The impact of head trauma on society

In this address I shall discuss head trauma from an angle which may be unusual for neuroscientists. Our preoccupations are diagnostic challenges and management problems, but that which we experience at the bedside is only a narrow segment of a continuum which started with trauma somewhere in a war, on the road, at home, on the football field, in the boxing ring, and in many other distinct locations. When our role is over, there are only three places where head trauma victims can be found; in cemeteries, where every year, 5,000 new graves are made to accommodate fatal head injuries in Canada; in chronic hospitals, which are already overloaded with victims of various insults to the brain, and, of course, within society, which accepts the fully recovered or tolerates the subtle and not so subtle consequences of so-called ‘minor’ head injuries.

Don't ban amateur boxing in Canada

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Brain damage in modern boxers

Eighteen former and active boxers underwent neurological examination, EEG, computed tomographic scan of the brain, and neuropsychological testing. Eighty-seven percent of the professional boxers had definite evidence of brain damage. All the boxers had abnormal results on at least one of the neuropsychological tests. Brain damage is a frequent result of a career in professional boxing.

Should the sport of boxing be banned in Canada?

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Brain and cervical spine injuries occurring during organized sports activities in children and adolescents

Eighty per cent of severe sports-related central nervous system trauma occurs as a result of collision sports, chiefly American football and rugby union football, followed by wrestling and gymnastics. Although serious head injury is uncommon, episodes of concussion are frequent; repeated concussion should be grounds for suggesting that the athlete give up collision sport. American and rugby union football are the sports mainly responsible for cervical spine injury with resultant quadriplegia.

Impacted third molars: a contributing factor in mandibular fractures in contact sports

Studies have shown that the presence of impacted third molars places the mandible at increased risk for fracture. Individuals participating in high contact sports are subject to maxillofacial trauma; therefore, participants with impacted third molars are at increased risk for fractured mandibles. Three cases are reviewed to illustrate this problem.

Risk factors for meningiomas in men in Los Angeles County

A case-control study among men in Los Angeles County was conducted to investigate further the causes of intracranial meningiomas. Meningioma patients and a neighbor of each one were interviewed about past experiences that might be associated with tumor development. Analysis of information from the 105 matched pairs showed an association with meningioma occurrence for various factors relating to head trauma and head X-rays: 1) ever boxed as a sport [odds ratio (OR) = 2.0, P = 0.03], 2) had a serious head injury (OR = 1.9, P = 0.01), and 3) had X-ray treatment to the head before 20 years of age and/or had five or more full mouth dental X-ray series before 1945 (OR = 3.5, P = 0.02). Of the 105 subjects, 72 (69%) had a history of exposure to at least one of these factors.

[Course of treatment of a luxation of the 4th and 5th carpometacarpal joint with hamate involvement]

An uncommon case of a closed dorsal dislocation of the fourth and fifth metacarpal bases associated with a flake fracture of the hamate bone is described because of the rarity of this injury. In order to regain full function, an open reduction was necessary. Stability of the carpometacarpal joints was achieved by osteosynthesis using a Kirschner wire.

Cervical spine fracture in a boxer - a rare but important sporting injury. A case report

Cervical vertebral injuries are rare in boxing. The case of an adult boxer with an isolated vertical fracture of the anterior arch of the atlas is described. The mechanism of injury, clinical presentation, complications and treatment are discussed. Measures to prevent head and neck injury in boxing are discussed.

Boxers--computed tomography, EEG, and neurological evaluation

During the last three years, 40 ex-boxers were examined to determine the effects of boxing in regard to their neurological status and the computed tomographic (CT) appearance of the brain. Thirty-eight of these patients had a CT scan of the brain, and 24 had a complete neurological examination including an EEG. The results demonstrate a significant relationship between the number of bouts fought and CT changes indicating cerebral atrophy. Positive neurological findings were not significantly correlated with the number of bouts. Electroencephalographic abnormalities were significantly correlated with the number of bouts fought. Computed tomography and EEG of the brain should be considered as part of a regular neurological examination for active boxers and, if possible, before and after each match, to detect not only the effects of acute life-threatening brain trauma such as subdural hematomas and brain hemorrhages, but the more subtle and debilitating long-term changes of cerebral atrophy.

Blood creatine kinase isoenzyme BB in boxers

Creatine kinase isoenzyme BB (CK-BB) is found in high concentrations in the brain. Normally concentrations in blood are undetectable or low. Blood concentrations of CK-BB were measured in 16 boxers before and after a fight and in 16 track cyclists before and after a race. Blood CK-BB rose to significantly higher concentrations in the boxers than in the cyclists. The number of blows received to the head was estimated in half the boxers and correlated significantly with the rise in CK-BB. This increase in blood CK-BB may indicate disruption of the blood-brain barrier. This may be one of the mechanisms accounting for brain damage in boxers.

Is chronic brain damage in boxing a hazard of the past?

Of fourteen boxers with a mean age of 31 years who had been Finnish, Scandinavian, or European champions, only one showed deficits in neurological status and he and one other had had episodes of inappropriate behaviour which were attributed to boxing. However, computed tomography revealed pathological findings attributable to brain injury in four of six professional and one of eight amateur boxers. Two of the professionals and four of the amateurs had electroencephalographic abnormalities which may have been caused by brain injury. Twelve of the boxers had psychological test results which suggested brain injury, although only two professionals had definite deviation from normal. The results indicate that modern medical control of boxing cannot prevent chronic brain injuries but may create a dangerous illusion of safety. The only way to prevent brain injuries is to disqualify blows to the head.

CT-scan and EEG findings in professional pugilists: early detection of cerebral atrophy in young boxers

In order to evaluate the possibility of early detection of minimal cerebral damages in the professional boxers, ten young pugilists were submitted to complete neurological examination, EEG recording and CT-scan. Neuroradiological data, electrical patterns and neurological aspects were examined in connection with sporting career of each boxer. Neurological examination was normal in all cases. EEG patterns were considered normal in 3 cases, borderline in 4 cases and pathological in 3 cases. CT-scan was considered normal in 4 cases, borderline in 4 and pathological (showing signs of cerebral atrophy) in 2 cases. A good correlation was found between CT-scan pictures, EEG patterns and sporting career of the boxers: the pugilistis who suffered knockouts had pathological and/or borderline CT-scan and EEGs, while the pugilists who did not experience knockouts during their career showed a normal CT-scan and EEG, independently of the years of activity and number of matches.

Pick's disease and head trauma

This is a clinico-pathological study of the relationship between Pick's disease and head trauma. Seven of our autopsied cases with Pick's disease had clinical histories and/or neuropathological evidence of a head trauma. Two cases showed no pathological evidence of traumatic brain damage, although they had clinical histories of a head trauma. The other five cases had old contusions located chiefly on the frontal and temporal bases. As far as we know, there is no reported case of Pick's disease with old contusions in the literature. Therefore, our five cases are of great importance to the study of the relationship between Pick's atrophic processes and traumatic brain damage. The conclusion of our study is that traumatic brain damage involving the atrophy centers of Pick's disease or the adjacent regions could evoke or intensify Pick's atrophic processes.