Jan. 1, 2013 ? In a Jan 2013 emanate of a Journal of Neurosurgery: Pediatrics, physicians during a Indiana University School of Medicine and a Northwest Radiology Network (Indianapolis) news on a box of a 17-year-old high propagandize football actor with second impact syndrome (SIS).
A singular and harmful dire mind injury, SIS occurs when a chairman — many mostly a teen — sustains a second conduct repairs before liberation from an progressing conduct repairs is complete. To a best of a authors’ knowledge, this is a initial reported box in that imaging studies were achieved after both injuries, adding new discernment and believe about a event. Findings in this box are reported and discussed in “Second impact syndrome in football: new imaging and insights into a singular and harmful condition. Case report,” by Elizabeth Weinstein, MD, and colleagues, published currently online, forward of print, in a Journal of Neurosurgery: Pediatrics.
The studious presumed a initial repairs when he perceived a helmet-to-helmet strike from an hostile actor during a punt return. Despite evident symptoms of nausea and visible disturbance, he continued to play in a game. For a subsequent few days he gifted critical headaches and fatigue. Four days after a game, he consulted a alloy about a headaches. Computerized tomography (CT) scans of a patient’s conduct seemed normal, though he was suggested not to lapse to play until all of his symptoms were gone. The immature male chose instead to lapse to use immediately.
The following day, notwithstanding complaints of headache and problem with concentration, a immature male participated in attack drills. After a few hits he was delayed station up, and after several some-more hits he collapsed, became unresponsive, and suffered a seizure. He was eliminated primarily to a internal puncture department, where a CT hearing suggested small, skinny subdural hematomas on any side of a brain. The studious perceived intubation and was treated medically. Shortly afterward he was airlifted to a tertiary mishap and neurosurgical core during Indiana University Health Methodist Hospital in Indianapolis.
At a tertiary center, a studious was found to be minimally manageable and to have increasing intracranial vigour (25-30 mm Hg; normal 5-15 mm Hg). Additional CT scans performed during a tertiary core reliable a participation of a subdural hematomas and amiable intelligent swelling. Magnetic inflection images of a mind and top spinal cord showed downward herniation of a brain, subdural hematomas on both sides of a brain, and aberrant freeing in a middle left thalamus. Structures in a closeness of a brain’s midline, including a thalamus and hypothalamus, had shifted downward. There did not seem to be any blood vessel repairs or spinal cord injury. The MR images did not detect intelligent edema.
The patient’s repairs concerned other critical consequences identified during a sanatorium stay, including enlarged towering intracranial pressure, areas of mind softening (in both thalami, a middle frontal lobes and elsewhere), hypotension, renal failure, sepsis, pneumonia, and proxy cardiac arrest. Even with optimal care, a studious remained in a sanatorium for 98 days and was incompetent to travel or speak when he was discharged. Three years later, he has regained most of his debate though is really guileless and is cramped to a wheelchair.
In SIS, a mind repairs produces a detriment of intelligent autoregulation. Cerebral arteries widen, permitting some-more blood to upsurge around a brain, and large intelligent flourishing can occur. These lead to increasing intracranial pressure, causing a mind to enlarge. Because a skull is a singular container, a mind can turn herniated as it seeks a space to expand. The authors note that some investigators formerly presumed that a detriment of intelligent autoregulation is caused by a “space-occupying injury” from a initial injury. Findings in this box do not justify that explain since a CT prove was normal. Weinstein and colleagues prove out that several forms of repairs do not indispensably register on an imaging study, and “a normal conduct CT prove does not nullify a need for tighten clinical follow-up, and for a contestant to be cognitively normal and asymptomatic before lapse to play.”
In this case, a studious gifted critical headaches around a interlude between injuries. The authors state that justification of persistent, long-lasting, critical headaches, that have regularly been identified in patients with SIS, prove an ongoing and poignant pathological neurophysiological condition in a deficiency of justification on a CT scan. The authors advise that this sign might be a specific predictor for a probability of SIS if a second repairs occurs before a initial has resolved.
The take-away summary in this study, according to co-author Michael Turner, MD, “is that there contingency not be a lapse to play if a contestant is during all symptomatic. A normal CT prove will not brand a studious who can be expelled to play. The resource of SIS is substantially hyperemia [increased blood in a brain], not mystic hematoma.”
SIS frequency occurs, though a outcome is customarily harmful when it does happen, and a studious mostly dies. The authors highlight a significance of educating coaches, athletes, family members, and treating physicians about a risks and probable consequences of sports-related conduct injuries.
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The above story is reprinted from materials supposing by American Association of Neurological Surgeons (AANS), around Newswise.
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Journal Reference:
- Elizabeth Weinstein, Michael Turner, Benjamin B. Kuzma, Henry Feuer. Second impact syndrome in football: new imaging and insights into a singular and harmful condition. Journal of Neurosurgery: Pediatrics, 2013; DOI: 10.3171/2012.11.PEDS12343
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