New imaging findings shed light on the pathophysiology of this traumatic brain injury
TUESDAY, Jan. 8 (HealthDay News) -- Neuroimaging scans performed after first and second head injuries in a high school football player may help physicians better understand a rare and devastating traumatic brain injury, known as second impact syndrome (SIS), that results from premature return to play, according to a case report published online Jan. 1 in the Journal of Neurosurgery: Pediatrics.
Elizabeth Weinstein, M.D., of the Indiana University School of Medicine in Indianapolis, and colleagues report on a case of a concussed 17-year-old football player who experienced an initial helmet-to-helmet head injury but who continued to play despite dizziness and visual disturbance. After several days of severe headaches and fatigue, a computed tomography (CT) scan was performed and the findings were normal. Against physician recommendations he returned to practice and, after a few hits, became unresponsive and suffered a seizure.
According to the researchers, subsequent CT scans revealed small, thin subdural hematomas and mild cerebral swelling. Magnetic resonance (MR) images did not detect cerebral edema but did show downward herniation of the brain, bilateral subdural hematomas, and abnormal diffusion in the medial left thalamus. In SIS, cerebral autoregulation is thought to be lost, and cerebral arteries dilate, contributing to massive cerebral swelling, increased intracranial pressure, and brain herniation. At approximately three months, the patient was discharged but was unable to walk or talk. After three years, the patient could speak but had limited motor and cognitive skills.
"Importantly, this case shows that a normal head CT scan does not obviate the need for close clinical follow-up and for the athlete to be cognitively normal and asymptomatic before return to play," Weinstein and colleagues conclude.
Two authors disclosed financial ties to athletic organizations.
Abstract (http://thejns.org/doi/abs/10.3171/2012.11.PEDS12343 )Full Text (http://thejns.org/doi/full/10.3171/2012.11.PEDS12343 )