Emergency Medicine Book


Second Impact Syndrome

Aka: Second Impact Syndrome
  1. See Also
    1. Concussion
    2. Postconcussion Syndrome
    3. Return to Play after Concussion
    4. Head Trauma
    5. Mild Traumatic Brain Injury
    6. Concussion Grading
    7. Cognitive Deficit following Concussion
  2. Epidemiology
    1. Uncommon to rare, but with devastating consequences
    2. Appears limited to children and adolescents
      1. Although adults with multiple Concussions may develop chronic Traumatic encephalopathy (CTE)
      2. CTE, by contrast, results in a chronic neurodegenerative disorder with Dementia and Parkinsonism features
  3. Pathophysiology
    1. Results from repeated Concussions over a short period of time
    2. Rapid and diffuse cerebral edema with no effective treatment (does not respond to manitol)
  4. Course
    1. Mortality approaches 50% with severe neurologic sequelae in the other 50%
  5. Prevention
    1. Helmets should not offer a false sense of security against Second Impact Syndrome
      1. Helmets do not prevent Second Impact Syndrome in those with unresolved prior Concussion-related symptoms
    2. Prevention of Second Impact Syndrome is the primary focus of post-Concussion guidelines in sports
      1. See Return to Play after Concussion
  6. References
    1. McCrory (2012) Br J Sports Med 47(5): 250-8 [PubMed]

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