Second Impact Syndrome

November 21, 2017, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Concussion in high school athletics is a problem. Sports such as football and hockey are frequent sources of concussion for teenaged athletes.  School boards have been aggressively targeting the problem with concussion awareness and safety programmes aimed at reducing concussion rates, recognizing concussions, treating them appropriately and developing return to play guidelines to keep our children safe.

A recent example of how a concussion can derail a teen life was featured in the Washington Post this week.

Nick Daugherty is a young football player who was hit by an offensive lineman on the crown of his helmet. He immediately collapsed, and coaches think he lost consciousness briefly. He looked ok once he was on the bench and wanted to return to play but the trainer stopped him. Minutes later he was swaying and limp with closed eyes. He was rushed to the hospital and ended up in the ICU.

When he regained consciousness, he wanted to know if he could play again in the upcoming season. The doctors told him ‘no’ that he should never play again. His doctors believe that Nick sustained a concussion in the previous game that went undiagnosed, and that this second hit left him with second impact syndrome. He speaks slowly, his balance is impaired, and he uses a cane. He is sensitive to light and sound.

His doctors now treat him as a stroke victim rather than a concussion victim his injuries are so serious. The hit itself didn’t look overly serious, and Nick was not targeted. He was hit by the offensive lineman who was flagged with a ‘blindside block’ penalty but all parties agree that Nick just got caught in an especially vulnerable position.

Doctors hope that Nick will have recovered from the speech problems and dizziness in the next six months. He has missed two months of school so far. They think it’ll be another year before Nick will return to regular activity, but he should never play a contact sport again.

Second impact syndrome is particularly dangerous. It occurs when a second concussion is received before the first one is fully healed causing rapid and severe brain swelling and often has catastrophic results. It can happen even from very mild concussions occurring days or weeks after the initial one.

The following information is from BrainandSpinalCord.org

What is Second Impact Syndrome?

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. 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.

Populations at Risk for 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.

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
• Vomiting
• Headache
• Fatigue
• Nausea
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Ringing in the ears
• Slurred speech
• 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.

Symptoms of Second Impact Syndrome

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. Common symptoms include:

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

Prognosis of Second Impact Syndrome

In many cases, second impact syndrome is fatal. True SIS involves brain herniation and death usually within minutes. However, a patient who is suspected of suffering from SIS should immediately be stabilized with special emphasis on airway management.  Neurosurgery will also be considered depending on the severity of the injuries. In cases where SIS isn’t fatal, the long-term effects will likely be similar to those of severe traumatic brain injury.

About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us at 1-519-742-7774.

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