The Second Impact in Catastrophic Contact-Sports Head Trauma

TLDR

Catastrophic brain injury after minor impact is known in contact sports, yet the mechanism remains unclear, and sequential minor blows may compound to trigger a sudden rise in intracranial pressure through loss of vasomotor tone. The authors report a case of a preexisting cerebral contusion that was fatally exacerbated by a second minor impact, underscoring the need for CT scanning before clearance of athletes with prior concussion. The study is a case report of a 19‑year‑old college football player. The case demonstrates that a second minor impact can be lethal in the presence of a preexisting contusion and that clinical examination alone may miss ongoing symptoms after minor head injury.

Abstract

CATASTROPHIC brain injury following minor impact has been known to occur in contact sports, particularly football.¹This peculiar susceptibility remains unexplained. However, the common resumption of contact play soon after concussion suggests that sequential minor impacts may occasionally lead to major cerebral pathological conditions. If these injuries have a compounding effect rather than representing isolated events, then additional impact to an already compliance-compromised brain might precipitate a catastrophic increase in intracranial pressure, perhaps through loss of vasomotor tone. We report a case documenting a preexisting cerebral contusion and the lethal effect of a second minor impact. This case suggests that clinical examination alone may sometimes be inadequate in evaluating persisting symptoms after minor head injury. In the athlete who has had a cerebral concussion, computed tomographic (CT) scanning may be required before medical clearance to resume play is justified. <h3>Report of a Case</h3> A 19-year-old, right-handed, college football player