What Actually Happened to Nick Blackwell?

In the absence of official verification on the precise type of brain or ‘skull’ bleed suffered by Nick Blackwell we are forced to deal in probabilities for the time being. Having reviewed the fight tape in detail & noting the significant volume of uppercuts landed by Eubank Junior on Blackwell as well as the medical response in the days that followed it seems probable that the fighter is suffering from a subdural hematoma – where blood collects between the skull and the surface of the brain.

This would make sense in terms of the treatment he has received thus far – essentially sedating him, attempting to allow the body to heal itself whilst being closely observed. This treatment is one of three available – lending credence to the claims that the bleed was ‘small’ & weight to the ascertain that Eubank Senior’s intervention in encouraging his son not to target Blackwell’s head later on could well have proved pivotal in saving the 25 year olds life – the other treatments being drilling a small hole in his head and the surgical opening of the skull.

Subdural hematomas are most often caused when rapidly changing velocities within the skull stretch and then tear small veins. More common than epidural hemorrhages, subdural hemorrhages result from rotational or linear forces. The injury is often found in shaken baby syndrome. The injury is also often seen in car crash victims who experienced severe whiplash. There have even been examples in the medical literature of subdural hematomas as a result of head banging at heavy metal concerts – the mechanism is essentially the same fast, violent movement of the skull followed by an equally violent and sudden stop.

Subdural hematoma is the most common life-threatening injury in the sport of boxing. Acute Subdural hematoma sustained while boxing can result in everything from mild symptomatology like headaches to neurological deficits and death. The mortality rate for patients with an acute Subdural hematoma ranges from 50 percent to 90 percent.

Statements such as “Blackwell’s in an induced coma but the good thing for his situation is the bleed is not in the brain itself” from Audley Harrison are both inaccurate & unhelpful. There is no ‘good thing’ with this type of injury – there is no hierarchy of misery. Its all serious and its all potentially very, very bad.

The Two Forms of traumatic brain injury

Injuries involving the entire brain are called diffuse & these range from the milder concussion to diffuse axonal injury (a shearing and stretching of the nerve cells at the cellular level) through to Traumatic Subarachnoid Hemorrhage which is bleeding into the space that surrounds the brain. It is unlikely that Blackwell is suffering from a diffuse form of brain injury simply because of the nature of how he attained the injury.

Injuries involving specific areas of the brain are called focal and range from a contusion or bruising of a specific area of the brain to a blood clot or Hematoma formed by blood vessels rupturing. Blood that escapes the normal bloodstream starts to thicken and clot. Clotting is the body’s natural way to stop the bleeding. A hematoma may be small or it may grow large and compress the brain. Symptoms vary depending on the location of the clot. A clot that forms between the skull and the dura lining of the brain is called an epidural hematoma. A clot that forms between the brain and the dura is called a subdural hematoma. A clot that forms deep within the brain tissue itself is called an intracerebral hematoma. Over time the body reabsorbs the clot. Sometimes surgery is performed to remove large clots. The fact that Blackwell has not undergone surgery would confirm reports that the clot is a relatively small one & it seems likely that the medical team are waiting for his body to reabsorb the clot naturally in the coming days.