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The Pathophysiology of Traumatic Brain Injury
Published in Mark R. Lovell, Ruben J. Echemendia, Jeffrey T. Barth, Michael W. Collins, Traumatic Brain Injury in Sports, 2020
Christopher C. Giza, David A. Hovda
Second impact syndrome is a very rare but catastrophic occurrence where a relatively minor second trauma superimposed on a brain recovering from an initial injury leads to rapid neurologic deterioration, cerebral edema and death (Cantu 1995). While diagnostic criteria for the syndrome are still undergoing debate, initial reports suggest a strong predilection for children and adolescents (Pickles, 1950; Bruce et al., 1981; Bruce, 1984; Aldrich et al., 1992; MMWR, 1997). Children and adults respond to brain injury differently, with children seemingly more vulnerable to cerebral swelling and subdural hematomas after mild injury. One proposed mechanism for second impact syndrome suggests impaired autoregulation in the traumatized developing brain leads to hyperemia and edema (Lobato et al., 1991; Snoek, Minderhoud, & Wilmink, 1984).
The future
Published in Dominic Malcolm, The Concussion Crisis in Sport, 2019
For instance, while sports have variously experimented with ‘concussion spotters’, independent doctors, and the use of technology such as ‘hawkeye’ (a movement tracking system) to detect concussions (Greenhow 2018), the development of a diagnostic biomarker (i.e. blood, saliva, or urine) is particularly keenly awaited. Yet as no diagnostic test is 100 per cent accurate, debates about the acceptable levels of sensitivity and specificity (the number of false positives or negatives) will be ongoing. Moreover, will the presence of signs traditionally associated with concussion (e.g. loss of consciousness) be disregarded if a diagnostic test is negative? Would a more ‘accurate’ diagnostic tool eliminate second impact syndrome (SIS), the mechanisms of which we currently do not understand? Indeed, the notion of a single diagnostic tool implies that existing theories about gender and age as ‘modifying factors’ for concussion may be rejected, yet it is unlikely that science alone will shift these deeply socially rooted concerns. The areas of uncertainty in concussion science are so broad that no single innovation will remove the suspicions which perpetuate the broader crisis.
Child and adolescent athletes
Published in Gordon A. Bloom, Jeffrey G. Caron, Psychological Aspects of Sport-Related Concussions, 2019
Limited research has been conducted looking at RTP following an SRC in youth. RTP recommendations in children and adolescents have been extrapolated from adult consensus guidelines (e.g., McCrory et al., 2013; McCrory et al., 2017). This is the area of concussion management with the highest risk of complications and potentially catastrophic injury (i.e., second impact syndrome) if athletes RTP before full recovery. As such, caution is warranted given that repeated concussions can result in cumulative effects negatively affecting concentration and attention (Moser, Schatz, & Jordan, 2005), as well as increased vulnerability to recurrent concussive injury (Collins et al., 2002; Guskiewicz et al., 2000). Second impact syndrome rarely occurs in young athletes less than 20 years of age when an athlete sustains a second head injury while still symptomatic from a previous injury, resulting in brain edema and death (Cantu, 1998; McCrory et al., 2012).
A convoluted concussion case
Published in Journal of American College Health, 2022
Additionally, symptom duration and intensity may have a negative impact on academic progress, resulting in missed class time and declining grades. A variety of preexisting conditions such as migraines,5 depression,6,7 and attention-deficit/hyperactivity disorder (ADHD)8,9 (ADHD) may adversely affect the recovery from a concussion and present challenges in clinical management. Students with preexisting conditions may require prolonged recovery time and can lead to a diagnosis of post concussive syndrome. Concussion sustained after an initial TBI, and often before recovery is complete, presents additional clinical management challenges. The repeat concussion, known as second impact syndrome, increases the risk of extensive neurologic impairment or even death.10
An update on diagnostic and prognostic biomarkers for traumatic brain injury
Published in Expert Review of Molecular Diagnostics, 2018
Kevin K. Wang, Zhihui Yang, Tian Zhu, Yuan Shi, Richard Rubenstein, J. Adrian Tyndall, Geoff T. Manley
On the opposite end of the TBI spectrum, a common form of everyday mild is sometimes referred to concussion. Sports-related single or repeated concussions are especially common among professional, recreational, and collegiate athletes. In this setting, it is very important to access (a) if a concussion indeed occurred, and (ii) the degree of injury. If a biomarker is present in circulation within 30 min postimpact, its detection might be useful in making decision for return to play (RTP) in real time. Alternatively, with repeated testing of the same biomarkers within the days following concussion, in conjunction with other measures such as sports concussion assessment tools (SCAT3), they are useful in RTP decision. Another important feature of sports-related mTBI, the athletes who take part in such impact-prone sports activity often experience not only a single concussion, but also repeated concussion over time, both in recreational or professional sport setting. There is another potential life-threatening but rare condition – ‘second impact syndrome’ – it occurs if an athlete who has not fully recovered from a recent concussion suffers another concussion, resulting in a greatly increase risk of severe disability or mortality [160–162].
‘Mild Traumatic Brain Injury’ and ‘Sport-related Concussion’: Different languages and mixed messages?
Published in Brain Injury, 2019
A number of SRC studies have also focussed on a specific, often fatal, form of this which has been termed ‘second impact syndrome’ (SIS) which sometimes occurs, after second blows to the head. The validity of the syndrome is not universally acknowledged and only a few cases have been reported outside of boxing and have been almost exclusively in those under the age of 20 (23). Such concerns are heightened by the fact that those who suffer an SRC in certain sports are four to six times more likely to receive further concussions compared to those who do not. In sports, like American Football an SRC can make it three times more likely to suffer a second one within the same season (24).