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To be knocked out means to lose consciousness or pass out, usually due to a blow or series of blows to the head. A knockout (KO) in boxing occurs when a fighter goes down because of blows (to the head or body) by the opponent and the fighter does not get up within the allotted time. In Judo or Mixed Martial Arts, a knockout may also occur when the blood flow to the brain is cutoff by using a chokehold that presses on the carotid arteries. Most fighting arts also have a technical knockout (TKO) that occurs when a fighter is unable or unwilling to continue or when the referee stops the fight to protect a fighter from further injury. This topic will deal with a knockout due to a loss of consciousness from a blow to the head.

The brain is composed mostly of a soft fat similar to gelatin, so, for protection, it is incased in the skull. Most brain injuries due to fighting are closed head injuries where a blow to the head jars or fractures the skull without opening it and injuries the brain.

A blow to the head that stuns a person is but usually does not result in a loss of consciousness is a closed head injury called a concussion. A concussion may cause temporary headaches or blurred vision but it is generally not serious. The severity of a closed head injury is measured by the duration of the loss of consciousness.

A loss of consciousness of a few seconds or minutes is a mild injury and rarely results in permanent brain damage. Most fighters with such injuries are not admitted to the hospital. The loss of the consciousness results from a pressure wave from the force of the blow. If the pressure of the wave is higher than the person’s blood pressure, blood flow to the brainstem is interrupted and the person passes out. As the pressure wave recedes and blood flow to the brainstem returns, the person come to. Even if the person makes a full recover, years later, at post-mortem examinations, speck-like hemorrhages, called petechial hemorrhages, may be seen in the brain. Sometimes small tears are found in the fiber tracts of the brain, called white matter, that transmit messages from one region of nerve cells, called gray matter, to another region. Although each mild injury is not serious, repeated mild injuries may have a cumulative effect and may result in permanent brain damage. As the tiny petechial hemorrhages and the tiny tears in the white matter accumulate over time, a fighter may begin to stagger, lose balance, experience short-term memory loss, and make movements as if they were still in the ring, called being punch drunk”

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