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Second impact syndrome: A devastating injury to the young brain
Date:1/1/2013

atient received intubation and was treated medically. Shortly thereafter he was airlifted to a tertiary trauma and neurosurgical center at Indiana University Health Methodist Hospital in Indianapolis.

At the tertiary center, the patient was found to be minimally responsive and to have increased intracranial pressure (25-30 mm Hg; normal 5-15 mm Hg). Additional CT scans obtained there confirmed the presence of the subdural hematomas and mild cerebral swelling. Magnetic resonance images of the brain and upper spinal cord showed downward herniation of the brain, subdural hematomas on both sides of the brain, and abnormal diffusion in the medial left thalamus. Structures in the vicinity of the brain's midline, including the thalamus and hypothalamus, had shifted downward. There did not seem to be any blood vessel damage or spinal cord injury. The MR images did not detect cerebral edema.

The patient's injury involved other serious consequences identified during the hospital stay, including prolonged elevated intracranial pressure, areas of brain softening (in both thalami, the medial frontal lobes, and elsewhere), hypotension, renal failure, sepsis, pneumonia, and temporary cardiac arrest. Even with optimal care, the patient remained in the hospital for 98 days and was unable to walk or talk when he was discharged. Three years later, he has regained much of his speech but is very impulsive and is confined to a wheel chair.

In SIS, the brain injury produces a loss of cerebral autoregulation. Cerebral arteries widen, allowing more blood to flow throughout the brain, and massive cerebral swelling can occur. These lead to increased intracranial pressure, causing the brain to enlarge. Because the skull is a limited container, the brain can become herniated as it seeks a space to expand. The authors note that some investigators previously postulated that the loss of cerebral autoregulation is caused by a "space-occupying injury" from the initial i
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Contact: Jo Ann M Eliason
jaeliason@thejns.org
434-982-1209
Journal of Neurosurgery Publishing Group
Source:Eurekalert

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