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July 27, 1984

The Second Impact in Catastrophic Contact-Sports Head Trauma

Author Affiliations

From the Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Hanover, NH.

JAMA. 1984;252(4):538-539. doi:10.1001/jama.1984.03350040068030

CATASTROPHIC brain injury following minor impact has been known to occur in contact sports, particularly football.1 This peculiar susceptibility remains unexplained. However, the common resumption of contact play soon after concussion suggests that sequential minor impacts may occasionally lead to major cerebral pathological conditions. If these injuries have a compounding effect rather than representing isolated events, then additional impact to an already compliance-compromised brain might precipitate a catastrophic increase in intracranial pressure, perhaps through loss of vasomotor tone. We report a case documenting a preexisting cerebral contusion and the lethal effect of a second minor impact. This case suggests that clinical examination alone may sometimes be inadequate in evaluating persisting symptoms after minor head injury. In the athlete who has had a cerebral concussion, computed tomographic (CT) scanning may be required before medical clearance to resume play is justified.

Report of a Case  A 19-year-old, right-handed, college football player