An estimated 20% of high school football players suffer concussion during a single season, some have multiple concussions. Often these concussions are not associated with a loss of consciousness. A post concussion syndrome may exist between games and headaches may be noted. Repeat concussion within 1 week was fatal to a 17-year-old player in Colorado. After the second concussion caused by helmet-helmet impact, he fell unconscious and unresponsive and succumbed to a form of "malignant" cerebral edema. There is some evidence that this is a result of intracranial vasodilatation secondary to autoregulatory dysfunction. It is emphasized that concussion can occur without loss of consciousness. Concussion should be defined as a traumatically induced alteration in mental status. The Colorado Medical Society has developed guidelines to prevent such tragedies. JAMA 266:2867, 1991.
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