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Boxing Brain Injury (Punch Drunk Syndrome)

Impact has been implicated as a cofactor in the genesis of a number of progressive degenerative diseases (Strich 1976): dementia of Alzheimer's type (Hollander and Strich 1970), Pick's disease (Kosaka et al. 1982), Parkinson's disease (Grimberg 1934), amyotrophic lateral sclerosis and Creutzfeldt-Jakob disease (Behrmann et al. 1962). The inner and outer atrophies as well as the neuronal loss are thought to result from single or repeated episodes of subarach-noid hemorrhage.

Of special interest in this regard is the examination of the brains of former boxers, both amateur and professional, who have suffered repeated knock-outs. They are especially likely to develop both neurological symptoms and progressive dementia (Corsellis 1989) years after the last boxing-related traumatic event. A

Amateur Brain Surgery

Fig. 9.28a-d. Vascular lesions near mechanically caused hemor- arterial vessel (Prussian blue reaction, magnification X300); d an-rhages. a, b Intravasal fibrin precipitation (a H&E, magnification giostenosis of an artery within a posttraumatic cyst (van Gieson X100; b PAS, magnification Xl,000); c thrombotic occlusion of an stain, magnification X300)

Fig. 9.28a-d. Vascular lesions near mechanically caused hemor- arterial vessel (Prussian blue reaction, magnification X300); d an-rhages. a, b Intravasal fibrin precipitation (a H&E, magnification giostenosis of an artery within a posttraumatic cyst (van Gieson X100; b PAS, magnification Xl,000); c thrombotic occlusion of an stain, magnification X300)

detailed examination of 15 brains of boxers (Corsellis et al. 1973) revealed conspicuous changes in the septum pellucidum with enlargement of the cavum and fenestration of the interventricular septum. In a few cases the adjacent fornices and corpus callosum were thinned, there was a loss of nerve cells in the cerebellum, degeneration of the substantia nigra, and numerous neurofibrils in the nerve cells of the cerebral cortex and brain stem. Senile plaques were almost entirely lacking. A subsequent reexamination of the same 15 brains confirmed the presence of amyloid-beta protein (P-A4-amyloid) in the form of diffuse senile plaques in the cortex, revealing a close resemblance to dementia of Alzheimer's type (Roberts et al. 1990a, b; Tokuda et al. 1991; Gentleman et al. 1992).

The new imaging techniques allow one to visualize preclinical signs of chronic, repetitive head blows. Performing diffusion-weighted imaging in 24 boxers, Zhang and his team (2003) measured the diffusion values. This team stated that the values in the boxer group were significantly higher than those measured in the control group. The most common MR finding in the boxer group was a volume loss inappropriate to the age followed by cavum pellucidum, subcortical white matter disease, and periventricular white matter disease. These global findings can exist even when routine MR findings are normal.

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