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CRM: Characteristics—A Secondary Concussion
Concussion Recognition & Management
Module 2 Characteristics & Epidemiology

Multiple Injury Risks

Undiagnosed

boxer getting hit in the face

After a concussion, the injured person is more vulnerable to experience another concussion. If a subsequent concussion occurs while symptoms persist from an earlier concussion, evidence suggests this subsequent concussion may be worse and recovery will take longer. This can happen minutes, days, or weeks after the first concussion.

In rare instances — so rare that it is difficult to study — the consequences can be catastrophic. This is the phenomenon known as Second Impact Syndrome. It is often discussed today in the context of concussion, but the term refers to the rare circumstances in which the second impact is thought to lead to cerebrovascular congestion resulting in brain edema and increased intracranial pressure.

Labels in the field are not applied consistently, and terms such as Second Impact Syndrome are sometimes misused to describe any subsequent concussion.

That being said, however rare Second Impact Syndrome might be, it’s clear that the victim of concussion has suffered an insult to the brain, and it’s essential to avoid further insult of any kind. Evidence suggests the more concussions an individual suffers, the worse his or her subsequent concussions may be.

soccer player holding head, curled up in pain on ground
student alone in classroom, unable to study

The risk of additional injury is always present when concussion has occurred, in part because of its accompanying symptoms such as dizziness, blurred vision, and impaired thought-processing.

Though it is (fortunately) improbable that you will encounter true Second Impact Syndrome, the possibility of such tragic consequences underscores the importance of identifying concussion cases, providing proper treatment including mental and physical rest, and managing return to physical and mental activities so the patient is truly ready to play and learn.


Module 2 Characteristics & Epidemiology

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