SUMMARY Detailed neurological examinations, EEG and CT scans of the head were performed on 10 professional boxers aged 20 to 31 years shortly after being knocked-out. Intracerebral and subdural haematomas were not suspected or discovered. However, CT scans revealed cerebral atrophy in five of the boxers; this finding was most common in the boxers with the most bouts. The possible relationship of these findings to the chronic encephalopathy of boxers is discussed.Six North American professional boxers have died in the past year from injuries sustained in the ring. The Associated Press reports 330 boxing fatalities since 1945.1 In response to these deaths, there have been calls to ban boxing or at least institute stricter medical controls to prevent serious injury. Since most boxing deaths are due to acute subdural haematomas and other brain injuries,2 we initiated this study of the effects of boxing on the brain. The goals of our study are twofold (1) to determine if CT scanning of the head can contribute to the assessment of boxers' conditions after knockouts and (2) to correlate the results of neurological examination, electroencephalography, and CT scanning in these fighters. Materials and methodsTen active professional boxers who were knocked out in bouts, or were judged by a ringside physician to have sustained significant head trauma in a technical knockout have been included. A "knock-out" occurs when a boxer is knocked to the canvas and is unable to regain erect posture within 10 seconds. Information about the

In brief: Over a two-year period, we reviewed all acute boxing injuries among professional boxers statewide (484 the first year, 422 the second year). During the study period, the boxers fought 3,110 rounds and incurred 376 injuries (262 craniocerebral injuries, 114 other injuries), ie, they incurred 1.2 injuries per 10 rounds fought (0.8 craniocerebral, 0.4 others). Only four boxers required immediate neurological evaluation at a hospital after a fight; one of the four died as a result of bilateral subdural hematomas. Facial lacerations were the most common other type of injury (66 cases), followed by hand and eye injuries (8 cases each). The authors suggest that severe, acute neurological injuries are rare in professional boxing when strict medical supervision is present. However, they caution that their findings should not be used to draw inferences about the development of chronic neurological injuries among professional boxers.

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In brief: A 22-year-old professional boxer suffered a brain contusion associated with uncal herniation and cervical spine fracture in the ring. Unlike most catastrophic acute brain injuries in boxing, this one had a relatively favorable outcome. The authors discuss the role of emergency medical services in minimizing brain injury in boxing and the treatment of acute head trauma.