Fatal Second Impact Syndrome in Rowan Stringer, A 17-Year-Old Rugby Player

Figures

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  Figure 1:. Non-contrast brain CT 2 hours after the patient’s injury (column A), 2 days post-injury (column B), and 3 days post-injury (column C). (A) There is generalized cerebral edema, moreso on the left side, with effacement of the sulci, uncal herniation, 3 mm midline shift to the right, and a small left-sided SDH approximately 2–3 mm thick (arrows). (B) Two days after left decompressive craniectomy with persistent generalized cerebral edema and interval resolution of the midline shift and signs of uncal herniation, and drainage of the SDH. (C) Progression of cerebral edema with complete absence of gray–white matter differentiation.

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  Figure 2:. Additional Images of non-contrast CT head imaging 2 hours after the patient’s injury (column A), 2 days post-injury (column B), and 3 days post-injury (column C). There is initial generalized cerebral edema with early midline shift and a small left-sided SDH. The progression of cerebral edema and loss of gray–white matter differentiation, despite surgical and medical intervention including craniectomy, can be seen.

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  Figure 3:. Proposed mechanisms of malignant brain edema in children and youth with concussion or mild traumatic brain injury. See text for explanation.1,9