a normal neurological exam including balance, coordination and concentration during return to sport process.
Can a second head injury cause brain damage?
Trauma from the initial head injury is believed to put the athlete at risk of life-threatening swelling of the brain if they receive a second head injury while still recovering from the initial injury. Second impact syndrome can lead to severe brain damage, neurological problems and even death. It is also closely related to other life-threatening ...
Can you return to sport after a concussion?
Returning to sport too early following concussion leaves an athlete at risk to develop second impact syndrome should they receive a second head injury. This is a medical emergency and requires urgent medical attention at the nearest emergency room.
What is second impact syndrome?
Typically, it involves an athlete suffering post-concussive symptoms following a head injury.2 If, within several weeks, the athlete returns to play and sustains a second head injury, diffuse cerebral swelling, ...
How long does it take for a concussion to resolve?
A simple concussion is an athletic injury that resolves without complications within ten days, whereas a complex one involves persistent symptoms beyond ten days, or additional symptoms of seizures, cognitive impairment or exertional headache or confusion.
How long after intracranial lesion can you play?
Examine for signs of intracranial lesion at sidelines and obtain further exam by a trained person the same day. Allow return to play after 1 week if neurological exam is normal. Allow return to play after 2-week period of no symptoms at rest or with exertion.
Can a head trauma cause SIS?
SIS can occur with any two events involving head trauma. While rare, it is devastating in that young, healthy patients may die within a few minutes. Emergency physicians should be aware of this syndrome and counsel patients and their parents concerning when to allow an athlete to return to play.
How to treat second impact syndrome?
Treatment can begin on the field with intubation and mild hyperventilation, reverse Trendelenburg positioning, and intravenous mannitol, all in an attempt to decrease intracranial pressure. On arrival at a medical facility, CT scanning should be performed to rule out other causes of rapid neurologic dysfunction, such as intracranial hemorrhage. Other medical treatments include use of barbiturates for neuroprotection and newer pharmaceutical agents such as 21-aminosteroid tirilazad mesylate. Surgical treatment is limited, but bifrontal decompressive craniectomy has been performed in refractory cases.
What are the consequences of repeated concussions?
A major concern with repeated head injuries in children and young athletes is the ‘second impact syndrome,’ in which a second head injury impacts the brain before the effects of the first injury have resolved, resulting in severe cerebral edema.
How long does post concussion syndrome last?
Post-concussion syndrome - post-concussive symptoms that can last weeks to years after initial concussion. Malignant brain edema - can follow an initial head injury. With SIS, brain edema can occur with forces less than would typically be needed to cause such injury with initial head trauma.
How does a concussion affect the brain?
It has been proposed that during the primary concussion, cerebral edema is controlled by autoregulation which limits blood flow to the brain. Concussion is believed to alter cerebral metabolism, reducing the ability of the brain to respond appropriately to the stress incurred by subsequent concussions.
What are the risk factors for SIS?
Children, adolescents, and young adult - possibly due to increased risk taking behaviours or underdevelopment of the brain. Male gender - perhaps due to genetics or higher rate of participation in sports with the highest risk of SIS.
Can head trauma cause SIS?
It has also been suggested that indirect head injuries, for example caused by trauma to the chest which can transfer forces to the head, can cause SIS. It is controversial whether or not SIS truly exists, in part due to its ambiguous definition and lack of supporting evidence.
What sports have second impact syndrome?
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. If an athlete has suffered a concussion, it’s best if they don’t return to their sport until the symptoms of the initial head injury are gone.
How long does it take for a second impact to occur?
Second impact injury can result within a matter of days or weeks, or it can occur in the same game or competition if the athlete isn’t removed and treated after the first concussion. Neither impact has to be severe for second impact syndrome to occur. Symptoms usually occur immediately following the second impact and progress rapidly.
What happens if you have a second concussion?
In patients who sustains a second concussion when the first one has not fully healed, the brain loses its ability to auto regulate intracranial and cerebral perfusion pressure. This may lead to cerebral edema (severe swelling of the brain) and possible brain herniation.
What happens to the brain after a brain injury?
Loss of consciousness after the initial injury followed by secondary brain damage creates ionic fluxes, acute metabolic changes, and cerebral blood flow alterations. All of these characteristics enhance the vulnerability of the brain and greatly increase the risk of death, even if the second injury was far less intense.
What are the effects of a concussion?
Sleep disturbances. Concentration or memory problems. Irritability and other personality changes. If there are any doubts about whether the person is suffering from delayed effects of the concussion, it’s crucial to keep them out of situations that could lead to another concussion resulting in second impact syndrome.
Can a car crash cause a TBI?
Yes, a car crash can cause a traumatic brain injury (TBI) in many ways. In fact, according to the Centers for Disease Control and Prevention... More: Car Crash Traumatic Brain Injury ». TBI Traumatic Brain Injury.
Can you return to play after a second concussion?
Avoid Second Concussions. Any athlete, or person who has sustained a concussion, who shows signs of concussion should not be allowed to return to play or activities where impact is possible. Signs of concussion include the following: Disorientation.