SECOND IMPACT SYNDROME: Sports Confront Consequences of Concussions.

• Author: TYLER, JEFFREY H.

EACH YEAR, more than 300,000 people suffer brain injuries while playing a sport, most of which are concussions. In football slang, players say a team member got "dinged" or had his "bell rung." Boxers who get stunned by a blow to the head may be described as "punch-drunk." What an athlete experiences during a concussion is actually a temporary, trauma-induced alteration in mental status. Many concussions occur without the individual ever losing consciousness, but researchers have determined that even a seemingly minor "bell-ringing" in the course of play can cause lasting physical and mental injury, or even result in death.

Sports concussions have become more publicized recently, as celebrity athletes announce early retirement, and tragic accidents and major lawsuits in sports are covered more closely by the media. Nevertheless, such injuries persist across the country in recreational and school sports where clear preventive guidelines for managing head injuries are slow to reach the field.

Studies released by the American Academy of Neurology and the National Brain Injury Association indicate that 10% of college and 20% of high school football players receive brain injuries in any given season. Most of these are transitory, but those who suffer a first concussion may be four times more likely to suffer a second than someone who has never had one.

Researchers have identified a serious series of brain injury events they call second impact syndrome (SIS). According to James P. Kelly, director of the Brain Injury Program at the Rehabilitation Institute of Chicago, SIS occurs when an athlete suffers a mild head injury, returns to play too soon, and suffers what may be a relatively minor second hit before the brain has fully healed. If the second injury occurs while the individual still has symptoms from the first impact, the result can be a rapid, catastrophic increase in pressure within the brain. Effects of SIS include physical paralysis, mental disabilities, and epilepsy. Death can occur approximately 50% of the time.

"SIS can affect anyone exposed to a mild or moderate concussion; there's no age discrimination," notes Kelly. "But it seems to affect teenagers more often because they are the least likely to report their injuries or take the time to recover from a concussion when they do get hurt. They head back into the game too soon, not fully aware of the risks they are taking."

It is unclear how many cases of SIS occur each year in the U.S. because the first injury is not usually reported to a physician. The Center for Disease Control counted 17 cases of SIS between 1992 and 1995, but experts believe that the tree numbers are higher. Most cases involve male adolescents or young adults, who received a second catastrophic concussion while participating in football, boxing, ice hockey, or snow skiing.

The case of Brandon Schultz, a high school football player from Anacortes, Wash., is a prime example of the devastating consequences of SIS. Schultz's recently resolved lawsuit against the Anacortes School District is the first of its kind to argue that a school district was negligent for failing to prevent an SIS injury.

On Oct. 25, 1993, just two weeks after his 16th birthday, Schultz's life changed forever when he made a tackle during the final seconds of the...