Nutrition in Combat Sports

12 Boxing 203
Second impact syndrome
If a boxer receives an initial head injury (e.g., concussion) and returns to play
before all symptoms (headache, dizziness, difficulty in thinking, balance, etc.) clear
and receives again a second head blow, even minor, the second impact syndrome
may occur.
Posttraumatic cerebral swelling occurs due to two proposed pathophysiological
mechanisms. The first is a failure of cerebral autoregulatory mechanisms, followed
by an increased cerebral blood volume. The second mechanism of posttraumatic
brain swelling is due to true cerebral edema. This condition can increase the intracranial
pressure, resulting in brain herniation, and sometimes death. Both of these
mechanisms can occur within hours of head trauma, but typically are seen after
several days.
The prevention of this syndrome is most important: even a mild head injury must
be very carefully examined by the medical doctor. If a boxer has any sign or symptom
of concussion, he should not be allowed to return to competition until symptoms
disappear [8, 9] .
Concussion
Concussion is the most common head injury not only in boxing, but in many other
sports.
Concussion is defined as a complex pathophysiological process affecting the
brain, induced by traumatic biomechanical forces [10] . Several common features
that incorporate clinical, pathological, and biomechanical injury constructs may be
used in defining the nature of a concussive head injury. Concussion may be caused
either by a direct blow to the head, face, neck, or elsewhere on the body with an
“impulsive” force transmitted to the head.
Concussion typically results in the rapid onset of short-lived impairment of
neurological function that resolves spontaneously.
Concussion may result in neuropathological changes, but the acute clinical symptoms
largely reflect a functional disturbance rather than structural injury. Concussion
results in a graded set of clinical syndromes that may or may not involve loss of
consciousness. Resolution of the clinical and cognitive symptoms typically follows a
sequential course.
Concussion is typically associated with grossly normal structural neuroimaging
studies [11] .
Beside the clinical history a sideline evaluation of the boxer, including neurological
assessment and mental status testing, is an essential component of the diagnosis.
In the acute assessment of a concussive injury brief neuropsychological test
batteries that assess attention and memory function have been shown to be practical
and effective [12] .
In the management of the concussion the most important rule is that when a
boxer shows any symptoms or signs of a concussion (Table 12.3 ) return to play
should not be allowed.