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Courtesy the Lehe family.
Cody Lehe, now 23, had a clear CT scan after a concussion in a football game in 2006. But a second hit a week later left him with devastating injuries and changed how some doctors think about the condition known as second-impact syndrome. He's shown with his parents, Becky and Dale Lehe.
Cody Lehe was still having headaches sustained from a concussion several days earlier at a high school football game. But when his CT scan came back normal, the 17-year-old figured it was OK to play.
Five days after the helmet-to-helmet collision that the Brookston, Ind., teen described as "the hardest I've been hit in my whole life," he was back on the field practicing with his teammates. The Frontier High School Falcons were heading for the 2006 sectional finals and, as team captain, Lehe was determined to be there.
But in the fourth drill of the day, Lehe was hit once again and knocked to the ground. As he slowly pulled himself back onto his feet, the teen told a teammate that his head hurt, but he was OK.
Several plays later, though, Lehe dropped to one knee, dizzy, his legs numb. Then he collapsed, his body shaking with seizures.
He was rushed to the emergency room, where doctors discovered that the pressure in his brain was dangerously high. They reduced the pressure, but the damage was already done.
Six years later, Cody Lehe, now 23, cannot walk unassisted and gets around most of the time in a wheelchair. His short-term memory is shot. His plans for college have been put on hold -- perhaps forever.
Lehe is one of the latest victims of a rare injury known as “second-impact syndrome,” or SIS, which can occur when an athlete suffers a jolt to the head too soon after an earlier concussion. Experts say that if the brain doesn’t have enough time to recover from the initial concussion, a second one can have a devastating, often fatal, effect -- even when the second jolt is no more than a light bump.
The second hit causes the brain to swell catastrophically, but it’s the first injury, experts say, that makes the player a walking time bomb.
There have been many reports of second-impact syndrome over the past few decades. But what made Lehe the focus of a new case study, published in the latest issue of the Journal of Neurosurgery: Pediatrics, is that the teen had a CT scan after the first hit -- and it came back clean.
“The thing that pushed us to publish this case report was the imaging we had,” says Dr. Michael Turner a neurosurgeon at Goodman Campbell Brain and Spine, a center at the Indiana School of Medicine.
“The most important thing here is that a normal CT scan does not clear you for contact," added Turner, who worked on the study. He hopes the paper will draw the public’s attention once again to the dangers of returning to play too soon.
Experts estimate that more than a million and a half boys play football in U.S. secondary schools and three million play in organized youth leagues each year. Many players get concussions, but nobody knows the true number because players often dismiss head injuries as "dings" and "bell-ringers."
Second-impact syndrome appears to be relatively rare. The Centers for Disease Control and Prevention documented 17 deaths from the condition between 1992 and 1995 in a report that cautioned that those figures could be an underestimate.
A 2007 study in the American Journal of Sports Medicine found 94 incidents of severe football head injuries in high school and college players reported from 1989 through 2002. Nearly 60 percent of the players had a history of previous head injury and more than 70 percent occurred in the same season as the catastrophic injury, the report found. Nine percent of those players died and more than 50 percent suffered permanent neurological injuries.
Although SIS is rare, it is always devastating. Victims who don’t die are left with life-altering brain injuries.
Christine's Photography
Cody Lehe, shown here in 2006, was captain of his high school football team. A second hit after a concussion left him with disabling injuries.
Until Cody’s catastrophic injury, the Lehe family had never heard of second-impact syndrome. They weren’t even convinced that the teen actually had a concussion after the initial helmet-to-helmet hit. Back then, many parents and coaches believed that the signs of a “true” concussion included losing consciousness, blurred vision and vomiting, recalled Cody’s mom, Becky Lehe. Cody had none of those symptoms.
Although Cody was still having excruciating headaches, that clear CT scan gave the teen and his family a false sense of security. And Cody desperately wanted to play.
“He said, ‘I’ve had (headaches) before,” Becky Lehe says. “And if my CT scan says I’m OK, I’m going to keep playing.”
The new case study offers an important piece of information, says Dr. Robert Harbaugh, the researcher who co-authored the Journal of the American Medical Association paper back in 1984 that described second-impact syndrome -- and gave it its name.
“One of the things we postulated back in 1984 was that since athletes so often deny symptoms, including headache, it might make sense to have some type of brain imaging before they could go back to play,” says Harbaugh, a professor and director of the Institute for Neurosciences at Penn State University. “This says that even if imaging was done, it wouldn’t make any difference.”
Parents and athletes -- especially young ones -- need to take every jolt to the head seriously, says David Hovda, a professor of neurosurgery and molecular and medical pharmacology at the University of California, Los Angeles, and director of the UCLA Brain Injury Research Center.
Every reported case of second-impact syndrome has occurred in young people, Hovda says. And that’s because young brains are still maturing. And one of the big differences between the growing brain and a mature one is that it doesn’t have much room to accommodate swelling. So while an NFL player’s brain can survive some swelling without catastrophic consequences, young brains sometimes can’t.
One of the theories that might explain what happens in second-impact syndrome involves swollen blood vessels, Hovda says. The idea is that after the second hit, the blood vessel walls become less stiff. So, they expand, like a garden hose that becomes fatter as it ages. If enough blood vessels swell, it makes the brain bigger, squashing tissue up against the skull.
So does that mean kids shouldn’t play contact sports? No, says Hovda.
“I’d tell parents to allow their children to play sports, even sports that have contact,” Hovda says. “But be aware that as in any activity there are risks, and the risks of concussion in contact sports are higher than in others.
“When the signs and symptoms of concussion are evident, great caution should be employed before making a decision to return to play. And this decision should be made by a physician who is not affiliated with the team or the school and who has training in concussion management.”
That’s a message that Becky Lehe hopes will resonate with parents reading about her son.
“Cody’s life was spared,” she says. “And we think that part of the reason was so that he could help prevent someone from dying.”
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Leave a Comment:
Thanks for publishing this story in that it may make some parents re-think football for young children and even high school. As a parent of a freshman in a small town that never played football before, a lot of the boys are asked to play if they have any athletic skills. Unfortunately my son sat out final half of the season for mono which is a virus. It also is dangerous to play any contact sport when your diagnosed with mono and your spleen can become enlarged and burst at a moments notice. So needless to say he sat out the remainder of the season and will probably not want to play next year. After reading this story on concussions again, I know I will only ask him once. If he doesn't want to play, fine with me, subject dropped. Teenagers and children are not stupid and parents need to let them know of the risk with concussions and let them decide if they want to play the sport. To many parents I know tell them oh yes you will play. I wonder how they would feel if the worst happened to their child that got a concussion and then became paralyzed or worse yet death? Concussions are serious and this boy should have never been allowed to play while still having headaches. Apparently the doctor did not know and clear him properly, or the doctor could be in for a lawsuit if he willingly knew and then released the boy to return for playing. I know here in Illinois this past fall seen a concussion law go into effect that coaches, schools, doctors, and players must follow. I am sure it is to prevent lawsuits against school districts, but more importantly a player should not return no matter what his position or school team record in the sport unless he is 100% back to normal and that may mean several tests to confirm. The best thing to do is always listen to your body, if something doesn't feel right or is not normal, then it probably isn't and warrants further testing or just rest for several weeks. This boy is very lucky to be alive, but it could have been prevented too if the parents and coach has been stern in telling him no if he has headaches period he cannot play. Eventually football may be completely banned. but I doubt it. I only say that because look at the suicides in previous players that hae had concussions in the past. There may not really be a link there, but we all know that constant hits to the head is not normal and dangerous. Everytime this happens in the NFL, I know that is what they are thinking and talking about and it may just be a matter of time when scientist and doctors can make that fatal link. I hope Cody keeps trying and doesn't give upon getting his story across. Just know that there will be parents and students that decide not to play the game which is ok because we only get to live once.
It is truly sad what happened to this boy. I hope that others who read this will take heed and listen to their bodies. doctors do not know everything. Medical science is not all knowing. I was blessed early in life with an extreme awareness of my own body's condition. Often, even as young as 8 years old, I could walk into a doctor's office and tell them exactly what was wrong with me and what the proper treatment was. I could do that right up to the moment when my body was irrevocably damaged in an auto accident. The accident ruptured 3 disks in my neck and completely changed the way my entire body transmitted information to my brain. I now have to learn to re-interpret the information that is sent to my brain...especially pain. I am in constant pain but I have to verify if I have a new injury or if I am feeling pain from the former injury. The doctors took 6 months to diagnose me and a big part of that was that I couldn't tell them what was happening in my own body. If I had been playing a contact sport and been cleared to play after my crash then it is likely that I would have either been paralyzed or died. Lucky for me that I didn't have any serious falls or any other type of incident that would have caused more damage. I can still walk, talk, and complete any task that does not require lifting items over 15 lbs. Of course I lost my job(restaurant manager) and can not work in the industry that I have spent 23 years in. The point is that the doctors never found out what was wrong until 6 months after the accident and only then because of an MRI which they admitted was a shot in the dark. Beware injuries people and listen to your body. You know better than anybody when something is wrong.
Ct scans can detect damage obscured by edema within 24-72 hours, because the edema or swelling obscures the damage. CT is also damaging ionizing radiation so is the contrast, MRI contrast is worse. it' metal GADOLINIUM with and FDA black boxed warning. Stay away. Simple head xray can detect pituatary micro adenomas, does that tell you something? from 1980's, xray can detect a pituitary tumor. better start those antioxidants, ASAP and glutathione, N Acetyl Cysteine, no L.
nonsense youve posted many times before
Blaming the game of football is stupid. The game isn't more violent, our awareness has gone up. The game of football didn't cause this, a lack of understanding the injury did.
People still subscribe to 'no blood, no foul'. Brain injuries are far more subtle and infinitely more serious. This incident highlights the fact that our knowledge and understanding of brain injuries at all levels and how to treat them is sorely lacking.
His parents are incredibly lucky to still have their child despite the fact that they, and the medical team, and the coaches, said he could play when he was still experiencing "excruciating headaches."
I'd like to believe that if that were the case, I'd say "ABSOLUTELY NOT!" as a parent. The coaches don't care, the doctors rely to much on science, kids think they are invincible at that age, so it rests on the parents to say "How about we don't play until we FULLY recover from the last time we played, hmmm? I don't care what everyone else says, I'm saying NO."
And they are LUCKY because the second hit happened in practice. Practice hits are not as hard as game hits. Had that been a game, he might not be here.
As a result of a head-on auto wreck back in the 50s (before safe carseats) I was thrown head first into the dashboard which resulted in a severe concussion, thankfully not death. I was also 3yo at the time. I stopped talking for a year, but my dad felt that after I started talking again I was not as outgoing as I was before the concussion and the long stay in the hospital. Since then, and before the age of 9: I fell down a flight of wooden steps a number of times and was hit in the head with a 2x4; there were a lot of tears, but no trip to the ER for those. This was just "normal" playing back then. Medicine back then was about treating vaccinations, illnesses and treating accident victims brought in by an ambulance. Parents didn't have the money to bring the kids into the ER for every playtime accident, and technological testing wasn't there yet, otherwise we would have known about this a long time ago.
Even though Cody Lehe and others survived, the quality of life has changed, some players for the worst.
Why is the NFL changing the rules?
The kids are well aware of high degree of violence in football and less and less are interested in wanting to play so the participation base is shrinking.
Not to mention the law suits.
The fact of the matter is, football is a contact sport. This means that people get hurt as a result. This means that kids from an early age need to be taught not to hide injuries or not to make light of injuries. Most concussions do not result in kids staggering around, but are much more subtle.
In America, the only difference between the religious right and the Taliban is that the religious right seeks to dehumanize through "the law" instead of kill.
The only difference between America and Rome is that our gladiators aren't killed by knives and swords and clubs while in the ring.
But make no mistake, in 2013, there will be at least one human being killed in a ring by another human being, in front of the crowd, and once we as a society accept that too as a tragic consequence of "athletic endeavor", trust me brothers and sisters, it won't be the "christians" fed to the lions, but Jesus Christ will be the first thrown into the pit..
*facepalm*
Good. Can't happen soon enough.
Football has become an extremely violent sport. One concussion should side line a young player permanently! Find another less violent sport to play. Professional NFL players get paid big bucks and have excellent medical attention and are adults. If they choose to endanger themselves is one thing, but a teen in high school or even college, is quite another.
First I blame the parents who usually are trying to live through their kids by allowing him to play again, and encouraging him to play in the first place. Then the coach for not having any more sense than the parents - and just using him as a body. Then the Doctors who usually take 14.5 minutes to examaine AND explain things (the other .5 minute so they can run to the next room to make their quota for more $), greedy profession that it has now become. Then the high school for not having strict guidlines in sport injuries and prevention of them in the first place. Then the refs who look the other way with contact sports and don't call what they should. NOT the kid, who at this age can't imagine life past tomorrow. Pathetic what they all did to him isn't it?
Those of us in the field of neurotrauma have been well aware of this syndrome for decades. The piece references the literature dating back to 1984. Have I seen this in my career, yes. Often, no. But, we always take the time to discuss with any patient who has sustained a concussion the potential ramifications of a second hit--especially our young patients. The up side is that attention is being drawn to the long term impact of repetitive brain injury (a concussion is a brain injury) and things are slowly changing. However, because this syndrome is rather rare, most young people and their parents are willing to take a chance especially when a potential athletic scholarship and acolades are on the line. I don't judge. I do hold a hand and work my heart out if the worst case happens. Should we ban contact sports? No. As with anything, we need to take what we have learned and try our best to make things safer. Heck, who wants to go through life wearing bubble wrap?
To 7.62x39mm
Look at it this way he is collecting his parents SSI/Disability benefits early. He may not have paid into the pot but his parents have I am sure, so look at it that way. Don't lump all people into the same pool. They are not non-working welfare parents. They have or had jobs. I am sure you have received the same benefits papers ever so often as we all have, take the time to look at it. No all cases are not the same but this looks like a family that have contributed to the POT of benefits so he is using their benefits look at it as that.
Football is too risky for developing brains. Any moron can understand this but it doesn't stop anyone from the obvious. Football should be reexamined as a sport. I had football contact that nearly killed me. Football is for those that want to risk everything just to be able to take out their aggression. Football is an institution in the US. Either they redesign the helmet or keep kids out of danger. It couldn't be more simple. Look at the pros. They deal with the head injuries later in life. Was it worth it?
Football isn't going anywhere. Nor should it.
I hate to have people who never played or coached football making decisions on football. If coached correctly, people shouldn't be hitting with heads and if a kid has a concussion he shouldn't be playing until he or she gets cleared to play a doctor. also think of all the people who play high school sports who never get injured. against people who do. i bet there are overwhelmingly more people who dont get hurt. so before we start the witch hunt know the facts.
Allowing him back on the practice field so soon was the biggest mistake. Coaches put pressure on kids to get back as soon as possible. A common ploy used is to dress the kid out in "whites" and let him watch other kids start in front of him. Then, he gets "motivated" to get back on the practice field. The end game is that injuries become exacerbated when they don't heal.
It's not just football. My son sustained a concussion during a soccer game. The coach relied on his asst coach to take care of him and then they sent him back in the game. When the head coach found out we had taken son to hospital based on advice from doctor parents in the audience and found out it was a concussion he was livid. He apologized to me multiple times and the asst coach was in major trouble. He didn't let son play for over two weeks - which was the right thing to do. Coaches must be vigilant and know what is going on with their players - and then adhere to safety practices. It isn't worth a kid's life - my son still got a soccer scholarship and plays college.
Footballs kill...ban them! Wait...only the assault footballs...the rest can stay.
Are any of you ever going to get tired of this false equivocation non-witty commentary? It was old before you even started...
False equivocation non-witty commentary kills...ban it!
I'm so glad of the ignore feature here. Bye-bye, pelletbrain.
What did the doctors say after the first incident? I know our youngest was cleared to go back to playing by the hs sports person, before we had the appt/opinion of an orthopedic doctor, which made me very unhappy.
The helmet protects the scalp not the brain, without the helmet a blow to the head that would cause a nasty bleeding wound and get a kid benched won't happen. Harm to the brain goes unnoticed, change that.
Put accelerometers in all the kids helmets and connect them all by WiFi so that the intensity of a hit to the head can be monitored in real time with a team PC from the sidelines. Then you tell the kids that the objective is to teach them how to hit hard and safe, with the shoulder not the helmet, because if you cross a certain threshold of intensity of a hit to the helmet, regardless of how you say you feel, you are benched.
Clean up the game or stop letting kids play it
Concussions, without complications, DO NOT nor will they ever show on a CT scan. A CT scan will show bleeding or a fracture but NEVER a concussion. Coaches, players, and parents need to be educated. Know the symptoms, take the ImPACT test both as a baseline and following an injury. After a concussion players MUST be symptom free and pass the ImPACT test prior to light workout, if they remain symptom free then advance to moderate workouts then finally heavy. If symptoms return then return to square 1.
EDUCATE yourselves!!
a concussion is a clinical diagnosis, so of course its not usually seen on imaging. Whether or not this kid had a concussion is not the debate; I think most people agree he did
What is at debate is whether or not he should have returned to play 5 days later. What are the guidelines for this situation? How long must a player sit out after this kind of injury? If you pass the impact, are you guaranteed ready for play?
Those are the tough questions...
I wish there was some way to send this directly to the young man in the article. I had a classmate a few years ago who was completeing his BA. it had taken him over 20 years to attain it. He was in the military and suffered a devasting closed brain injury. He had to learn to walk, talk, feed himself, take care of himself all over again. But he did that and he also got married, had childern and continued his dream of attaining a college degree. It is not impossible. The actree Patricia O'Neal suffered a devasting stroke, couldn't talk or walk. She worked hard with the help of her husband and was able to do both again and act again, (she's John Boy's Mother in the movie, "The Waltons" made years after her stroke.
I hope that those around you are supportive of your recovery. You can do it, the brain is resilent and will find a way to function as fully as you need it to, if you just push it.
I hope that they will consider giving the teen megadoses of omega three's. There has been some evidence that omega three's can help the brain to repair damage. If it was my child, it is certainly something that I would be trying.
So what's next? The War on Contact Sports? Life is full of risks.
As somebody with damage done this is no joke. My short term memory sucks and it makes work difficult. (Everybody starts to hate you really quick.) You find yourself creating a regimen of tasks to try and keep your mind sharp. Of course mine was from being attacked by a certain deranged individual and not from a sports injury.