Boxing's deadly threat

Liz Hunt, Medical Correspondent, on how a succession of blows can cause terrible brain damage

Boxers risk two types of injuries; the slow deterioration of brain function resulting from hundreds of punches over many years, or the single, devastating, injury suffered by Gerald McClellan, which tears one or more of the delicate bridging veins between the skull and brain.

This usually follows a "rotational" blow, such as a hook, which moves both the skull and the brain. But the brain, suspended in a pool of fluid, moves after the skull moves, which leads to stretching and tearing of the veins and bleeding into the space between the brain tissue and the dura, a tough, protective membrane, which covers it.

According to John Sutcliffe, the consultant neurosurgeon who operated on McClellan a large clot forms which expands as further blows aggravate the bleeding. McClellan is estimated to have taken at least 70 blows to the head during the fight. "A critical point is reached, usually when the size of the clot is great enough to compress the bleeding vessel and stem the flow," Sutcliffe said. "Unfortunately, the brain also becomes compressed, and this [without intervention] can cause drowsiness, weakness, coma, and ultimately death."

Sutcliffe said that it was too soon to say what long-term effects of the injury might be, but that the boxer's chances of survival had been maximised by the "the best possible medical care".

The prognosis for this type of injury is related to the degree of consciousness before medical intervention. When McClellan arrived in casualty at 10.37pm on Saturday night he had been conscious and talking, Sutcliffe said. "I spoke to Gerald when he arrived. He said he had a headache all over his head but he was going to be all right. But then he deteriorated very quickly, becoming drowsy and vomiting."

Routinely a brain scan is carried out before surgery , but McClellan's condition meant he had to be ventilated and rushed to theatre first. "Any delay could have caused his death," Sutcliffe said. By midnight McClellan was in theatre undergoing an operation to remove a "significant" clot pressing on the right side of his brain and partially covering the right frontal, temporal and parietal lobes.

"We removed a small window in the skull, went in and took out the clot," Sutcliffe said. "Everything went very well in theatre. The operation took about an hour." A pressure monitor was left inside McClellan's skull to gauge brain pressure. There was some initial difficulty in maintaining normal pressure yesterday afternoon but "so far we appear to be winning the fight".