The death that devastated the cricketing world
The tragic death of 25-year-old Phillip Hughes due to vertebral artery dissection in the neck leading to subarachnoid haemorrhage (SAH) inside the head has shocked the sports world.
Hughes was struck in the neck by a bouncer from New South Wales bowler Sean Abbott on November 25 during a match between South Australia and New South Wales at the Sydney Cricket Ground. He was 63 not out then.
Hughes was wearing a helmet, but the ball made contact with an unprotected area in the neck. He immediately collapsed as many of you saw in the video and was taken to St Vincent’s Hospital. He underwent surgery but died two days later from his injuries, three days before his 26th birthday.
The vertebral arteries are major arteries of the neck. They branch from the subclavian arteries and merge to form the single midline basilar artery in a complex called the vertebrobasilar system, which supplies blood to a significant portion of the brain.
Phillip Hughes has scored 126 runs at SSC, Colombo, against Sri Lanka in 2011. In Australia he scored 112 in Melbourne and 138 in Hobart against Sri Lanka in One Day Internationals in 2013.
My first experience with this rare condition, SAH due to trauma to the neck, was in 1984 when 17-year-old Malik Alles, a promising schoolboy cricketer who had the potential to play for Sri Lanka collapsed when a cricket ball hit him on his neck at the D.S. Senanayake College grounds. He was fielding at the extra cover position. He was rushed to the Accident Service of the National Hospital but like Hughes died without regaining consciousness. He could not be operated.
When I attended the post mortem examination conducted by the then Deputy Judicial Medical Officer Dr. Ratnavadivel, subarachnoid blood coming through the ruptured vertebral artery was clearly visible in the subarachnoid space, the anatomic space between the arachnoid membrane and pia mater of the brain.
I have only read about this condition before and I could vividly remember an article titled “Traumatic subarachnoid haemorrhage following blows to the neck” written by my supervisor at Guy’s Hospital, Professor Keith Mant, a renowned Forensic Pathologist in the last century. He reviewed 8 case of SAH following injuries to the neck.
Cricket helmets only became common for players in the late 1970s and many a player had been struck before then. For example, Indian test cricketer Nari Contractor’s career was cut short when he was struck on the skull by a short delivery from West Indian pace bowler Charlie Griffith in Barbados in 1962. This left hand opening batsman’s life was in danger for some time and he needed several emergency operations. Almost two years later he commenced playing first class cricket, but despite a brave attempt to stage a comeback to Test cricket, he never could play test cricket again.
Batsman have been getting hit in the head in cricket for years but as the Australian team doctor Peter Brukner said the condition that caused Hughes’ death is “incredibly rare” happening only once before with a cricket ball. I am not sure whether he was referring to Malik Alles’s injury. Brukner added that there were only 100 reported cases of the vertebral artery dissection Hughes suffered.
Although SAH is rare following similar neck injuries, can these tragic accidents be prevented? It is time to consider whether the type of helmet worn by the cricketers can be modified to give some protection to the neck area.