Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Orthopaedic Sports Medicine


Answer 3
  1. Widespread edema with uncal herniation. The case patient is a victim of second-impact syndrome (SIS), which occurs when a patient receives a head injury, usually a concussion or cerebral contusion, and then receives a second head injury before the symptoms of the first injury have subsided. Usually an athlete suffering from SIS will collapse suddenly within seconds to minutes of impact. Preliminary signs include fixed, dilated pupils and evidence of respiratory failure. SIS is believed to result from a loss of autoregulation of the brain’s blood supply following the first concussion. The second impact therefore causes severe vascular engorgement within the cranium and an increase in intracranial pressure. A thorough head CT scan would reveal massive widespread edema and uncal herniation of the temporal lobe(s) through the foramen magnum. Brainstem compromise results from compression by this uncal hernia, causing respiratory failure, ocular involvement, and coma.4

    REFERENCE
    4. Cantu RC. Second-impact syndrome. Clin Sports Med 1998;17:37-44.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj