On March 26th, Nick Blackwell boxed Chris Eubank Jr. at London’s Wembley Arena. The fight was called off in the tenth round due to swelling on Blackwell’s forehead, which was obscuring his vision. Moments later he was transported to a hospital. Once there he was placed in a medically induced coma. He had blood pooling between his brain and skull. The bleed did not require surgery and he awoke from the coma a week later. Shortly after this Blackwell announced his retirement from boxing.
On April 9th, Portuguese mixed-martial-artist Joao Carvalho suffered a traumatic brain injury (TBI) during an unsanctioned fight in Dublin, Ireland. Like Blackwell, he also suffered bleeding from the brain. Carvalho died in hospital two days later.
On September 30th, Mike Towell was TKO’d in the fifth round of a professional boxing bout in Glasgow, Scotland. He was transferred to a hospital where it was discovered he too was bleeding from the brain. He died that same night.
On November 18th, German boxer Eduard Gutknecht lost a unanimous decision to George Groves in London, England. After the fight he collapsed in the locker room, yet another case of a brain bleed. Gutknecht was placed in a medically induced coma and was still in that condition as recently as December 4th.
Brain hematomas (bleeds) occur in two varieties: epidural and subdural. An epidural hematoma is a bleed that occurs between the skull and the outermost layer of the brain (the dura mater). Subdural hematomas are bleeds beneath the dura mater. Both injuries are commonly caused by linear acceleration of the brain within the skull.
“Linear acceleration is when the brain moves at a different rate from the skull,” explained Dr. Tator, a neurosurgeon from Toronto Western Hospital. “[And that causes] bruising of the brain and blood clots in the brain as well, because veins can be torn off during that type of movement to and fro, or front to back, or side to side.”
In as many as 50% of cases involving an epidural hematoma the sufferer feels fine at first, before suddenly falling unconscious. The period in which the sufferer appears symptom free is known as a ‘lucid interval.’
Without a lucid interval, people experiencing brain bleeds may have headaches and/or bouts of confusion that slowly increases in intensity. The Glasgow Coma Scale (GSC) is commonly used to detect brain bleeds, this test includes checking a patient’s eye response to stimuli as well as their verbal and motor skills. A CT or an MRI scan is traditionally used to confirm a diagnosis of a brain bleed.
Bleeds from ruptured veins and arteries either above or below the dura mater put pressure on the brain itself. This pressure can be fatal once it damages delicate brain tissue or causes the brain to herniate. Both epidural and subdural hematomas can be treated with surgical openings of the skull, where blood is removed and pressure on the brain is alleviated.
Because of the subtly of the early symptoms associated with brain bleeds, many fighters have died before a diagnosis or a surgery can be performed.
Currently, an item the size of a house brick is seeking to revolutionize the manner in which we treat brain bleeds. Its creators say it can shred the wait time between injury and diagnosis, and thus get fighters into surgery before it is too late to save them.
In 2013 the US Food and Drug Administration approved the Infrascanner 2000 as a medical device permitted for use in the United States of America. The handheld instrument was invented by the late Dr. Britton Chance of the University of Pennsylvania School of Medicine. It was developed by Dr. Claudia Robertson, Medical Director of the neurosurgical intensive care unit (ICU) at Ben Taub General Hospital in Houston, Texas.
“The unit actually works on a very simple method,” said Roy Bachrach, a former paramedic and current Vice President of Business Development for InfraScan, the makers of Infrascanner 2000.
The device beams near-infrared light into the brain and then measures how much of that light is absorbed. Parts of the brain which are bleeding will absorb more than parts which are not.
“The brain by definition is a symmetrical unit so the right side equals the left side, it’s not completely symmetrical but the components we’re looking for are symmetrical,” said Bachrach. “What we’re doing is comparing the left side of the brain to the right side of the brain, in the same location, and checking for a difference.”
A substantial difference between two opposing parts of the brain means that one of those parts is bleeding. An entire scan of the brain, using this method, takes about two minutes with the device.
It was funded in part by the US Navy. In 2014 200 units were purchased by the US Marine Corps for use in warzones. The device is also in use in approximately 90 other countries, mostly by hospitals and emergency services.
In addition to finding a home in medical centers, ambulances, and the battlefield the Infrascanner 2000, which costs between $12,000 and $15,000 per unit, has started appearing in the world of sports.
The product is owned by the Pittsburgh Steelers and the Miami Dolphins of the National Football League (NFL). It was also purchased by the NFL Head, Neck and Spine Committee. The Russian Sports Agency for Olympic Teams also purchased their own machine, which they deployed at this year’s Rio Summer Olympics.
Combat sports are taking notice too. In October it was reported by Sky News that the British Boxing Board of Control (BBBC) was ‘closely monitoring’ the technology. The Infrascanner 2000 has already been bought by the Russian Martial Arts Association. The south Florida MMA super-camp The Blackzilians - home to many UFC fighters - also owns one of these devices.
Dr. Corey Peacock, the Blackzilians head performance coach, learned of the Infrascanner 2000 through connections with both the Steelers and Dolphins. He believes devices with the capability to almost-instantly diagnose brain bleeds are going to be, “a must have for every high-level MMA gym.”
Dr. Peacock stated that his team uses the Infrascanner 2000 in situations where an athlete has taken contact to the head and has then displayed symptoms that might be consistent with a TBI.
“If head contact was made during a session, we take the cautious approach, scanning all four lobes of the brain,” added Dr. Peacock, who stated that his team uses the machine “nearly twice a month.”
The California State Athletic Commission, which regulates amateur and professional boxing, kickboxing, and mixed-martial arts, has also started using the Infrascanner 2000. They purchased three units almost two years ago, out of the commission’s self-funded neurological fund. CSAC’s commissioner Andy Foster is very happy with the purchase.
“If there’s a piece of technology that exists out there that we can use to improve fighter safety, I think to be good stewards of the money, we should use it so that we’re able to protect the fighters.”
Foster confirmed that the device will be cageside at UFC on FOX 22: VanZant vs. Waterson in Sacramento on December 17th. Foster stated that the Infrascanner is not available at all of California’s boxing and MMA shows because some ringside physicians have opted not to take it. Since the state acquired the devices, Foster estimates that there have been 30 to 40 incidents in which it has been used. Foster is open to buying more units in the future and recommended his counterparts in different states do the same, stating: “I think any commission should look at this tool.”
Top 10 ranked UFC lightweight Michael Johnson, a member of the BlackZilians, would be happy to see this device cageside at all UFC events. “That would be pretty good to see and to have them right after the fight,” said Johnson. “It’s definitely needed, to detect things a lot quicker, and stop things from happening and getting worse.”
UFC welterweight Zak Cummings agreed, “Any time you have that type capability, that kind of technology, and can maybe save a life or save serious brain damage, I’m on board.” Though Cummings is unwavering in his support for having such technology available in the immediate aftermath of a fight, he was not sure if he’d like to see such a machine used during an actual contest. “I wouldn’t want the fight stopped because of a potential for something,” said Cummings. “It would be hard for me to agree with it, although it’s probably for the best.”
Andy Foster was also unsure whether a brain scanner should be used in between rounds or during timeouts, but said if his ringside/cageside doctors wanted to do that, he wouldn’t stop them.
InfraScan’s Roy Bachrach recommends his company’s brain scanner be used as close to the time of potential injury as possible and then periodically over a number of hours. It’s his hope that this kind of technology becomes a common feature on the sidelines of full-contact sports.
“Where there are endorphins, they kinda cover a lot of injuries and we want to make sure that, even if there are endorphins that make the patient very into the game, we’re still be able to detect the bleeds and take them quickly to an establishment that can take care of them,” said Bachrach.
“In the US there are about 6,500 hospitals and only 250 [level II] trauma centers, so the difference between taking a patient to a nearby hospital where they can diagnose a brain bleed but cannot do anything about it, versus taking a patient a longer distance to a hospital that can actually operate makes a big difference. I think we can significantly decrease the damage this causes to people, especially in the sports industry.”
Time will tell whether or not more athletic commissions and MMA gyms pick up this kind of technology. Or whether the UFC itself will procure similar medical equipment, to guarantee it's availability at each of their events (UFC Vice President of Athlete Health and Performance Jeff Novitzky did not respond to Bloody Elbow’s invitation to discuss this matter).
This weekend, at least, when the world's premiere MMA promotion heads back to California for UFC on FOX 22, cageside doctors will have the ability to detect a potentially deadly brain bleed in just minutes, potentially saving fighters' lives. And hopefully, if it is used, all the results come back injury free.