Second impact syndrome: concussion and second injury brain complications.

P A C a t t m p e p R b e econd impact syndrome was first described in 1973 by ichard Schneider in 2 young athletes who experienced nitial concussive syndromes and subsequently died after a elatively minor second head injury. Saunders and Haraugh coined the term second impact syndrome in their 984 description of a 19-year-old college football player ho suffered a head injury with brief loss of consciousness, eturned to play, reported a headache, and on the 4 day ollapsed, became unresponsive, and died. Postmortem xamination revealed no space-occupying hematoma and xtensive cerebral edema. It is the second collision impact, bsence of space-occupying hematoma, and subsequent apid and profound brain swelling that identify and mark he second impact syndrome. The severe brain swelling and bsence of impact hematoma are identical to first head njury findings duplicated in head injury laboratory nvestigations and identified in clinical series of severe ead injury patients. Statistics as to the occurrence of second impact synrome do not exist and the actual prevalence and incidence emain unknown. Second impact syndrome has always had roponents and detractors. Multiple head injury experts ave discussed this phenomenon as a worrisome corollary n virtually every article or chapter on sport-related head njury. However, others have been suspicious that the ure form is rare, and some have called into question its xistence, commenting “. . . it is fear of this entity that nderpins concussion guidelines regarding return to port.” The latter statement prompted a strong rebuttal rom a long-term and fully fledged head injury investigator ho noted that, although the syndrome might be uncomon, its existence is a reality and is identifiable at some evel virtually every year. In addition, it would be naïve to uggest return to play guidelines are solely in place as a onsequence of possible second impact syndrome, when here are multiple reasons to protect a concussed athlete rom re-exposure to play too early. Second impact synrome is only a small determinant for return to play guide-