Traumatic spinal cord injuries in professonal wrestling

     Traumatic spinal cord injury is a devastating condition that has the potential to result in partial or permanent disability.  In the United States the incidence of traumatic spinal cord injury is approximately 40 per million persons per year.

     The main causes of spinal cord injury are: (1)

• Motor vehicle accidents: 47 percent.
• Falls: 23 percent.
• Violence (i.e. gunshot wounds): 14 percent. 
• Sports: 9 percent. 
• Other: 9 percent.

     Most spinal cord injuries are the result of an injury to the vertebral column.  This can occur by a number of mechanisms including: (2)

• Fracture of a vertebral bone. 
• Dislocation of a joint.
• Ligament tear.
• Herniation of a disc.

       With a complete cord injury the individual may experience loss of sensation and complete paralysis below the level of injury.  Such an injury occurred to wrestler Darren Drozdov (Droz).  On October 5. 1999 while wrestling Accie Conner (D'Lo Brown) he suffered a cervical spinal cord injury at the C4-C5 level.  He was eventually able to regain partial use of his upper extremities.

     Transient paralysis can occur after a spinal cord injury and result in temporary paralysis, loss of sensation and reflexes below the level of injury.  Individuals will often times make a complete recovery.  Such an injury occurred to referee Tommy Young on November 28, 1989.






     Another example of a transient spinal cord injury occurred to wrestler Steve Williams (Steve Austin) on August 3, 1997.




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Mitsuharu Misawa

     A sudden traumatic spinal cord injury can be immediately life threatening.  This is especially true the higher the lesion is in the cervical spine.  An injury at the C1-C2 level is associated with a 6.6 fold increased risk of death, C3-C4 injury a 2.5 fold increased risk, and a C6 to C8 a 1.5 fold increased risk. (3)  Japanese professional wrestler Mitsuharu Misawa died June 13, 2009 in the ring after getting injured from a suplex.  While the official cause of death was not released by the family, it is presumed he sustained a high cervical spine injury causing cardiopulmonary arrest.

     Another well publicized spinal cord injury occurred on December 11, 1990 in Tampa, Florida during a WWE Suprestars TV taping.  Enhancement wrestler Chad Austin teamed with Lanny Poffo (The Genius) against The Rockers, Frederick Jannetty (Marty Jannetty) and Michael Hickenbottom (Shawn Michaels).  Jannetty performed a "Rocker Dropper" on Austin.  Austin landed incorrectly and suffered a spinal cord injury.  Austin subsequently sued the WWE and on April 29, 1994 the case was settled and he was awarded a reported 26.7 million.




References:

1. www.spinalcord.uab.edu
2. Spine (Phil Pa 1976) 2001; 26: S2.  
3. Arch Intern Med 1989; 149(8): 1761.

The medical resource www.uptodate.com was used in the preparation of this blog.

Photographs and videos are for illustrative purposes only.  Wrestling with Death does not claim ownership.

Randy Savage (November 15, 1952-May 20, 2011).

Randy Savage

      Randy Poffo, know worldwide as "Macho Man" Randy Savage died in a single motor vehicle accident in Seminole, Florida on the morning of May 20, 2011.  The preliminary autopsy report did not reveal a cause of death according to Bill Pellan of the Pinellas-Pasco medical examiner's office.   No extensive trauma was present. (1)   Toxicology and histology results are still pending.  In an interview with Bright House Sports network conducted on June 7, 2011 Lanny Poffo, brother of Savage, reported that the cause of death was ventricular fibrillation. (2)

     The medical event that occurred with Savage is referred to as sudden cardiac death.  This happens  when there is a sudden cessation of heart function and collapse of the circulatory system.  The final event is an unstable heart rhythm known as ventricular fibrillation.  During ventricular fibrillation there are rapid, uncoordinated, ineffective, contractions of the lower heart chambers.  This rhythm is universally fatal unless the individual is fortunate enough to be quickly resuscitated.  When sudden cardiac death happens outside of a hospital, the likelihood of surviving is very low.  Only about 10% of individuals survive, many of whom will never make a complete recovery.

     There are many different causes of  ventricular fibrillation that can result in sudden cardiac death as listed in Table 1.

 
Table 1

• Coronary artery disease: 65-70%.
• Structural heart disease (i.e. hypertrophic cardiomyopathy): 10%.
• No heart disease (i.e. drugs, trauma, bleeding): 15-35%.

     There has been speculation that Savage's death could be linked to anabolic-androgenic steroid (AAS) use.  The final autopsy report should provide information on this, as several autopsy findings due to AAS use have previously been described.  For more information on this refer to the May 7, 2011 blog on this site titled Anabolic androgenic steroids and heart disease.

Randy Savage

References

1. http://www2.tbo.com/news/news/2011/may/24/MENEWSO6-macho-man-autopsy-results-dont-reveal-cau-ar-227846/
2. http://www.baynews9.com/article/sports/2011/june/258715/%22Macho-Man%22-Randy-Savages-death-attributed-to-heart-condition

The medical refernce www.uptodate.com was used in the preparation of this blog.

Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.

Professional wrestlers with acromegaly

     Acromegaly is a condition that results from an excess of growth hormone.  The most common cause is a tumor located in the anterior pituitary gland that secretes growth hormone.  Rarely, acromegaly occurs due other conditions such as a tumor in the hypothalamus or  cancer.  The annual incidence is only about 3 to 4 per million. (1,2)  The progression of acromegaly is generally slow, and a diagnosis may not be made for over a decade after the initial onset of symptoms.  The mean age of diagnosis is usually around 40 to 45 years old.  Excess growth hormone as a child or adolescent is often referred to as gigantism.

     Symptoms of acromegaly can be due to local effects of the tumor or as a result of high circulating levels of growth hormone (see Table 1).


Table 1

Local effects of tumor

• Change in vision
• Headache
• Decreased secretion of other pituitary hormones

Systemic effects of growth hormone

• Increased thickness of soft tissue of hands/feet
• Carpel tunnel syndrome
• Arthritis
• Enlargement of frontal bones of skull
• Colon polyps    
• Cardiomyopathy
• Congestive heart failure
• Hypertension
• Sleep apnea
• Enlarged internal organs (liver, spleen, thyroid gland)

     Acromegaly is associated with colon and other gastrointestinal cancers. (3)  Individuals are also at an increased risk of death due to cardiovascular disease.  Treatment with resultant cure can reduce the risk of early mortality. (1)  The primary treatment is surgery to remove the tumor.  For individuals who are not candidates for surgery, treatment options may include medical therapy and radiation.

The French Angel

     Big men have always been a part of professional wrestling.  While generally not great athletes due to their size,  the visual impact of a "giant" is undeniable.  Several wrestlers had acromegaly.  One of the earliest in wrestling was Maurice Tillet.  Born in France, Tillet moved to the United States and enjoyed success in professional wrestling during the 1940's as  The French Angel.

The Swedish Angel

 




     Tillet wasn't the only angel with acromegaly.  Phil Olafsson was known as the Swedish Angel and also wrestled in the 1940's.








     Of course, the most popular wrestler with acromegaly was Andre Roussimoff known worldwide as Andre the Giant.  Andre displayed symptoms of the disease at a young age, reaching a height of 6'3" and weight of 240 lbs before becoming a teenager.  He died at the age of 46 from congestive heart failure.

Andre the Giant

     Other professional wrestlers reported to have acromegaly include Max Palmer (Paul Bunyon), Shohei Baba (Giant Baba), Jorge Gonzalez (El Gigante), Dalip Singh Rana (The Great Khali), and Paul Wight (The Big Show).

     

References.

1. NEJM 2006; 355(24): 2558.
2. Acta Med Scand 1988; 223(4): 327. 
3. Cancer 1991; 38(8): 1673. 

The medical reference www.uptodate.com was used in the preparation of this blog.


Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.

The Benoit autopsy

Chris Benoit

     The article Chronic traumatic encephalopathy in a professional American wrestler was published in the Journal of Forensic Nursing in 2010. (1) The lead author is Bennet Omalu, M.D., professor of pathology in the Department of Pathology at the University of California, Davis.  He is also a founding member of the Brain injury Research Institute.  He is credited with being the first to describe the physical findings of chronic traumatic encephalopathy. (2) 

     The article describes the autopsy results of Chris Benoit.  The most important findings with interpretation are as follows:
                                                                                                                                     

Cause of death: asphyxiation due to hanging. 

Benoit chocked to death by hanging.  At autopsy there was a tight looped rope ligature around the neck.  Underneath the rope ligature was a white towel wrapped around the neck.  The ligature indentation was 0.6 to 1.3 cm in width circumferentially situated around the neck.  Internally there were no fractures to the hyoid bone or thyroid cartilage.

Manner of death: suicide.

There was cardiomegaly (620 g) with bilateral atrioventricular dilatation.  

The findings describe an enlarged heart (cardiomyopathy).  The findings are suspicious for androgenic anabolic steroid (AAS) use.  The average adult human male heart weighs about 300 g.  Use of AAS can cause an abnormal enlargement of the heart. (3, 4) 
 
Liver weighed 2,620 g and the spleen weighed 300 g. 

The findings describe an enlarged liver (hepatomegaly) and an enlarged spleen (splenomegaly).  In a healthy adult the liver weighs about 1,500 g and the spleen about 170 g.  The findings suggest the use of performance enhancing drugs.  AAS have been associated with hepatomegaly.  (5)   However, when multiple organs are enlarged the possibility of human growth hormone (HGH) use needs to be considered.

HGH has been used by athletes.  Benoit was linked to the Signature Pharmacy drug ring which sold AAS/HGH to a number of professional wrestlers. (6)  The side effects of HGH use have not been well studied. (7)  What little information is available in the medical literature pertains to the use of HGH in adults deficient of the hormone.  Reported side effects of HGH administration include peripheral edema, carpal tunnel syndrome, impaired glucose levels, and arthralgias. (8)   If given at high enough doses, HGH would be expected to cause acromegaly.  This condition has been associated with organ enlargement.  Definite acromegaly however has not been reported in any athletes using HGH.  

The testes appeared grossly normal, but microscopic examination showed atrophy of the seminiferous tubules with arrest of germ cell maturation. 

The microscopic findings are consistent with AAS use.  AAS administration has a number of effects on the male reproductive system including declines in sperm density, sperm count, and sperm motility.  The use of AAS can produce an infertility state that typically resolves upon cessation of drug use. (9)


The brain appeared grossly normal, but microscopic and immunohistochemical findings showed there were mild to moderate neocortical neuronal dropout and diffuse cerebral taupathy. 


There was evidence of abnormal accumulation of tau protein.  Tau is normally present in the cells of the nervous system.  It is responsible for binding microtubules, which play a role in the maintenance of cell shape and function.  An abnormal accumulation of tau protein may follow chronic traumatic brain injury. (1)  This may in turn impair normal nervous system functioning and give rise to the symptoms seen with chronic traumatic encephalopathy which may include cognitive, intellectual, and psychiatric problems. (10)  An abnormality with the tau protein has been observed in other neurodegenerative disorders such as Alzheimer's Disease, Progressive supranuclear palsy, and Frontotemporal dementia.

Alprazolam (50 ug/L) and Hydrocodone (45 ug/L) were present. 


Alprazolam is a type of benzodiazepine.  It is approved for treatment of anxiety, anxiety with depression, and panic disorder.  

Hydrocodone is an opiate used for analgesia. It is usually sold in combination with another drug such as acetominophen and known by brand names such as Vicodin and Lortab.



An elevated Testosterone (207 ug/L) and Testosterone to Epi-testosterone (59) were present. 

There are a number of factors that can influence the testosterone level in a male.  The "normal" range is often defined as 3.5-12 ug/L.  

Epitestosterone is a naturally occurring steroid that differs slightly is structure from testosterone.  In a healthy male the ratio of testosterone to epitestosterone is 1:1.  While normal ratios up to 4:1 and even 10:1 can occur, ratios greater than 1:1 are always suspicious for the use of exogenous testosterone.

It is known that Benoit's personal physician Dr. Phillippe Astin was accused of prescribing a 10 month supply (specific quantity not reported) of testosterone every 3 to 4 weeks from May 4, 2006 to May 9, 2007. (11)

References:

1.   J Forensic Nurs 2010; 6: 130.
2.   www.braininjuryresearchinstitiute.org.
3.   Physician Sportsmed 1988; 16(11): 109.
4.   Med J Aust 1993; 158: 34.
5.   J Forensic Sci 1990; 35(6): 1441.
6.   http://sportsillustrated.cnn.com/2007/more/08/30/wrestlers/
7.   Ann Intern Med 2008; 148: 747.
8.   Clin Endocrinol 1995; 43(2): 143.
9.   Sports Med 2002; 32(5): 285.
10.   J Forensic Nurs 2010; 6(1): 128.  
11.   http://sports.espn.go.com/espn/news/story?id=2973334

Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.