Chronic Traumatic Encephalopathy (Brain Damage)

By Norman Marcus on February 17, 2013
Chronic Traumatic Encephalopathy (Brain Damage)
"Irish" Micky Ward is undergoing tests while still alive to further the research into CTE.

“Shadowy ex-champion Beau Jack sat in his dusty office hearing bells and fighting old fights over and over, throwing jabs in the dusty air…”

“Some people should just have their heads examined…”

CTE as it is called has plagued the “sweet science of bruising” since the beginning of time. It was first officially addressed by Dr. Harrison Martland, a forensic pathologist, in the Journal of the American Medical Association in 1928. The doctor had done many post-mortem studies on the brains of deceased boxers. Only in an autopsy can this disease be diagnosed for certain. The condition goes by many different names today. Boxer’s dementia, dementia pugilistic, even punch drunk syndrome is used to describe the condition. But chronic traumatic encephalopathy is the most accepted and correct term for the late consequences of repetitive traumatic brain injury. It is caused by repeated blows to the head which can cause concussive or even sub-concussive damage to the brain. A concussion occurs when the brain strikes the inside of the skull from a blow to the head. It is a mild form of traumatic brain injury. Concussion can involve sheer injury and alterations in tractography on MRI. The concussion causes “a jarring injury of the brain resulting in disturbance of cerebral function.” (I hope the reader can follow all this medical mumbo jumbo.)

Not all fighters are equally vulnerable to CTE but all fighters can get it. Most believe it is a function of severity and frequency of injury and not heredity. The British Journal of Sports Medicine reported several years ago “decreasing incidence of CTE with shorter careers, new regulations, and longer mandatory prohibition on competition after KO’s.” The damage to the brain can be gradual and take years or decades to become apparent or can be a rare but sudden injury such as blindness. Usually a decade or two after the start of a boxing career the symptoms start to show themselves. Damage to different areas of the brain will result in different problems for the fighter. On December 2, 2012, Deborah Kotz of the Boston Globe reported that the Boston University School of Medicine set “four stages of the disease… 1–starts with headaches and concentration, 2–followed by depression, aggression, anger and short term memory loss… 3–followed by more serious cognitive impairment.” 4–Finally ending in “full-blown dementia.” Parkinson’s-like symptoms (a swaying, shaking gait) may also occur in some fighters.

Irish Micky Ward, the former IBF light welterweight champion, has agreed that after his death, his brain and spinal cord will go to neurosurgeon Dr. Robert Cantu for research purposes. Ward is undergoing tests while still alive to further the research into CTE. Dr. Cantu, who runs the Boston University Center for the Study of Traumatic Encephalopathy told the Boston Globe, “I think it is huge, I think its really great. We will be able to know for certain what we have found in our studies while he is alive if that is really CTE or not. The sheer size of our study should make any doubters no longer doubt.”

Micky Ward said that “When you do get a concussion take more time off before you come back, make sure you are seen by a doctor and get the proper diagnosis.”

About twenty percent of boxers show signs of this disease. The real percentage may be much higher because CTE is often misdiagnosed as Alzheimer’s. There seems to be a genetic link that determines whether a person with repeated head trauma has a greater chance to develop CTE. Most athletes in contact sports escape its effects but fifteen to twenty percent do not, with tragic results.

Boxers are also subject to more devastating brain injuries such as subdural hematomas (collection of blood on the surface of the brain), vessel dissection (an abrupt tear along the inside wall of an artery), and second hit injuries (a second concussion before the first concussive effects have disappeared, causing brain swelling that can be lethal).

The great Yankee slugger Lou Gehrig was said to suffer from ALS (a disease of the brain and spinal cord). The disease was informally named after him (Lou Gehrig’s Disease), yet today some researchers have doubts whether Gehrig ever had this disease in the first place! Lou was hit in the head so many times at home plate and knocked out that he may have really suffered from CTE! The symptoms are very similar. No batting helmets were used in those days and players just regained consciousness and went back in the game. Gehrig also played football and baseball for Columbia University and records show that he was knocked out several times during his college career in both sports.

The majority opinion among neurosurgeons however, leans to Lou having had the disease ALS and not CTE. Athletes do have an unexplained high rate of ALS, suggesting another link to repeated head trauma.

Some of the best known boxers in the history of the sport have been affected by some sort of mental degeneration. For example, Jack Sharkey, Mickey Walker, Beau Jack, Floyd Patterson, Joe Frazier, Sugar Ray Robinson, Billy Conn, Joe Louis, Jerry Quarry, Emile Griffith, Freddie Roach and Muhammad Ali. Later in life Floyd Patterson actually had to resign as a member of the New York State Boxing Commission because cognitively, he couldn’t think things through anymore. His reasoning was simply gone.

Muhammad Ali’s personal doctor Ferdie Pacheco however stated in his book Fight Doctor that Ali doesn’t have CTE but true Parkinson’s syndrome, brought on by trauma to the head. We seem to be walking a very fine diagnostic line here. Ferdie blames the press with this rush to label Ali and others as suffering from CTE. In an interview with writer Jordon Melnick in 2010, Dr. Pacheco said “There used to be such a thing as a boxing writer. A boxing writer went to every fight. He knew everybody, knew who was coming up and who was going down. But now they just send somebody with a camera. You can take a picture with a camera and write a couple of paragraphs but they don’t know what they are talking about.”

In his second book, Tales From the 5th Street Gym, Dr. Pacheco laments the slow slide of the legendary gym on Miami’s South Beach into oblivion. This gym was owned by Chris Dundee. It was where the owner’s brother Angelo Dundee worked his magic with the young Ali. The gym later fell on hard times, “a haunted house of brilliant memories run by a shadowy ex-champion Beau Jack who sat in his dusty office hearing bells and fighting old fights over and over, throwing jabs in the dusty air.”

That is the fate of boxers with CTE, such as the great two-time lightweight champion of the world Beau Jack. Beau fought twenty-one main events at Madison Square Garden. No boxer has ever beaten that record. Yet there he sat, in the 5th Street Gym, suffering from severe dementia. A great champion, brought low by too many shots to the head.

Yet real punchers who liked to mix it up, such as Rocky Graziano, Tony Zale, Max Schmeling and Jack Dempsey escaped this mental damage. Schmeling made it to the age of ninety-nine, Dempsey lasted to eighty-seven, Zale survived to eighty-three and Graziano reached seventy-one. All four men were sharp as a tack till the end. Well maybe not Graziano, but he wasn’t too sharp even when Mrs. Barbella gave birth to him in 1919. When “Noo Yawker” Graziano slurred, “Yo youz guyz” it was not CTE, he was just from Brooklyn!

The verdict seems to be pretty well in on CTE in contact sports. The next step is to decide how we deal with it, how to help prevent it and treat its effects after damage has been done.

Note: I would like to thank Ken Blumenfeld M.D. a neurosurgeon and part-time fight doctor, who checked over the medical facts in this story for me.

Follow us on Twitter@boxing_com to continue the discussion

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  1. Bob 07:09am, 02/23/2013

    Very interesting article. I’m glad Jason mentioned George Chuvalo as an example of an ex-fighter sans apparent drain damage. George took some hellacious shots from a number of guys who were truly heavy-handed. I don’t know if there is a link here, but George was never off his feet and that’s not a testament to his defensive skills.

  2. Rich Kim 06:41pm, 02/20/2013

    Enjoyed the article thoroughly Norman.  I think boxing fans everywhere appreciate reading about this very devastating ‘side-effect’ of the sport they love so much. It is a reminder that while boxers (and many other athletes) look larger than life in the ring they pay a heavy price. But then again what is life if you don’t burn at both ends?

  3. Sam 1969 06:13pm, 02/18/2013

    This is an excellent article but of course it makes me really sad, this is a high price for several courageous boxers who must pay a terrible toll for this sport we love to watch, hope the effort and cooperation Micky is furnishing help many upcoming generations of fighters.

  4. th thresher 10:42am, 02/18/2013

    Jason, 3 years ago I suffered a subdural hematoma and they drilled a hole in my head to relieve the pressure. The blood came out like a geyser. That was an experience I don’t ever want to repeat and any boxer who thinks he can fight after such an experience has a hole in his head.

    BTW, When I asked the neurosurgeon what my chances were, he said it was a “no brainer.”

  5. Jason 10:35am, 02/18/2013


    I agree with the heredity thought. I believe that plays a part. Some people have more grey matter than others. Therefore, are more sensitive to head injuries, etc., etc.

    I took a hard knock about a month ago. I was out for about two seconds. I had a headache for three days afterwards. It took me a full week to feel normal again. I went ahead and took a month off.

    George Chuvalo took as many punches as there were to take, and the man sounds like a businessman to this day. Go figure.

  6. the thresher 07:26am, 02/18/2013

    “...and not heredity.” I do think heredity plays a part, albeit a small one, and I cite the Quarry Brothers and the Moyer Brothers as just two examples of this.

    As for subdural hematomas, as long as a blood clot does not develop, a boxer has a solid chance to recover, but should never fight again. I suspect this is what Katsidis had.

    There is so much more on this subjevt that Norman should do a series.

  7. THE THRESHER 06:24am, 02/18/2013

    Great stuff Norm. These articles need to be kept at the forefront as they contrIbute to the reform of boxing. Any one who has witnessed the Moyer brothers walking down a path and hold hands with football helmets on their heads can appreciate the real horror of PD.

  8. john coiley 05:27am, 02/18/2013

    How is it said? “Been there, done that?” After the Licata debacle in 1970 I experienced perpetual, severe headaches for years until chiropractic treatment slowly eased the pain I never want to know again…

  9. Norm Marcus 04:42am, 02/18/2013

    Thanks Clarence- This article was tough. It’s the first time I had to try and mix drama, humor and a medical journal all into one story. I tried to dumb it down a bit for the average reader like me. Hope people push through it. There’s a lot of good information in there if you keep going.

  10. Clarence George 03:35am, 02/18/2013

    Excellent job, Norm:  The research, the writing, and the importance of the topic.

    If it weren’t for a handful of charitable organizations—Ring 8, for example—DP sufferers such as Sandy Saddler and Tami Mauriello would have wound up on the street.  Saddler, in fact, was found wandering, saved only because the only thing he had on him was his Ring 8 membership card.

    Contrary to popular belief, Maxie Rosenbloom didn’t die from DP (despite always playing punch drunks), but from Paget’s disease, as did fellow boxer heavyweight Clarence Burman.