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Second Impact Syndrome Explained

Second Impact Syndrome Explained

The Mayo Clinic describes second impact syndrome (SIS) as a complication arising from a concussion. It occurs when someone experiences a second concussion prior to fully recovering from the initial one. With SIS, “typically fatal brain swelling” occurs. R.C. Schneider first described this condition in 1973, but it wasn’t until 1984 that someone gave it the name, “second impact syndrome”. The condition is rare enough that only 21 cases had been cited in the literature up until 2003.

When a concussion takes place, the levels of various chemicals in the brain are changed. This altered state is believed to contribute to a person’s susceptibility to second impact syndrome. Because it normally takes approximately one week for the chemical levels in the brain to return to normal after a concussion, the patient should wait at least this long before returning to any activity that might result in another concussion. But one week is a minimum. The time it takes to recovery fully from a concussion is highly variable and depends on both the nature of the injury and the patient involved. For this reason, it is vitally important that athletes not return to sports while symptoms of a concussion persist and that they receive clearance from an appropriately trained healthcare professional before resuming any sort of risky activity.

NHL star Sidney Crosby learned a lot about concussions first-hand. While playing with the Pittsburgh Penguins in January 2011, he received a concussion. He suffered from a second one only four days later. It took him 11 months to fully recover. Crosby said, “With concussions there is not generally a time frame or a span where you’re feeling better. You feel like you’re getting better and it can be one day and you’re back to where you started. It’s a frustrating injury.” It wasn’t until he was treated by chiropractic clinical neurologist, Ted Carrick, DC, that Crosby recovered from all his symptoms.

Even the mildest of concussions can lead to second impact syndrome, because it’s not the strength of the impact that is the greatest danger. An impact of any force while the brain is still recovering can result in the catastrophic swelling attributed to the syndrome.

Most cases attributed to SIS occur in those who are not yet fully grown. Children and adolescents are thought to be the most susceptible with adolescent athletes at greatest risk for second impact syndrome.

Some researchers have recently raised questions about whether or not SIS actually exists. In their own analysis, they concluded that a majority of cases they examined did not actually meet the diagnostic criteria for SIS. They also found that in some cases the reports of first impact were incorrect or unreliable. While their findings have led to some controversy in the medical community, it should be pointed out that no one has disproven the existence of the syndrome.

Whatever the controversy, it’s difficult to argue against prevention and an abundance of caution given the potential dangers associated with concussions (and multiple concussions). If you’re an athlete, the first step is to wear appropriate safety equipment for the sport you’re playing. For certain activities (such as football, baseball and cycling), a helmet is essential. On-field awareness and proper technique can also go a long way toward preventing head injuries. However, it’s important for players, parents and coaches to recognize that even helmets, good supervision and expert training are no guarantee against initial concussions. They are a risk that can be managed but never wholly eliminated.

When it comes to preventing subsequent concussions, though, there are three additional steps many communities have taken to protect young athletes:

  • Requiring responsible adults to receive concussion-awareness training so that they can recognize the signs of a potential concussion.
  • Requiring officials, coaches and managers to remove injured players from the field when a concussion is suspected.
  • Requiring the approval of an appropriately trained healthcare professional before allowing any athlete with a suspected/actual concussion to return to sports-related activities.
Youth Concussions in the Spotlight

Youth Concussions in the Spotlight

News
News

A concussion is essentially an injury to the tissues or blood vessels in the brain. It can occur when the soft tissues are pressed against the bone of the skull, resulting from an impact or blow to the head experienced during a fall or from sports injury. The Centers for Disease Control and Prevention (CDC) defines a concussion as “a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works.” In addition, the CDC notes that “Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a ‘ding,’ ‘getting your bell rung,’ or what seems to be mild bump or blow to the head can be serious.”

Shining a Spotlight on Youth Concussions

Over the past few years, there have been a variety of efforts to educate the public about the dangers of childhood concussions. In particular, a great deal of focus has been placed on preventing “second impact syndrome” and managing the recovery of young athletes. For example:

In 2007, the Pennsylvania Department of Education, the Brain Injury Association of Pennsylvania, and the Pennsylvania Department of Health joined together to create the BrainSTEPS program—a “Return to School Protocol” designed to help shorten the duration of concussion symptoms by eliminating all activity that might worsen the child’s condition. This includes ceasing all physical activities during recess, all sports, physical education classes, and similar activities.

In 2009, Washington State become the first state in the U.S. to enact a comprehensive youth sports concussion safety law (called the Zackery Lystedt Law). By early 2014, 47 other states and the District of Columbia had followed Washington’s lead.

In 2014, the NCAA and the U.S. Department of Defense funded the largest study of sports-related concussions in history to further our scientific understanding. Researchers from 21 schools will “eventually gather data from 35,000 athletes and military academy cadets across all sports at 30 campuses…”

Concussion Symptoms: What Parents Should Know

Mild concussions in childhood are fairly common and are not usually a cause for serious concern. However, childhood concussions should never be taken lightly and it’s important to know what symptoms to look for. These symptoms can vary depending on the severity of the injury and the individual themselves, and some are so mild that they may be difficult to notice. Sometimes they go away quickly, sometimes they return and sometimes their appearance is delayed for days or even weeks. Other times, they linger for years or even get worse.

  • Dizziness
  • Loss of consciousness
  • Seizures
  • Mild to moderate headache
  • Mood changes, such as unusual irritability or loss of interest in favorite activities
  • Difficulty focusing or remembering things
  • Drowsiness and reduced energy

Ask your child if they have any of the symptoms, and make sure to observe them closely for a few weeks. Your child is at increased risk if they have experienced previous head injury, are taking a blood thinning medicine, suffer bleeding disorders, are under one year old, have other neurological problems, have difficulty walking or are active in high contact sports.

If your child is harder to wake up than normal, shows worsened symptoms, won’t stop crying, doesn’t eat well, has worsening headaches or symptoms that have lasted longer than six weeks, then contact your doctor or caregiver. If your child shows a change in personality, bleeds out of the ears or nose, has trouble recognizing people, or vomits repeatedly, go to the emergency room. Dial 911 in the event of seizures, unequal pupil size and longer-term unconsciousness.

Irrespective of advice you get on the Internet or by phone, if you have any doubt in your mind about your child’s health after a head injury, seek the help of a professional. You know your child best!