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Second-Impact Syndrome
Surjith Vattoth, MD, FRCR; Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • 2nd impact syndrome (SIS)
              • Synonyms

                • Dysautoregulation
              • Definitions

                • Repeated head trauma within "window of vulnerability" before brain recovers from initial concussive injury
                • Can result in catastrophic brain swelling with permanent disability or death
                • 2nd head injury in SIS typically minor, without immediate loss of consciousness
                  • Severe vascular engorgement, brain edema, & herniation usually within minutes of 2nd injury

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Harmon KG et al: American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 53(4):213-25, 2019
                                      2. Stovitz SD et al: What definition is used to describe second impact syndrome in sports? a systematic and critical review. Curr Sports Med Rep. 16(1):50-5, 2017
                                      3. Cantu RC: Dysautoregulation/second-impact syndrome with recurrent athletic head injury. World Neurosurg. 95:601-2, 2016
                                      4. Mckee AC et al: The neuropathology of traumatic brain injury. Handb Clin Neurol. 127:45-66, 2015
                                      5. McKee AC et al: The neuropathology of sport. Acta Neuropathol. 127(1):29-51, 2014
                                      6. Harmon KG et al: American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 47(1):15-26, 2013
                                      7. Weinstein E et al: Second impact syndrome in football: new imaging and insights into a rare and devastating condition. J Neurosurg Pediatr. 11(3):331-4, 2013
                                      8. Cantu RC et al: Second-impact syndrome and a small subdural hematoma: an uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance. J Neurotrauma. 27(9):1557-64, 2010
                                      9. Wetjen NM et al: Second impact syndrome: concussion and second injury brain complications. J Am Coll Surg. 211(4):553-7, 2010
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • 2nd impact syndrome (SIS)
                                                  • Synonyms

                                                    • Dysautoregulation
                                                  • Definitions

                                                    • Repeated head trauma within "window of vulnerability" before brain recovers from initial concussive injury
                                                    • Can result in catastrophic brain swelling with permanent disability or death
                                                    • 2nd head injury in SIS typically minor, without immediate loss of consciousness
                                                      • Severe vascular engorgement, brain edema, & herniation usually within minutes of 2nd injury

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Harmon KG et al: American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 53(4):213-25, 2019
                                                                          2. Stovitz SD et al: What definition is used to describe second impact syndrome in sports? a systematic and critical review. Curr Sports Med Rep. 16(1):50-5, 2017
                                                                          3. Cantu RC: Dysautoregulation/second-impact syndrome with recurrent athletic head injury. World Neurosurg. 95:601-2, 2016
                                                                          4. Mckee AC et al: The neuropathology of traumatic brain injury. Handb Clin Neurol. 127:45-66, 2015
                                                                          5. McKee AC et al: The neuropathology of sport. Acta Neuropathol. 127(1):29-51, 2014
                                                                          6. Harmon KG et al: American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 47(1):15-26, 2013
                                                                          7. Weinstein E et al: Second impact syndrome in football: new imaging and insights into a rare and devastating condition. J Neurosurg Pediatr. 11(3):331-4, 2013
                                                                          8. Cantu RC et al: Second-impact syndrome and a small subdural hematoma: an uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance. J Neurotrauma. 27(9):1557-64, 2010
                                                                          9. Wetjen NM et al: Second impact syndrome: concussion and second injury brain complications. J Am Coll Surg. 211(4):553-7, 2010