Second-Impact Syndrome Puts Teen In A Wheelchair

This nightmarish case study will hopefully prove to be a teachable moment for youth athletes.

The Journal of Neurosurgery: Pediatrics this week outlined a case where a 17-year-old high school football player, who had sustained a concussion, went back to practices before he had fully recovered. He ended up having a seizure and is confined to a wheelchair now.

In fact, according to the article this youth three years after his accident “is living at home and has regained limited verbal, motor and cognitive skills.”

http://thejns.org/doi/full/10.3171/2012.11.PEDS12343

The case illustrates all too perfectly the danger of so-called second-impact syndrome, a traumatic brain injury (TBI) that can occur when a person has a second head injury before fully recovering from a previous concussion.

In the case study, the player had a helmet-to-helmet hit with an opposing player. The teen was dizzy and had trouble seeing, but resumed playing. After the game, the teen had a headache and told a teammate, “That was the hardest I’ve been hit in my whole life.”

In the next few days he still had a headache. He was given a CT scan, which determined that his brain looked normal. Nonetheless, he was advised “to refrain from practice until his symptoms resolved; however, he returned to practice that afternoon,” the Journal of Neurosurgery article said.

During a subsequent practice that included hitting drills, the teen took a hit.

“Several plays later he went down on one knee, complained of dizziness and headache, and said he could not feel his legs,” according to the article.

The youth became unresponsive and had a seizure. He was diagnosed with bilateral subdural hematomas, or a build-up of blood on the brain. The teen’s brain had also swelled.

After a concussion, with a second blow to the head the brain’s arteries get bigger, and the increased blood flow causes the brain to swell beyond the limits of the skull.

“One of the most alarming features of our case is that our patient suffered from what has been historically euphemized as just a ‘ding’ during a play that was not extraordinary in any way,” the authors of the story wrote.

The bottom line is that youths’ brains are not fully developed and therefore are more susceptible to injury. And even if a CT indicates that a brain is normal, an athlete must should be “cognitively normal and asymptomatic before return to play.”