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Cited by 173Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesChild Abuse and Related Trauma

Second-Impact Syndrome and a Small Subdural Hematoma: An Uncommon Catastrophic Result of Repetitive Head Injury with a Characteristic Imaging Appearance

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Cantu, Robert C., Gean, Alisa D.·2010·Journal of Neurotrauma
DOI 10.1089/neu.2010.1334PMC PMC2956379
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Abstract

There have been a handful of previously published cases of athletes who were still symptomatic from a prior head injury, and then suffered a second injury in which a thin, acute subdural hematoma (SDH) with unilateral hemisphere vascular engorgement was demonstrated on CT scan. In those cases, the cause of the brain swelling/dysautoregulation was ascribed to the presence of the acute SDH rather than to the acceleration/deceleration forces that caused the SDH. We believe that the brain swelling is due to “second-impact dysautoregulation,” rather than due to the effect of the SDH on the underlying hemisphere. To support our hypothesis, we present 10 additional cases of acute hemispheric swelling in association with small SDHs in athletes who received a second head injury while still symptomatic from a previous head injury. The clinical history and the unique neuroimaging features of this entity on CT are described and illustrated in detail. The CT findings included an engorged cerebral hemisphere with initial preservation of grey-white matter differentiation, and abnormal mass effect and midline shift that appeared disproportionately greater than the size of the SDH. In addition, the imaging similarities between our patients and those with non-accidental head trauma (shaken-baby syndrome) will be discussed.

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Crossref · 10.1089/neu.2010.1334

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  • Second-impact syndrome 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.

    “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 [19]

  • In two-thirds of second-impact syndrome cases, a thin, acute subdural hematoma has been reported on neuroimaging or at autopsy.

    “In two-thirds of cases, a thin, acute subdural hematoma has been reported on neuroimaging or at autopsy [19, 137]”

    From The neuropathology of sport (2014) · cites this paper as [19]

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Authors
Cantu, R. C., & Gean, A. D.
Affiliations
  • Boston University (US)
  • San Francisco General Hospital (US)
Corresponding author
Cantu, Robert C.
ORCID
Venue
Journal of Neurotrauma
Publisher
SAGE Publications
Published
2010-09
Volume
27
Issue
9
Pages
1557-1564
ISSN
  • 0897-7151 (ISSN-L)
  • 1557-9042
DOI
10.1089/neu.2010.1334
PMC
PMC2956379
OpenAlex
W2127863420
Cited by
173
References
18
Citations by year
2026: 3 · 2025: 1 · 2024: 6 · 2023: 3 · 2022: 2 · 2021: 10 · 2020: 11 · 2019: 15 · 2018: 9 · 2017: 17 · 2016: 21 · 2015: 25 · 2014: 19 · 2013: 11 · 2012: 12
FWCI
7.24
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Neurotrauma (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child Abuse and Related Trauma
Keywords
second impact syndrome, subdural hematoma, repetitive head injury, cerebral edema, athletes, CT imaging features, midline shift, sports-related concussion
MeSH terms
Adolescent, Aged, Athletic Injuries, Catastrophic Illness, Child, Female, Craniocerebral Trauma, Hematoma, Subdural, Humans, Male, Recurrence, Syndrome, Young Adult

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