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Second Impact Syndrome Risk Requires Caution in Return-to-Play Decision

Return before symptoms clear exposes risks serious, potentially fatal brain injury

Protecting The Head

Traumatic brain injury (tbi) is the most frequent direct cause of death in sport. Injury to the head takes on unique importance when one understands that the brain is neither capable of regeneration nor, unlike many other body parts and organs, of transplantation. Therefore, every effort needs to be made to protect the athlete's head because injury can lead to dementia, epilepsy, paralysis, and death.

Second Impact Syndrome: On The Rise

As a result of rule changes, equipment standards, better conditioning of the neck, and improved on-field medical care, there has been a dramatic decrease over the past 20 years in the most serious head injuries. Unfortunately, there has been during this same period, and especially in the last five to ten years, a substantial increase in the number of reported cases of second impact syndrome (SIS), which occurs when an athlete who sustains head trauma, i.e. a traumatic brain injury - often a concussion or worse injury, such as a cerebral contusion (bruised brain) - sustains a second head injury before signs of the initial injury have cleared. The Difficulty Of Recognizing Head Injuries

Recognition of a head injury is easy if the athlete has lost consciousness. It is much more difficult to recognize the far more frequent head injuries in which there is no loss of consciousness but rather only temporary loss of mental sharpness. More than 90% of all cerebral concussions fall into this mild, or Grade 1, category, which, under my brain injury guidelines is characterized by only a brief (less than 30 minutes) period of post-traumatic amnesia (PTA) or other post-concussion signs and symptoms. Because SIS can occur after even a Grade 1 concussion, just as it can after more serious head injuries, it is very important for on-field medical personnel be able to properly evaluate and recognize all grades of concussion.

Exercising Caution

This is why, under my guidelines it is preferable for athletes suffering even a single Grade 1 concussion not to return to play for at least one week in order to allow time for evaluating and treating the concussion post head injury and for the brain to heal.

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