The insidious consequences of one punch attacks

Concussions are often associated with subtle symptoms of headache, memory loss, and confusion. Image: Megan Campbell, QBIThe devastating death of Cole Miller, as in the case of Daniel Christie, who was coward punched in Sydney in 2014, is yet another eye opener to the grave consequences of alcohol-fueled one-punch attacks in Australia. These tragic cases have gained much media attention because of the immediate severity of the violence, but the reality is that, in many thousands of cases, a punch – fatal or not – is more than just a knock to the head. A single punch has more insidious, unseen effects that can surface and become more apparent decades down the track.

The brain is a soft and fragile organ floating in a cushioning fluid, much like jelly in a suspension, within the hard protective skull. When banged, it accelerates, knocks against the skull and bounces back, leading to a mild form of brain injury known as concussion.

Concussions are often associated with subtle symptoms of headache, memory loss, and confusion that may not be immediately apparent. Even when they are, the symptoms are often downplayed because they seem reversible, and therefore not that serious. However, research in the field of traumatic brain injury clearly shows that even the most superficial and ‘silent’ of knocks triggers changes in brain physiology and in the metabolism of nerve cells.

Of more significant concern is repetitive concussive trauma, where relatively minor hits to the head cumulate over time to trigger significant problems at later stages.

Even subconcussive knocks, which seem to have no effect, can eventually lead to progressive neurodegeneration and a condition known as chronic traumatic encephalopathy, or CTE. In American football, for example, where head injuries are common, players have developed dementia-like symptoms and CTE as early as their late 30s.

While concussions have taken centre stage in recent years, it is still largely an unrecognised public health problem. General lack of awareness and denial is the core issue: people need to understand that getting up from a violent hit to the head, with few symptoms, is not consequence-free. Bridging the link between repetitive concussions and progressive brain deterioration will provide concrete evidence of the potential side effects that are too grave to ignore. It needs to be emphasised to young men that one punch—a single punch—even if doesn’t seem to have any serious immediate effects, can result in lasting and irreversible damage later on. Only a deeper understanding of the consequences of a single, foolish punch will make young men more accountable for their actions.

Given the current unavailability of efficient treatment, prevention is therefore key. This may mean greater penalties for problem drinkers, increased taxes on alcoholic beverages, improved education campaigns, or limiting advertising and marketing strategies that encourage alcohol consumption, particularly to young people.

Dr Fatima Nasrallah is the MAIC Senior Research Fellow in Traumatic Brain Injury at the Queensland Brain Institute. Her research focuses on functional neuroimaging and brain injury.

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