Boxing injuries: neurologic, radiologic, and neuropsychologic evaluation.

Boxing is an endeavor that may have to be re-evaluated in the coming years as to whether it should be designated as a sport. It is the only "sport" in which victory is determined by the amount of physical damage done to the opponent. We have presented the largest number of professional and amateur boxers (58) evaluated by various modern diagnostic modalities and have unequivocally demonstrated the deleterious effects of boxing upon the brain. There have been few, if any, meaningful actions taken by the promoters of boxing to correct the conditions under which boxers are subjected to physical abuse. Recommendations regarding the creation of a National Board of Boxing to supervise this "sport" have not been heeded. Suggested safeguards for the boxer, including mandatory medical and boxing history records (passports), use of headgear and approved safe boxing gloves, avoiding blows to the head, improved boxing ring floors, mandatory neurologic examinations, and more competent physicians at ringsides making medical decisions, have essentially not been implemented. The suggestions that mandatory computed tomograms at various stages in a boxer's career be used to determine possible changes of atrophy have not been followed, even when the CT scans have been made available at no cost to the boxers. The effective use of neuropsychologic evaluation, even when offered at no cost, has also been denied. The established medical injuries due to boxing and the lack of any sustained and significant efforts on the part of organized boxing create an atmosphere that is conducive to following the call for the consideration of a ban of boxing.

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.

Neurological and CT evaluation of knocked-out boxers.

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.