• boxing
• brain injury
• concussion
• cavum septum pellucidum

Boxing has been a human activity since antiquity. In ancient Rome, it was banned because of the high injury rate when boxers used leather hand wraps with sharp metal spikes called spharai. The safety of boxers became an issue in Great Britain in the early 18th century, when the use of biting, gouging, kicking, and other brutal techniques was outlawed. In 1743, the Broughton rules were introduced to limit some of these techniques, and these were subsequently replaced by the London Prize Ring rules in 1839. In 1867, the Marquis of Queensbury rules introduced the use of boxing gloves, three minute rounds, and the 10 second knockout in an attempt to make boxing safer.¹ These measures did not eliminate either the acute or chronic neurological effects of boxing. Numerous accounts in both the medical literature and lay press have extensively documented the boxing deaths occurring in the ring since that time.²

In 1928, Martland first described the syndrome of dementia pugilistica or chronic traumatic encephalopathy in boxers.³ Before this time, it was known in lay boxing circles that a few professional boxers developed the so called “punch drunk” or “slug nutty” state. Other medical authors of the era further elucidated the clinical features of this condition.^4,5 Since that time the association of chronic brain injury in boxers has been the subject of numerous studies.^1,6–13

A commonly reported association of chronic brain injury in boxing is the presence on neuroimaging or post mortem studies of a cavum septum pellucidum. Some authors have suggested that a cavum represents an incidental anatomical variant of no clinical significance,¹⁴ whereas others have speculated that the higher incidence of cavum septum pellucidum …