Dr. James Kelly is professor of Neurosurgery and Physical Medicine and Rehabilitation at the University of Colorado Denver School of Medicine and associate director of the Colorado Area Health Education Center System. This is BrainLine's exclusive interview with Dr. Kelly recorded on July 11, 2008.
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Well, Second Impact Syndrome is a fortunately rare,
but often devastating and often fatal
swelling of the brain
after what are repeated concussions.
That's the way it's been described,
and I and others have written about certain cases of that.
It can also happen after one blow--
and we've seen that--
or at least without there having been
identified earlier blows to the head,
and the same massive brain swelling can occur.
So this is without a big blood clot pressing on the brain.
It actually is a problem with the what we call
"autoregulation" of the blood vessels of the brain.
The blood vessels themselves dilate and constrict,
and if they stay dilated, they carry more blood in them
and that leads to pressure elevations in the brain,
because now there's more liquid than there should be.
And so, if that's happening,
the brain under those circumstances becomes very tight,
the circulation is sluggish,
the brain doesn't get the nourishment it needs,
and so under the pressure that the liquid is creating,
the brain becomes dysfunctional.
Once that gets far enough down the road in its evolution,
oftentimes, we can't stop it.
So early on, in certain cases, with proper medication
and positioning of the individual and so forth,
that can be halted, and yet I don't know anybody
who's come through that unscathed.
If they live through Second Impact Syndrome with that massive brain swelling,
they're left with some kind of deficit.
It's not just a concussion effect.
Craniectomy can be used, but what that amounts to is
a surgery in which a big area of bone is removed
and the brain is allowed to swell
outside of the normal confinement.
The problem with that is that sometimes the edge of the bone
where the brain is swelling up against
becomes infarcted.
There's a stroke along there because
it's literally herniated up against and stuck in that way,
and they can't get blood supply past there.
So even though it can be life-saving,
it creates in many cases a different kind of neurological deficit as well.
There have been studies--and I don't know if they're still ongoing--
of taking off essentially the entire forehead
and letting the brain swell forward,
where it doesn't get stuck, it doesn't herniate up against the edge of the bone,
covering all of that with a sterile plastic
that's similar to the lining of the skull--the dura.
And I know that there was some interest in doing that
in a multi-centered trial around the States,
but I have to admit I don't know if that's gone forward,
or if it's still in the planning stages.
(pause)
Second Impact Syndrome and Shaken Baby Syndrome are very similar.
The pathophysiology--the physiological change that occurs in a baby's brain--
is again the swelling after repeated blows.
And so, there may be many more blows
that any individual one of them would not have caused trouble,
but it's the repeated blow that causes the problem.
And the picture on scan and the picture on examination
and the picture at autopsy is very similar between the two.
James Kelly, MD,
James Kelly, MA, MD, FAAN, a neurologist who is one of America’s top experts on treating concussions, serves as the director of the National Intrepid Center of Excellence (NICoE). While serving as NICoE’s Director, Kelly is on a leave of absence from his position as professor of neurosurgery and physical medicine and rehabilitation at the University of Colorado School of Medicine.
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Wonderfully, understandable and succinct explanation about second impact syndrome. Thank you Brain Line, thank you Defense and Veterans BI Center and Dr. Kelly!!!!!You are doing a huge public service. Helen Hines
Jul 27th, 2011 12:13pm