Dr. James Kelly Talks About Second Impact Syndrome

One concussion can be dangerous, another one — and too soon after the first — can be devastating, even fatal.

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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.
Posted on BrainLine November 20, 2008.

Comments (4)

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I suffered a fall hit back of head was unconscious no memory of fall I did vomit a few time but then slept while sleeping I woke up to use Bathroom rooked out of bed an was so dizzy I hit my wooden nightstand hard.
I went back to sleep then waited full day before going to ER due to extreme headache, nausea, dizziness. They did CT scan said I had Hemorrhage, my Bp was extremely high although that ER sent me to larger ER capable of handling it. That ER they diagnosed a Subachrnoid Hemmorage in frontal lobe I tore a vessel there was small amount of bleeding they watched it for 2-3 hours repeated CT scan said bleeding was stable felt in safe place sent me home with day off work. I went to work very high stress job in front of computer all day.
Within a few days headaches got worse, dead tired, ringing in ears, sinus congestion, speech slurred, felt lethargic .
Friday My Primary care Dr put me off work that day when I noted the issues as I was following up for referral to neurologist per the ER.

I have been off work for a week My Primary care did a follow up CT Tuesday this would be during second week falls said no changes no additional bleeding .

I am still have ringing in ears, headaches come an go still very dizzy upon laying down , showering, standing up to fast, still very tired although Congestion gone but still get blurry vision on/off mainly mid morning and hit/cold spells regularly.

I see the Neurologist next week.
I’m asking to be released back to work is it too soon?

My husband is concerned the stress will cause more issues raise BP I can’t afford to loose more time but don’t want to cause any additional issues with the injury.

Please can you add feedback

Dr. Kelly,
I have assisted veterans obtain benefits for disabilities which were a result of their military service. I have tried to assist several veterans recently who were US Navy and US Marine Corp pilot who flew many mission from Aircraft Carriers. They seem to have symptoms similar to those incurred by football players and boxers. Is it possible that their neurological issues are are result of the take off and landings from these carriers. Both individuals have neurological issues as you described in your presentation. They both flew hundreds of missions in Vietnam and other places. It would seem that the g forces experienced from take off and the sudden impact of landings could be the same as those experiencing multiple head impacts experienced by athletes. Would it be possible that these veterans are suffering from mTBIs They are both around 80 years of age.

It can happen to anyone, not just athletes.

I was the head softball coach at a small dlll college in Erie, PA. I got hit in the head fracturing my zygomatic arch and maxillary sinus back on April 5, 2013. Since then I've settled with the college. They originally did a CT scan and, of course, nothing came up. The doc was in and out of my room very quickly. Before I left, I asked if I had a concussion. She said 'does your head hurt?' and left it at that. I've been to numerous docs (including Pittsburgh and Cleveland clinic), therapies, meds, and a PT. I believe I had 4 ime docs who of course didn't believe I had a concussion. It was all made up and in my head. The one even said I was his longest patient of over three hours. During and following that time I got hit in the head with a soccer ball, jarred in a car accident, hit my head while getting into my van (this was a pretty significant hit too), and hit on the top of my head with a basketball. I think there may have been one more hit in there along the way. I was having headaches just about every day for months. Usually, as days progressed they got worse. Docs still don't understand why today after almost 5yrs that I still get headaches. Also, about a year after the original hit, I got what they tell me are myoclonic jerks. This happened all of the sudden following a day at work. I left work, got home and walked in the house with which my body started shaking and speech slurred. Again, they told me that I made this up. How do I do this when I had never seen it or knew about it? I'm wondering if you have any suggestions or why the headaches still happen. They said I should be better by now. As you probably can see there's more to the story than I can write. Please advise...