Second Affect Syndrome (SIS): What Athletes, Coaches and Trainers Must Know

Second Affect Syndrome (SIS): What Athletes, Coaches and Trainers Must Know

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Second impact syndrome (SIS) is a devastating situation that happens when a person who suffers from preliminary concussive signs as a consequence of a head damage sustains a second influence upon their head earlier than absolutely recovering from the primary blow. The mind is in a weak state within the aftermath of a concussion, and even a slight blow may cause a sudden chain of reactions within the physique that results in harmful mind swelling. Given the severity of second influence syndrome, it must be actively mentioned between medical doctors and sufferers throughout post-concussive care and thought of as a variable in Return-To-Play protocol for concussed athletes. There have been only a few instances of the situation, however the instances which have taken place are so extreme that it’s essential and worthwhile to take steps in the direction of SIS prevention in all concussion care.

What’s Second Affect Syndrome (SIS)?


Second influence syndrome was first described in 1973 by R.C. Schneider, after he witnessed two instances of athletes experiencing preliminary concussion syndromes after which dying after solely minor second accidents. The time period itself was later coined by Schneider in 1984. The situation is taken into account uncommon, however precise numbers are comparatively unknown as a result of frequent underdiagnosis of preliminary accidents and the similarities shared between SIS and different traumatic mind accidents. SIS might be laborious to conclusively diagnose as a result of it requires establishing a causal relationship between the preliminary and secondary head accidents. Whereas missed prognosis of SIS has made it troublesome to know what number of instances there are yearly, a 2016 study published by researchers from Indiana University School of Medicine in Pediatric Neurology discovered that solely 17 instances have been absolutely documented over the previous few a long time in medical literature.

Regardless of the rarity of second influence syndrome, it’s more and more essential that each medical doctors and sufferers are conscious of its risk and take steps to stop its onset, given its deadliness.

When a concussion happens and its prognosis is missed or signs are lined up or ignored, then there’s the chance for SIS. “Despite the fact that the precise frequency of second influence syndrome isn’t properly established as a result of it’s so laborious to establish, diagnose and deal with, it may be averted if each suspected concussion is totally evaluated utilizing goal measures like VOMS, infrared eye monitoring and neuro-cognitive testing,” says Dr. Schaller. “Since it’s typically deadly or may end up in extreme bodily and psychological impairments, lacking any concussion and correctly treating that concussion for protected return to play, might be met with a extreme and even lethal end result. Subsequently, figuring out and diagnosing all concussions is essential.”

Why is a Second Affect so Harmful for Folks Recovering From a Concussion?

When a person experiences a concussion, the physique undergoes quite a few neuronal, metabolic and ionic modifications in response. One such change is seen in axonal shearing – the tearing of the mind’s lengthy connecting nerve fibers because the mind quickly shifts contained in the cranium when an damage happens. Axonal shearing results in quite a few neural responses, dysregulating and reducing cerebral blood circulate to some extent through which edema – swelling as a consequence of extra fluid – takes place. It takes time and power for the mind’s neurotransmitters to return to their regular physiology after a concussion — typically, the return to normalcy is assumed to take seven to 10 days, however it typically takes longer in younger individuals. Thus, throughout such a time interval, the post-concussive mind is especially weak to additional damage.

“Attempting to cowl up a concussive occasion by an athlete or perhaps a father or mother can lead generally to long run points with stability, cognition, migraine complications, visible monitoring and nervousness and/or melancholy—which research have discovered have an effect on 37% of younger athletes with concussions),” says Dr. Schaller. Returning to play earlier than an athlete is absolutely recovered after which sustaining one other concussion earlier than the prior concussion is absolutely recovered not solely raises the uncommon risk of SIS, says Dr. Schaller, however it snowballs the impact of those identical very problems with stability, cognition, migraine complications, nervousness, melancholy and visible monitoring.

SIS Presents Itself Quickly and in Varied Methods

“After the second influence, SIS might current itself in several methods,” says Dr. Schaller. “For instance, an individual might initially look like surprised, with dilated pupils, however nonetheless be acutely aware sufficient to proceed transferring. Then, inside minutes, they’ll lose consciousness and collapse into a daunting semi-comatose state.”

This was seen within the case of Zackery Lystedt. Lystedt was a highschool soccer participant within the state of Washington in 2006 when he was injured throughout a sport. He returned to the sphere after solely a short second on the bench and subsequently suffered one other blow. Inside seconds of this extra blow, he collapsed to the bottom, shedding consciousness and struggling a hemorrhage in his mind. Lystedt was fortunate to outlive, however his survival got here at a value: a part of his cranium was eliminated to alleviate strain, he spent seven days on life assist, and he’s since spent years relearning fundamental cognitive and motor abilities. Lystedt’s case led to the signing of the Lystedt Regulation in Washington State in Might 2009, thought-about one of many hardest Return-to-Play legal guidelines within the nation. This legislation prohibits any athlete suspected of sustaining a concussion from returning to play with out the specific approval of a healthcare supplier.

Physiopedia summarizes SIS as we’d witness in athletes as a scenario the place the person may very well be capable of stand up and keep on his or her toes lengthy sufficient to stroll off the sphere, however inside a couple of minutes time (or much less), they might collapse and present indicators of respiratory failure — one thing that may be mistaken for a cardiovascular emergency.  Other potential symptoms experienced throughout this preliminary moments after the second influence interval embody seizures, complications and vomiting.

After being rushed to the hospital, SIS can be diagnosed with a computed tomography (CT) scan to see if the patient has cerebral swelling, midline brain herniation and acute subdural hematoma. If this happens, the scenario is life-threatening and neurosurgical staff will  elimination of half of the cranium, leaving simply the scalp and relieving strain within the mind to keep away from herniation.

How Can Second Affect Syndrome Be Prevented?

Based on Nationwide Heart for Biotechnology Data (NCBI) sources, prevention must be the precedence in addressing second influence syndrome as a result of the situation could be very troublesome to deal with upon onset. Schooling on the syndrome amongst each sufferers and medical professionals is likely one of the greatest methods to stop SIS — as a result of the syndrome is so uncommon, it’s typically neglected of post-concussive care. The group most at risk for SIS is young males between the ages of 13 and 24 — significantly athletes in excessive contact sports activities akin to American soccer, hockey and boxing.

Being conscious of what the situation is previous to a primary concussion is likely one of the greatest methods to stop SIS, as a result of it permits sufferers and their care groups to make knowledgeable selections about the right way to shield themselves and their mind after an preliminary TBI. Time and relaxation are the most effective options. Concussed people ought to relaxation each cognitively and bodily for an prolonged time interval after their concussion.

“The secret’s not complete relaxation, however modified relaxation,” says Dr. Schaller. “For instance, they should keep away from noisy and crowded locations, keep away from studying and display time, keep away from journey over half-hour a day, keep away from cardiovascular efforts like jogging and heavy weight lifting, keep away from sweating and warmth publicity, and many others. However concussion sufferers are inspired to stroll, collect with a small group of pals and prolong their cardiovascular and lifting workout routines in a graduated supervised vogue with a educated medical skilled.” He notes that after they graduate a five-stage vestibular rehabilitation program, sufferers can they safely return to sports activities. Nonetheless, athletes shouldn’t be allowed to return to play in the event that they proceed to exhibit any concussion signs, which embody:

  • Fatigue
  • Headache
  • Disorientation
  • Nausea
  • Feeling “in a fog”

Return to Play After Preliminary Concussions Impacts SIS Threat

Even when these signs are not current, it’s all the time higher to err on the facet of warning and never rush the return to play or work no matter circumstance. Any athlete who has returned to play after a concussion must be watched fastidiously, even when they’ve had an acceptable restoration interval and accomplished a return to play protocol. Medical doctors, athletic trainers, medical suppliers, sufferers and their household ought to work collectively to find out the most effective protocol for his or her particular person case. When an athlete does return to play, they need to be watched fastidiously.

“Bear in mind, return-to-play protocols doesn’t imply concussion restoration is one-size-fits-all,” says Dr. Schaller. “Each affected person’s journey again to from a brain injury goes to be totally different, which is why they must be monitored and comply with their physician’s orders.”

The Finest Option to Keep away from Second Affect Syndrome is Nonetheless to Forestall the First Affect

Ultimately, the last word strategy to forestall second influence syndrome is to stop any concussions from taking place within the first place. In high-risk actions akin to influence sports activities or wheeled actions (akin to biking or skateboarding) it is best to #RockYourHelmet and put on a well-fitting helmet that’s acceptable for the exercise you’re partaking in. For sports activities akin to soccer and rugby, practice safe and proper techniques for tackling and different types of direct contact. When driving in a motorized vehicle, you will need to all the time put on your seatbelt and make the most of age- and size-appropriate car and booster seats for children.

Moreover, in the event you maintain a head damage and suspect you may need a concussion, it is best to instantly take steps to relaxation and get well and forestall additional concussions. Athletes must be removed from play after a suspected head injury, even when exhibiting solely gentle concussion signs, and they need to not return to play till they’ve been evaluated by a medical skilled. Taking preventative steps in each defending your head and recognizing preliminary damage are the last word methods to proceed enjoyment of actions and sports activities whereas additionally stopping second influence syndrome.

MAC Alliance and Second Affect Syndrome Prevention

Mid-Atlantic Concussion (MAC) Alliance is a community of licensed medical professionals and athletic coach associates situated all through Delaware, Maryland, New Jersey, New York, Pennsylvania and Virginia. We work with a wide selection of traumatic brain injury instances, together with post-SIS sufferers. It’s our mission to boost SIS  consciousness and assist cut back dangers for the syndrome — beginning with higher prognosis and take care of preliminary concussions. We use quite a few state-of-the-art mind monitoring instruments for concussion prognosis and therapy to mitigate the results of mind trauma, together with ImPACT, CBS Health, EyeGuide, RightEye and BrainScope evaluation instruments. We’re dedicated to the welfare of our sufferers by means of the prognosis, therapy and long-term care administration of concussions and traumatic mind accidents. For extra data, click here to seek out the closest MAC Alliance accomplice to you or name us at (303) 235-8808.

—Reporting by Rebecca Rainey

[UPDATED: 8/30/23]
[ORIGINAL POST: 8/18/21]


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