Second Impact Syndrome

Second Impact Syndrome is a type of brain injury that has devastating consequences. There is not much published research on the topic though we still hear about it in the news, mostly affecting children and teens. Although second impact syndrome is rare, we believe it is worth discussing because it could be the cause of catastrophic injury and is preventable.

Second impact syndrome is concerning due to the nature of how it occurs. It is said to occur when an individual sustains a mild concussion and then sustains a second mild head injury within hours or days after the first injury. The second injury, on top of the first injury, can cause massive pressure in the brain which may need emergency surgery and can even lead to death. Many children and teens ignore symptoms of a mild concussion and continue to participate in sports. Continued activity with a mild concussion allows more vulnerability for a second injury. Likely a second injury will only lead to symptoms worsening temporarily; but, in the case of second impact syndrome, the end result could be devastating.

Second impact syndrome is most commonly reported in more “violent” contact sports, such as football. Football is also one of the sports where there is greater opportunity for repeat head injuries. Though adults play football as well, research theorizes that children are more likely to sustain second impact syndrome due to having a more vulnerable brain (read our June 2019 blog for more details on this).

So, what can we do to prevent second impact syndrome? We can educate, educate, and educate. We need to do a better job educating coaches and parents so that they can educate their children and teens. Children and teens in contact sports need to know symptoms of a potential concussion, and that, if they experience any of these symptoms after head hit, they need to stop game play/activities, report symptoms, and be evaluated.

This is what we tell our patients so that they can recognize a possible concussion. After a head injury, it is normal to have a headache or soreness at the site of injury. Though pain at the site of the hit/injury is expected, it is NOT normal to have any of these symptoms: feeling “dazed,” “seeing stars,” feeling of “getting bell rung,” dizziness, nausea or vomiting, feeling slowed down and foggy, feeling disoriented, having balance difficulty or trouble walking, having light or noise sensitivity, having a headache that persists, or difficulty with concentration or memory. If any of these symptoms are present (even only momentarily) after a head injury (or injury to the body where the head moves back and forth rapidly), they should stop the activity and discuss symptoms with a parent, school nurse, coach, athletic trainer, or primary care provider. If the child/teen removes himself/herself from activity, and does not sustain a reinjury, they should be protected from second impact syndrome.