SIS is caused by a second physical impact, in a close period
of time (minutes, days, weeks) after
the symptoms from prior concussion have subsided. It is caused by rapid
and extreme swelling in the brain, which can often be fatal, lead to severe
disability or coma. The patient feels signs of concussion after the first head
injury such as headaches, visual, sensory or motor changes and especially
recognised is effect on memory. Although the symptoms may subside quickly, the
effect of swelling on the brain takes a long time to reduce.
If the athlete continues playing, and experiences a second impact they appear
stunned but do not have loss of consciousness, however after seconds to minutes
the athlete collapses, semi-conscious with dilating pupils, loss eye movement
and stops breathing.
The cause is thought to be due to the brain’s arterioles
losing their ability to regulate the diameter, therefore lose control over
cerebral blood flow, causing massive cerebral edema. Cerebral edema is when
there is an excess accumulation of fluid within the intracellular or
extracellular brain spaces. With an increase in water content in the brain, the
pressure within the skull rises . For this reason it is considered an medical
emergency because blood vessels can become compacted, and hence oxygen supply
limited. In serious cases
herniation is thought to occur, which is leads to decreased blood flow in the
brain because with an increase in pressure the brain is squeezed through small
holes within the skull.
The vast majority of cases occur within males under the age
of eighteen, because their brains are still developing so the symptoms of
concussion take longer to subside. Two years ago, Benjamin Robinson, 14 died
during a rugby match from Second Impact Syndrome. His parents are campaigning
to have new legislation put in place to protect further incidences occurring in
Ireland and the UK. For Example in
the National Football League in America, players diagnosed with concussion
during the game were not allowed to continue playing and are subjected to
testing over the following days to determine if the player is fit to play the
next match.
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