Head injuries in MMA

This article was written by our student Danella Eliasov from Johannesburg, South Africa. She is a doctor and explains in simple language all you need to know about head injuries. The article was originally published at the South African website Pretty Tuff (http://prettytuff.co.za) and is reproduced here with her consent.

HEAD INJURIES FOR DUMMIES

by DANELLA ELIASOV

I am a qualified doctor now specializing in psychiatry. I am currently working in the department of neurology at Chris Hani Baragwanath hospital in Soweto. I am also an MMA fighter and a BJJ enthusiast.

Recent events in the MMA community have highlighted the issue of traumatic brain injury. This article serves to explain what happens to the brain after injury and refers to brain injuries in general. At the end, I make some suggestions about preventing head injuries. This is by no means a comprehensive discussion of the topic. I will not discuss any specific patients or details pertaining to recent events. The brain is a pretty complicated organ so I will attempt to explain as simply as possible. This is for both your benefit and mine as I have been studying brains for about 13 years and I still don’t know enough about them!

Traumatic brain injuries range from mild concussion (which resolves on its own without lasting damage), to more severe injuries resulting in permanent damage and disability, to death. The result of the injury depends on many factors. Different areas in the brain control different functions. For example, there are areas for speech, memory, movement, eyesight etc. The brainstem is an area that controls basic vital functions such as breathing, heart rate and temperature. Therefore, the location of the injury plays a role in the outcome. The health status of the patient at the time of the injury also plays a role. For example: a young, healthy person has a better prognosis than an elderly person with many other medical problems. Drugs, medication and alcohol can also play a role by making the brain more susceptible to injury.

In contact sports, injuries to the brain may occur as a result of a blow to the head, which could result in bleeding (haemorrhage) and/or bruising (contusion). A process called “diffuse axonal injury” may also occur where the force of the blow causes rotation of the brain and tearing and shearing of the brain cells (neurons).

A common result of severe brain injury is a bleed just beneath his skull bone. As the blood seeps into the cranial cavity, pressure builds up and compresses the brain causing swelling and death/damage to the brain itself. This pressure needs to be relieved as soon as possible to prevent further damage. If this is delayed, the brain swells and is pushed out of the skull. This is known as ‘coning’. The brain stem (which controls vital functions such as breathing, heart rate and temperature) may be damaged and the chances of the patient surviving and breathing without life support are slim.

Doctors manage brain injuries by attempting to minimize the damage caused. If the patient is unconscious, we may need to “intubate” them. This involves inserting a breathing tube attached to a ventilator, which helps the patient to breathe until they recover. We may also give drugs to minimize brain swelling. At the hospital, a brain scan is done. This shows us the extent and location of the damage. The neurosurgeon may then decide to operate in order to drain the blood or relieve swelling of the brain. Not all patients need surgery so this depends on what the brain scan shows.

Extensive damage may occur and the patient may be declared “brain dead”. This is quite a complicated process and requires specialists to perform specific tests on the patient. A patient who is “brain dead” may remain on life support, which keeps them breathing with a beating heart. At this point, according to law and religious doctrine, they are still alive. The decision to continue or stop life support will be made by the treating medical team in conjunction with the patient’s family. If the patient dies, they are “certified” dead by a doctor who established that the heart is not beating, the patient is not breathing and the brain is not functioning.

Brains are rather unpredictable things. They sometimes make amazing recoveries and surprise us all. Brains are ‘plastic’, this means they have a way of changing and compensating for damaged areas. It can take 6 months to a year for the brain to fully recover from injury. Thus, rehabilitation is a slow and frustrating process for the patient and family. Patients who sustain brain injuries may recover fully, partially, or not at all. Some patients are left with persisting memory loss, others manifest a change in personality or may have paralyzed limbs. Rehabilitation involves a team of doctors, physiotherapists, speech therapists and psychologists who work together to aid recovery.

Thus, brain injuries are complex, unpredictable entities, which are sometimes difficult to treat. Thus prevention is always better than cure. Wearing seat belts in cars, helmets when riding bikes, not drinking and driving etc are possible preventative measures. In contact sports, head injuries are not always preventable but occur relatively infrequently.

More studies are needed on ways to prevent head injuries in combat sports. Some suggestions I can make are as follows:

People with previous head injuries or epilepsy should avoid contact sports. Take adequate time off between fights and limit full contact sparing sessions where possible. Fighters should not take fights if they are ill, injured or have sustained a recent concussion. Fighters who cut weight need to exercise caution in doing so and make sure they are adequately hydrated before the fight. Discuss any supplements, drugs or medication you are taking with your doctor if you plan on fighting. Some sports medicine centers offer concussion testing and management programs, which can be very helpful in guiding your return to training after a concussion. If you sustain a blow to the head watch out for warning signs and symptoms and seek medical help if you experience any of the following: nausea, vomiting, worsening headache, confusion, slurred speech, drowsiness, visual problems.

I hope this little article helps you understand a bit more about head injuries. Bear in mind, us doctors are pretty clueless when it comes to the brain. We don’t fully understand how it works and why and we are discovering new things about the fascinating brain all the time. You only have one brain so look after it!

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