Second Impact Syndrome and Other Concussion Complications

Second-impact syndrome (SIS) is a rare condition in which a person receives a second concussion before their first concussion has properly healed. The result is rapid and severe brain swelling and the outcome is often catastrophic. Second impact syndrome can result from even a mild concussion that occurs days or weeks after the initial incident. It most often occurs when someone is susceptible to multiple concussions, like an athlete. However, it can occur to any person who receives multiple concussions within a short time frame, perhaps if a person in unlucky enough to been involved in two vehicle collision within a short period of time.

Who’s at risk for second impact syndrome?

Young athletes (around high school age) seem to be the age group that is most at risk, particularly those who participate in sports such as boxing, baseball, football, hockey, and skiing. Despite what might first come to mind, some sports that involve no person-to-person contact, still pose a significant risk, like skiing or track and field. Often, these sports produce concussions from the intense ground impact. If an athlete has suffered a concussion, it is imperative that they do not return to their sport until the symptoms of the initial head injury have completely subsided.

“A study of American high school and college football players demonstrated 94 catastrophic head injuries (those with significant intracranial bleeding or fluid buildup) over a 13-year period. Of these, only two occurred at the college level. Seventy-one percent of high school players suffering such injuries had a previous concussion in the same season, with 39% playing with residual symptoms.” [1]

The second injury may occur days or even weeks after the first concussion. After receiving an initial concussion and returning to sports, the second impact may not cause a loss of consciousness. The impact may, in fact, seem relatively mild, with only a brief “dazed” feeling initially. However, this second impact causes cerebral edema and herniation, leading to collapse and death within minutes [2].

Keep in mind that this condition is extremely rare, however, it is not rare for an athlete to receive a concussion and either, (a) not notice it and continue to play, or (b) notice the injury, but not report it to a coach or parent. There may also be pressure from the athlete (placed on the self), from the coaches and team, or from the parent to continue play since mild traumatic brain injuries do not always have outward symptoms. Similarly, coaches, parents or athletes may be under the impression that they need to lose consciousness in order to have a “real” concussion.

What are the signs of an initial concussion?

Parents, coaches, and anyone who is responsible for a young athlete should be just as familiar with the signs and symptoms of a concussion as they are with the rules of the game. The more informed a guardian—and even the athlete themselves—the more likely SIS or other complications can be avoided. Symptoms of an initial concussion include:

  • Disorientation
  • Vomiting
  • Headache
  • Fatigue
  • Nausea
  • Temporary loss of consciousness
  • Confusion or dazed
  • Ringing in the ears
  • Slurred speech
  • Sleep problems, either insomnia or oversleeping
  • Concentration or memory problems
  • Irritability
  • Changes in personality [3]

If there is any doubt that your child or young athlete has received a concussion, speak up and do not allow them to continue to play. Despite any resistance from your athlete or the coaches, any recoil is not worth jeopardizing your child’s brain (after all, it’s a pretty important organ).

The same goes for anyone who has suffered an initial concussion, an impact to the head, or another traumatic brain injury. If at all possible, it is best to avoid any bumps or jolts to the head.

Aren’t TBIs only those injuries that cause life-long disability?

It should be cleared up that the term “traumatic brain injury” does not necessarily apply only to severe instances. In fact, TBI may conjure images of a person in a wheelchair, struggling to talk or support themselves. While this is no doubt one possible outcome, the term is much more encompassing.

The American Medical Association defines the term as: “A nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

Meaning: It’s an injury to the head that you did not develop, nor were you born with it, and it led to some type of problems thinking, moving, or interacting, possibly with a lapse in consciousness.

What are the signs of second impact syndrome?

Injuries from a second impact to the head can begin days or even weeks after the incident, or they can begin immediately. Neither impact has to be all that severe for second impact syndrome to occur. Despite the possibility of some delay, symptoms usually occur immediately following the second impact and progress rapidly. Common symptoms include:

  • Dilated pupils
  • Loss of eye movement
  • Unconsciousness
  • Respiratory failure
  • And ultimately, Death [4]

What is the prognosis of second impact syndrome?

True second impact syndrome involves brain herniation and is usually fatal within minutes. If an athlete, or any person, is suspected of receiving the second impact, they should immediately be stabilized with special emphasis on managing their airway. Surgery on the brain (neurosurgery) will also be considered by the treating physicians, depending on the severity of the injuries. In cases where it isn’t fatal, the long-term effects will likely be similar to those of severe traumatic brain injury.

What is repetitive head injury syndrome?

Even if the effects of the initial concussion have healed—which usually takes 6 to 18 months after the injury—the effect of multiple concussions over time remains significant and can result in long-term neurologic and functional deficits. Such multiple impacts and concussions are termed repetitive head injury syndrome, but this does not fit within the true classification of SIS. If the case was, in fact, SIS, it would most likely have a devastating outcome, like a coma, severe disabilities, or death.

What are some other complications from a concussion?

Despite a whole host of symptoms and issues that can arise after a traumatic brain injury (read more about them here), there are some particular complications that can result from a concussion. They include:

EpilepsyPeople who have had a concussion are twice as likely to develop epilepsy within the first five (5) years after their injury.

Repetitive Head Injury Syndrome Evidence exists indicating that people who have had multiple concussions or traumatic brain injuries over the course of their lives may acquire permanent, and possibly progressive, impairments that limit their ability to function [4].

Post-concussion syndrome PCS describes the symptoms after someone has received a concussion, such as headaches, dizziness, and trouble thinking. Symptoms may continue for weeks to a few months after a concussion.

Post-traumatic headaches Some people experience headaches, ranging from mild to severe, within the weeks or months following a traumatic brain injury.

Post-traumatic vertigo– Vertigo is a condition in which a patient feels extreme dizziness and lack of balance due to complications with the inner-ear. Because of the nature of TBI, vertigo is a possible complication. [5]

After a concussion, the levels of brain chemicals are altered which usually takes about a week to stabilize again. However, recovery time varies quite a bit from patient to patient and depending on the severity.

Remember, any athlete who still shows signs of concussion should not be allowed to return to play. Such signs include fatigue, headache, disorientation, nausea, vomiting, feeling of being “in a fog” or “slowed down,” as well as other differences from a patient’s normal function. If there are any doubts about the severity of their injury, the athlete should not be allowed to resume play.

If your child—or any loved onehas sustained a brain injury from playing sports, an auto accident, or any other type of accident, it is important to speak to an experienced brain injury lawyer in the Tampa area. At the Dolman Law Group in Clearwater, Florida, our team of highly skilled brain injury lawyers has helped many victims obtain the recovery they deserve for their injuries and related losses including lost wages, medical expenses as well as pain and suffering. Please call our office at 727-853-6275 today.

Dolman Law Group
5435 Main Street
New Port Richey, FL 34652
(727) 853-6275

Sources: (from Am. Journal of Sports Medicine, 2007 and eMedicine, 2008).