The First Reported Case of Second Impact Syndrome: A Reexamination of Dr Fekete's Case Report from 1968
23 September 2016
24 August 2017
29 September 2017 (online)
Background In the December 28, 1968 edition of the Canadian Medical Association Journal, Dr John Fekete described a 16-year-old hockey player with fatal cerebral edema following a brain impact while actively symptomatic of a concussion incurred 4 days ago. This case has been described as a “possible” case of second impact syndrome, an entity that was named in 1984 and purportedly first described by Schneider in 1973.
Method An audit of material in the public register of Dr Fekete's case was undertaken. Information sources included the newspaper report of the death, transcripts from a coroner's inquest held 12 days later, including the autopsy report, genealogical data available online, and available internet resources.
Results There was clear documentation of concussive symptomatology following an initial head injury and evidence of a medical assessment, thus fulfilling the “definite” clinical criteria for second impact syndrome as proposed. After 4 days of ongoing concussive symptomatology, a dramatic, rapid neurological deterioration took place following an apparently unremarkable body contact and fall on the ice while playing hockey. His primary brain pathology included cerebral edema.
Conclusion Cerebral edema may follow primary or secondary head injury, the latter comprising second impact syndrome. Dr Fekete's case, as described in the December 28, 1968 edition of the Canadian Medical Association Journal, should be recognized as the first description of this condition.
The author has no financial relationships relevant to this article to disclose.
- 1 Cantu RC. Second-impact syndrome. Clin Sports Med 1998; 17 (01) 37-44
- 2 Cantu RC, Gean AD. Second-impact syndrome and a small subdural hematoma: an uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance. J Neurotrauma 2010; 27 (09) 1557-1564
- 3 McCrory PR, Berkovic SF. Second impact syndrome. Neurology 1998; 50 (03) 677-683
- 4 McCrory P. Does second impact syndrome exist?. Clin J Sport Med 2001; 11 (03) 144-149
- 5 Thomas M, Haas TS, Doerer JJ. , et al. Epidemiology of sudden death in young, competitive athletes due to blunt trauma. Pediatrics 2011; 128 (01) e1-e8
- 6 Fekete JF. Severe brain injury and death following minor hockey accidents: the effectiveness of the “safety helmets” of amateur hockey players. Can Med Assoc J 1968; 99 (25) 1234-1239
- 7 Available at: https://www.google.ca/maps Accessed May 7, 2014
- 8 Available at: http://climate.weather.gc.ca/climate_data/hourly_data_e.html?hlyRange=1953-01-01%7C2010-04-08&dlyRange=1951-04-01%7C2012-01-12&mlyRange=1951-01-01%7C2008-01-01&StationID=6157&Prov=NB&urlExtension=_e.html&searchType=stnProv&optLimit=specDate&StartYear=1840&EndYear=2017&selRowPerPage=25&Line=18&Month=2&Day=1&lstProvince=NB&timeframe=1&Year=1968 . Accessed September 21, 2017
- 9 Dekaban AS. Changes in brain weights during the span of human life: relation of brain weights to body heights and body weights. Ann Neurol 1978; 4 (04) 345-356
- 10 McCrory P, Davis G, Makdissi M. Second impact syndrome or cerebral swelling after sporting head injury. Curr Sports Med Rep 2012; 11 (01) 21-23
- 11 Snoek JW, Minderhoud JM, Wilmink JT. Delayed deterioration following mild head injury in children. Brain 1984; 107 (Pt 1): 15-36
- 12 Bruce DA, Alavi A, Bilaniuk L, Dolinskas C, Obrist W, Uzzell B. Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema”. J Neurosurg 1981; 54 (02) 170-178
- 13 Chadwick DL, Chin S, Salerno C, Landsverk J, Kitchen L. Deaths from falls in children: how far is fatal?. J Trauma 1991; 31 (10) 1353-1355
- 14 Plunkett J. Fatal pediatric head injuries caused by short-distance falls. Am J Forensic Med Pathol 2001; 22 (01) 1-12
- 15 Chadwick DL, Bertocci G, Castillo E. , et al. Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics 2008; 121 (06) 1213-1224
- 16 Spivack B. Fatal pediatric head injuries caused by short-distance falls. Am J Forensic Med Pathol 2001; 22 (03) 332-336
- 17 Kors EE, Terwindt GM, Vermeulen FL. , et al. Delayed cerebral edema and fatal coma after minor head trauma: role of the CACNA1A calcium channel subunit gene and relationship with familial hemiplegic migraine. Ann Neurol 2001; 49 (06) 753-760
- 18 Kors EE, Haan J, Giffin NJ. , et al. Expanding the phenotypic spectrum of the CACNA1A gene T666M mutation: a description of 5 families with familial hemiplegic migraine. Arch Neurol 2003; 60 (05) 684-688
- 19 Thomsen LL, Kirchmann M, Bjornsson A. , et al. The genetic spectrum of a population-based sample of familial hemiplegic migraine. Brain 2007; 130 (Pt 2): 346-356
- 20 McCrory P, Meeuwisse W, Aubry M. , et al. Consensus statement on concussion in sport--the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clin J Sport Med 2013; 23 (02) 89-117
- 21 Saunders RL, Harbaugh RE. The second impact in catastrophic contact-sports head trauma. JAMA 1984; 252 (04) 538-539
- 22 Schneider RC. Head and Neck Injuries in Football. Baltimore, MD: Williams & Wilkins; 1973