“Second-impact syndrome (SIS): Blows to the head that are too soft to cause concussions can still cause Chronic Traumatic Encephalopathy (CTE), allowing the disease to spread unnoticed for decades.

“Often Its connection to football has been denied by coaches, the NFL, the NCAA and youth organizations.

“Second-impact syndrome appears to require an initial concussion, giving coaches a chance to pull a player and keep the player on the sidelines before he takes another hit.

“CTE can’t be diagnosed until after death; concussions can be revealed with a quick sideline exam or 30-minute computerized test, which can expose symptoms like headache, nausea or memory loss.

“Dr. Bob Cantu spent years fighting to call attention to CTE. Cantu is a neurosurgeon, medical director of the National Center for Catastrophic Sport Injury Research at UNC-Chapel Hill, an investigator for the CTE Center at Boston University and clinical professor of neurosurgery at Boston University School of Medicine, where he collected samples from the brains of dead athletes who had manifest dementia. Cantu published studies reflecting the findings.

“There’s no national governing body for the 1.1 million boys expected to play middle and high school football this season, no nationwide research of the game’s casualties. The tally of players who have been injured or killed by second-impact syndrome starts at 17 but climbs to dozens, depending on who’s counting.

“Yet for all the uncertainty, one fact seems clear: Second-Impact Syndrome is utterly preventable. And that frustrates Dr. Robert Cantu, a leading expert on brain trauma and O’Neil’s partner on the project.

“SIS is characterized by dramatic swelling, its signature pathology, secondary to the brain pushing against, not just the skull, but sometimes down into the spinal column.

“Most doctors suspect the brain’s plumbing breaks, unleashing a flood of blood and fluid, caused, not by one blow but two: first a malfunction and then a full rupture. The blows can be separated by seconds or by weeks. Much else, from why it occurs to why it seems to strike only young men, remains a mystery.

“The number of young football players who die from head trauma is just a fraction of the game’s death toll each season, which itself is minuscule compared to the number who participate: Of all the middle and high school boys who suited up in pads and helmets in the past three years, just 7 died directly as a result of on-field injuries in 2015, 5 in 2014 and 8 the year before, according to data compiled by the National Center for Catastrophic Sport Injury Research, largely culled from media reports. That’s an incidence rate of 0.58 per 100,000 athletes.

“Yet every year since 1995, at least 1 middle or high school student has died from playing football, 33% from a “direct” impact like head trauma or a spinal fracture, according to the national center. Many died as early as the August preseason, when states place relatively few limits on contact.
“Inevitably, you just do the math on this around the country, you can predict there’s going to be something very serious by the end of the month,” says O’Neil, who now runs Practice Like Pros, a coaching and advocacy group working to limit contact in practice and eliminate tackling before 9th grade. “You can just count on it.”

“The pipes that carry blood to the brain, arterioles, can expand and contract to regulate blood flow. In SIS, however, the arterioles malfunction, dilating and opening a flood that engorges the brain. Among the only treatments is to remove parts of the skull, a strategy that’s also used in car crashes. Even then, hope is slim.

“It’s like a leaky faucet, and the water’s going everywhere. It’s no longer going right out the outlet; it’s spraying all over the kitchen,” Koroshetz says. “There’s no place for the water to go inside the skull, so it just pushes on everything.”

“But there seems to be a trend: Many, if not most, victims had suffered a previous concussion, some during that very game, others a few days or few weeks prior but still suffering the symptoms, indicating their brains had not yet healed. In cases where no first impact was apparent, Cantu and O’Neil suspected it may have come during the same game or practice but was masked by the player from his coaches and teammates.

“These kids are good at hiding it,” says O’Neil. “It’s another dimension of the whole syndrome: It’s really not clinically diagnosable, and if you’re good at it and insistent, you can hide the symptoms and stay on the field. And that makes them vulnerable.”

“Something seems to break in that second hit, before the brain’s had a chance to recover. If that’s true, what’s unclear is why: the mechanism, that is, that causes the arterioles to malfunction. Nor do doctors know why of the hundreds, if not thousands, of players who surely hide headaches, dizziness and other signs of a concussion from their coaches and trainers every season, only a few suffer second-impact syndrome.

“One survey of college football players from 2014 found that for every head injury an athlete reported, another 27 went unreported. Among offensive linemen, that number rose to 32.

“There probably are a couple of genetic issues or environmental issues that put a small number of kids at risk, but we don’t know what they are,” says Dr. Meredith Golomb, associate professor of child neurology at Indiana University School of Medicine.

“Most pressing, neurologists still don’t know why only the young seem to succumb to the syndrome.

“Nobody has a clue as to why that would be,” Koroshetz says. “You have all these NFL players getting concussion after concussion and you don’t see it. The young brain is different than the older brain, it changes, so that might be the answer.”

“What does seem apparent, however, is the danger posed by taking first one hit and then another: It’s why, for a condition that’s also sometimes known as dysautoregulation or malignant brain edema, so many insist on the term Second-Impact Syndrome.

“It’s telling you that it’s preventable. If you had the means to understand that this brain’s already been injured, the kid never should be playing,” Cantu says. “It implies there’s something that can be done about it.”

“The Lystedt Law is a wonderful thing, but the states, the organizations, are not really carrying out what they’re talking about,” Cantu says. “They’re talking about the law, but there’s no funding for it.”

“What’s more, not only can players hide the symptoms of a concussion, but parents, trainers and coaches may also miss – or not want to see – the signs.

“In 2009, Washington became the first state to pass the Zackery Lystedt Law, named for a high school football player left permanently brain-damage from suspected second-impact syndrome. The measure set standards for when youth athletes with concussion symptoms have to be sidelined, when they’re allowed back on the field, and includes education components for players, coaches and parents. Since then, every state and the District of Columbia has passed a version of what’s become known as the “Return to Play” law.

“What’s more, not only can players hide the symptoms of a concussion, but parents, trainers and coaches may also miss, or not want to see, the signs.

“This level of medical attention is necessary to preserve the game; our children deserve that,” she says. “Football adds something to a town, to a high school, to a college. It brings so much goodwill, and the students and the children who are participating and entertaining and drawing crowds are not being paid. They at least deserve the appropriate advocacy and medical attention. We at least owe them that.”

Please see the entire article: [Sudden Death: The Mysterious Brain Injury Killing Young Football Players, By Ann Neuhauser, Aug 2016 U.S. News & World Report]

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