second impact syndrome post concussion syndrome

1. SECOND IMPACT
SYNDROME AND
CONCUSSION
DR. GOVIND GAIKWAD

2. CONCUSSION- TO SHAKE VIOLENTLY
LATIN WORD- CONCUTERE- TO SHAKE VIOLENTLY
Def- An immediate and transient loss of consciousness a/w brief amnesia after
blow to head
Simple concussion - resolve within 10 days
Complex concussion - persistent symptoms beyond 10 days or additional
symptoms of seizures, headache and cognitive impairment.

3. Clinical features
Headache
Dizzines
Fatigue
Insomnia
Irritability
Alcohol intolerance
Subconscious memory disturbances

4. Amnesia
Anterograde - new information
Retrograde -preceding trauma

5. Pathophysiology
Initial cerebral concussion
Cerebral edema
Autoregulatory mechanism
Compensation for mechanical and physical stress, protective against massive swelling
- Reduced cerebral flow
- Accumulations of lactates and ions
- Last for 10 days
- Altered metabolism
- Enhances vulnerability

6. Second impact
Sublethal
Less intensity impact
NO autoregulatory mechanism
No compensations
Malignant cerebral edema
Cerebral herniation
Sudden death within 2- 5 minutes

7. CANTU Grading
Grade 1
No LOC
Transient
Confusion
Resolution of mental abnormality within 15 minutes

8. CANTU Grade 2
LOC <1Min
Mental symptoms >15 minutes
PTA->30 minutes

9. CANTU Grade 3
LOC < 1Min
PTA->24 Hrs

10. RETURN TO PLAY PROTOCOL
GRADE 1 FIRST CONTUSION
Remove from play
Examine @ 5 min interval
May return to play if symptoms resolve within 15 mins
Grade 1 second contusion
RTP after 1 wk

11. Grade 2
first contusion
Remove from play
No play on same day
Allow RTP after 1wk if NLE is normal
Second contusion
2 weeks
If radiology abnormal - no play for sesion

12. Grade 3
First contusion
2 week
Second contusion
1 month till all symptoms resolves