- Malignant cerebral edema due to a second head injury while still symptomatic from an earlier one.
- Mech
- Classically, the athlete walks off the field under their own power after the second injury, → deteriorate to coma within 1–5 minutes
- Due to vascular engorgement, develops malignant cerebral edema that is refractory to all treatment and progresses to herniation.
- Mortality: 50–100%.
- Risk of SIS is high after 10 days post injury
- Although it is contended that SIS is rare (if it exists at all) and may be overdiagnosed, its apparent predilection for teens and children still warrants extra precaution following concussion.
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