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BACKGROUND: Catastrophic brain injuries among high school football players can be devastating, resulting in subdural hemorrhages. This is particularly true among individuals with repeated brain injuries.
CASE REPORT: A 14-year-old male presented with a helmet-to-helmet collision and a loss of consciousness. According to the Clinical Academy of Neurology concussion grading system, this patient had a grade 3 concussion. He had a subdural bleed with a 6-mm midline shift that did not require surgery. Two years later, the same patient presented with a second helmet-to-helmet collision. He suffered a grade 2 concussion with a subdural bleed and an 8–9-mm midline shift that required a craniotomy and evacuation. Intraoperatively, the dura was thicker and more vascular than normal, possibly reflecting consequences of the previous subdural hematoma.
CONCLUSIONS: With a 2-year interval between concussions, the patient exceeded the average time for cognitive and symptom recovery. However, his second head injury resulted in a lower-grade concussion but a more severe subdural hemorrhage. The scientific community must decide if former bridging vein injury represents a higher risk for subsequent head injuries. There is an established timeline for short-term recovery from concussions both cognitively and symptomatically; however, there must be a greater focus on the long-term recovery of the brain and its vessels.

Keywords: Brain Concussion, Craniotomy, Football, Hematoma, Subdural