Critical Care Registered Nurse (CCRN) Practice Exam

What is a major risk associated with second impact syndrome in athletes?

1. Cerebral edema

2. Severe headache

3. Increased levels of glutamate neurotransmitter

4. Chronic pain syndrome

The correct answer is: Increased levels of glutamate neurotransmitter

Second impact syndrome is a critical condition that occurs when an athlete sustains a second concussion before fully recovering from a previous one. The primary risk associated with this syndrome is the rapid swelling of the brain, which is primarily driven by the pathophysiological processes activated in response to the second injury. One key element in this process is the change in levels of neurotransmitters, particularly glutamate. When a second concussion occurs, the brain's cellular environment becomes destabilized. This leads to excessive release of glutamate, an excitatory neurotransmitter. Elevated levels of glutamate can result in cytotoxic edema due to increased neuronal excitability and subsequent cell damage. This cascade of events can significantly contribute to the development of cerebral edema, which is a hallmark of second impact syndrome. Understanding that increased levels of glutamate play a central role in the worsening of brain injury after a second impact highlights the importance of adequate recovery time before an athlete returns to play after a concussion. While other symptoms and complications may arise, such as severe headaches, chronic pain, or edema, the direct link between the neurochemical changes and the critical risk of second impact syndrome underscores the relevance of glutamate levels in this context.