Cavum Septi Pellucidi in Boxers

Abstract

Objective Controversy exists over the significance of the isolated finding of cavum septi pellucidi (CSP) and its prevalence rate in healthy individuals and in professional boxers. Few magnetic resonance imaging (MRI) studies have looked at large cohorts of boxers. The aim of this study was to identify the prevalence and extent of a CSP among professional boxers and to compare these with a control group. Methods MRI studies of 164 male boxers scanned for annual British boxing board license renewal were reviewed and compared with 43 control patients. CSP prevalence, size, and extent were recorded. Extent was classified as type 1, anterior to the fornix; type 2, extending up to the fornix; and type 3, extending into the cavum vergae. Parenchymal abnormalities were documented, and the Evan's ratio was used as an indication of brain atrophy. Results A CSP was present in 40% of controls and 49% of boxers. There was a trend to a higher CSP prevalence in boxers ( P = .099). No control patient had type 2 or 3 extension ( P < .0009), as opposed to 30% and 16% prevalence in boxers. Three boxers increased their extent over serial imaging. No difference in CSP size was established between the 2 groups ( P = .43), but there was an association between progressive scans and increased CSP size over time in boxers, independent of age ( P = .05). Eight boxers demonstrated a CSP on a subsequent scan not seen on an earlier scan. Conclusion The prevalence of a CSP is high among both control patients and boxers. There is a trend to a larger CSP with increasing number of scans without evidence of atrophy and independent of age. Boxers also have a greater posterior extent than controls. The findings may be explained by sudden increases in intracranial pressure that forced cerebrospinal fluid (CSF) through small defects in the septal leaflets, which result in an increase in size and or extent of a CSP.