"Punch Drunk Syndrome" is a condition seen in combat sport athletes, football and ice hockey players, military veterans and others who are prone to receiving blows to the head in practice, competition and life. Repeated cerebral concussions are the cause of Punch Drunk Syndrome. Symptoms are characterized by weakness in the lower limbs, difficulty walking, slowness of muscle reaction, slurred or strained speech, and mental cloudiness. Doesn't this sound very similar to a long night at the bar? Or maybe you don't remember it. Sometimes it is better that way. We don't judge . . .

Signs of Punch Drunkenness

It is not unheard of for a competitor to have a headache and feel exhausted after a hard fight, sparring session or practice. Indications of being “punch drunk” really present themselves hours later when nausea and vertigo set in. The reaction is comparable, if not the exact replica of a hard night of drinking alcohol. There may even be periods of lost memory, similar to a blackout.

"I think the day after being rocked, you feel like the day before was almost like a dream," professional MMA fighter Lorawnt-T "Smash" Nelson told Receptra. "Just like when you wake up with a bad hangover. Dang, did all that really happen?

Common Symptoms for Both Punch and Alcohol Induced Hangovers:

1. Headache
2. Weakness
3. Nausea/Vomiting
4. Fatigue
5. Vertigo/Double Vision
6. Mental Dullness/Confusion
7. Disorientation as to time, date or place
8. Speech Impairment
9. Lack of Coordination
10. Partial Amnesia

Slug Nutty and Cookoo: Medical History of the Punch Drunk

Medical journals written nearly 100 years ago note a rare but serious form of dementia that was linked to repetitive head injuries in boxing. The form of dementia was appropriately named, “Boxer's dementia” or “dementia pugilistica.” This same condition is also referred to as “punch drunk.”

A study published in the October 13, 1928 Journal of the American Medical Association states, “For some time, fight fans and promoters have recognized a peculiar condition occurring among prize-fighters which, in ring parlance, they speak of as “punch drunk.” Fighters in whom the early symptoms are well recognized are said by the fans to be “cookoo,” “goofy,” “cutting paper dolls,” or “slug nutty.”

The article goes on to say, “In some cases, periods of slight mental confusion may occur as well as distinct slowing of muscular action. The early symptoms of punch drunk are well known to fight fans, and the gallery of gods (heckling audience) often shout “cuckoo” at a fighter. I know of one fight that was stopped by the referee because he thought one of the fighters was intoxicated.”

The Serious Side of Punch Drunkenness

Even in the 1920's the term “punch drunk” was linked to brain damage, and many neurological and memory related diseases. Though technology has progressed with time, the findings are virtually the same, but also include some shiny new terminology.

Chronic Traumatic Encephalopathy (CTE) is a medical term that relates to Boxer's Dementia, and encompasses the long-term effects of repeated head trauma in the form of brain disorder. Dementia pugilistica is a variant of CTE. The effects of CTE are frightening and have caused multiple competitors to leave the game in both boxing and MMA and well as sports such as professional wrestling, football, baseball and hockey.

CTE is linked to depression, aggression and problems with impulse control.

According to the Concussion Legacy Foundation, “This doesn't mean a handful of concussions: most people diagnosed with CTE suffered hundreds or thousands of head impacts over the course of many years playing contact sports or serving in the military. And it's not just concussions: the best available evidence points towards subconcussive impacts, or hits to the head that don't cause full-blown concussions, as the biggest factor.”

Brain Damage and Punches to the Face

Former Bellator fighter Jordan Parsons, who was killed by a drunk driver in 2016, was the first publicly diagnosed case of CTE in MMA. Fighters are hoping that better information and research will help in avoiding CTE in the sport.

Coach John Kavanagh told the Irish Independent, It's a concern of every fighter. At that level of fighting, the risk is very real . . . CTE concerns me more than anything about all combat sports. This can be the first generation of fighters ever who don't get CTE.

Heavyweight Mark Hunt (13-11) was pulled off the UFC Fight Night 121 card for comments he made during an interview stating, “My body is [expletive] but my mind is still here. I've still got my senses about me and I know what's right and wrong, which is the main thing. Sometimes I don't sleep well. You can hear me starting to stutter and slur my words. My memory is not that good anymore. I'll forget something I did yesterday but I can remember the [expletive] I did years and years ago.”

The UFC took the comments as a potential indication of punch-drunk syndrome. Hunt was pulled off the card to ensure that he was healthy enough to still compete. The promotion then put Hunt through a series of medical tests in order to clear him for his upcoming bout against Curtis Blaydes (8-1) at UFC 221.

The Concussion

Punch drunkenness is often considered synonymous with having a concussion. This may or may not be the case, but a concussion is not to be taken lightly. Symptoms are often the same. Concussions are graded on a three-point scale used as a basis for treatment decisions.

• Grade 1: No loss of consciousness, transient confusion, and other symptoms that resolve within 15 minutes
• Grade 2: No loss of consciousness, transient confusion and other symptoms that require more than 15 minutes to resolve
• Grade 3: Loss of consciousness for any period. Days or weeks after the accident, the person may show signs of: Headache, poor attention and concentration, memory difficulties, anxiety, depression, sleep disturbances and/or light and noise intolerance

When any of these symptoms occur it is considered "post-concussion syndrome.” An athlete should never return to training activities until all symptoms are gone.

Coping With the Hangover

The phrase “punch drunk” has adapted over decades to mean the immediate or short-term effect of repeated head injury as it usually relates to a single incident (practice or competition) involving trauma. Without delving into the long-term CTE concerns, being punch drunk can be a set back.

Just like with any hangover, it is hard to do much of anything once symptoms set in. With a pounding head, churning stomach and spinning universe it can be difficult to function in life, let alone participate in athletic activities.

It is important that athletes understand the risks and are prepared to pay the consequences or a hard sparring session or rough game. It is also crucial to know when enough is enough. If you are getting blasted repeatedly, you may want to consider calling it a night early.

This is especially true if you work a regular 8-5 job are out of sick days. Though more serious, the excuse sounds just as lame as an alcohol hangover; “I'm sorry, I can't make it in today. I got hit it the head too many times…”

Punch Drunk Prevention and Treatment

There are no specific remedies for the punch drunk hangover, but the same things that work for an alcohol hangover are good for restoring balance to the body, and therefore a good place to start. Everyone has their own coping method, for a tough night on the town. But the most trusted remedies are rest, hydration and putting the right nutrients in the body. The best prevention is not to get hit.

Keep your hands up!