OTHER ATHLETES AFFECTED:
Last month, featherweight boxer Robert Benson, 24, lapsed into a coma after a televised 10-round fight. He never regained consciousness. Doctors operated on his brain to try to stop the bleeding and to relieve pressure in his head, but Benson died a few days later.
Bertolotti is 33 and plays soccer for Modena, a lower-division team in Italy.
HOW IT HAPPENED:
During a game on Nov. 19, which pitted Modena against Como, Bertolotti sparred with Massimiliano Ferrigno, Como's team captain and a former teammate. Even though Ferrigno was ejected following the confrontation, Como went on to win 1-0. But after the game, the fight was renewed in a locker room confrontation. The Associated Press reported that Bertolotti was hit with an uppercut and struck his head on the floor when he fell.
WHAT'S INVOLVED WITH TREATMENT:
The skull offers the brain significant protection from minor bumps and scrapes. But the very things that make it such effective protection for the brain -- like being a hard, enclosed cavity that is capable of transferring force around its circumference -- can make it dangerous in cases of a sudden blow, which can cause a traumatic brain injury. A direct hard blow can jar the brain at the point of impact; it can also cause the brain to go in the opposite direction and collide with the skull. This leads to brain injury on the opposite side of the impact. The ability of the skull to transfer and diffuse a blow can also lead to a more widespread injury.
If blood vessels are damaged, bleeding can happen in or around the brain. In addition to the loss of blood supply to the brain, which can cause irreparable damage within minutes, bleeding within the confined space of the skull can compress the brain and cause damage and even death. This damage is often "silent," with the patient being conscious for a few hours while the bleeding continues to build up pressure in the brain. The fact that Bertolotti lapsed into a coma means that he suffered a severe brain injury.
The first-line of treatment for severe traumatic brain injury is surgery, during which doctors try to control the bleeding and ease the pressure that can build up as brain tissue is damaged. The surgeon will try to preserve as much of the regular circulation through the brain as possible. Doctors operated on Bertolotti on Monday. He remained in a coma and was in serious but stable condition afterward.
A head scan, such as from an MRI, can show doctors where fluid is building up in the brain by using magnetism and a computer to create images of the structures inside the head. Doctors can also use an electroencephalogram (EEG) to measure the electrical activity of the brain.
If he survives this initial stage of his injury but remains in a coma, doctors will assess Bertolotti's brain injury by the responsiveness of different parts of his body. His ability to respond will give doctors an idea of his chances to recover.
Officials were trying to prevent further altercations between these players by ejecting Ferrigno, but they fought on their own, presumably on a surface much harder than a soccer field. Bertolotti may have been unconscious after being punched, so he would not have been able to protect his head as he fell.
Bertolotti still faces hurdles to survive. Doctors have to watch his circulation and keep the swelling down inside his head, while they are also mindful of possible complications like infection and blood clots. Then, it will take physical therapy and rehab to try to restore any function he has lost.
The next question is whether Bertolotti will regain consciousness. People can spend years in a coma, called a "persistent vegetative state." There are many levels of this state of unconsciousness, and the patient's state of awareness and ability to respond to people around him varies greatly. If he does awaken, his therapists can give him progressive treatments that can, depending on the extent of the brain injury he suffered, potentially rehabilitate him.