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The Second Impact in Catastrophic Contact-Sports Head Trauma
Abstract
CATASTROPHIC brain injury following minor impact has been known to occur in contact sports, particularly football.1This peculiar susceptibility remains unexplained. However, the common resumption of contact play soon after concussion suggests that sequential minor impacts may occasionally lead to major cerebral pathological conditions. If these injuries have a compounding effect rather than representing isolated events, then additional impact to an already compliance-compromised brain might precipitate a catastrophic increase in intracranial pressure, perhaps through loss of vasomotor tone. We report a case documenting a preexisting cerebral contusion and the lethal effect of a second minor impact. This case suggests that clinical examination alone may sometimes be inadequate in evaluating persisting symptoms after minor head injury. In the athlete who has had a cerebral concussion, computed tomographic (CT) scanning may be required before medical clearance to resume play is justified. Report of a Case A 19-year-old, right-handed, college football player
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“Second-impact syndrome (SIS) occurs when an athlete sustains an initial mild head injury or concussion, then suffers a second head injury before the symptoms associated with the first impact have cleared, with resultant diffuse cerebral swelling and grave deterioration [19, 20, 113, 133, 137, 164].”
From The neuropathology of sport (2014) · cites this paper as [164]
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Metadata
- Authors
- Saunders, R. L.
- Affiliations
- Dartmouth College (US)
- Corresponding author
- Saunders, Richard L.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1984-07-27
- Volume
- 252
- Issue
- 4
- Pages
- 538
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2005040118
- Cited by
- 382
- References
- 6
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 10 · 2020: 26 · 2019: 16 · 2018: 4 · 2017: 8 · 2016: 18 · 2015: 18 · 2014: 24 · 2013: 13 · 2012: 16
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Keywords
- second impact syndrome, contact sports, football, concussion, cerebral contusion, intracranial pressure, vascular tone, computed tomography, return to sport, medical clearance
- MeSH terms
- Adult, Athletic Injuries, Brain Concussion, Football, Hematoma, Subdural, Humans, Male, Radiography
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