The recent violent attack on Chris Rock at the Oscars ceremony struck a chord with me. I often meet persons who suffer injuries in the workplace. A minor mishap can lead to health problems down the line. Consider problems that might follow a blow to the face:

• Craniofacial trauma. Facial bone fractures, sinus disruption, temporo-mandibular joint damage, jaw fracture or dental injuries may ensue. Indeed, craniofacial surgeons must specialize for years to be able to diagnose and manage this complex anatomical area.
• Brain injury. Retired football players may suffer cognitive problems ranging from impaired concentration to “brain fog,” seizures and poor memory. Moreover, we now appreciate that sub-concussive trauma may suffer chronic post-traumatic brain dysfunction, at least when it occurs repeatedly. Head trauma deserves respect.
• “Injury to psyche.” Attorneys use this term to encompass psychiatric or psychological problems in the wake of a traumatic event. Consider, for example, secondary anxiety, depression or even post-traumatic stress disorder. As I watched the Oscar ceremony attack, it struck me that an open-handed slap conveys a kind of dismissal and disdain. Might the victim suffer insomnia, flashbacks, family difficulties or substance abuse as a result?
• Vascular injuries. I have encountered strokes in persons with neck trauma due to injuries to vertebral arteries. Trauma to the head may disrupt blood flow to the brain, causing secondary damage.
• Ocular trauma. Detached retinas, displaced lenses, rupture of the globe or “blow out” fractures of the orbit may cause blindness or impaired ability visual function. Indeed, brain trauma can cause vision loss, referred to as “cortical blindness.”
• Acoustic trauma. Damage to the ear drum or inner ear anatomy can cause hearing loss, balance disruption or ringing in the ears.
• Internal organ damage. Painkillers, anti-depressants, muscle relaxers, or other agents prescribed after an injury, can lead to stomach ulcers, liver inflammation, kidney damage or added injuries due to sedation. Weight gain or weight loss caused by altered functional status can affect diabetes, hypertension or heart disease.
• Social and economic implications. I cannot offer legal opinions as a physician. We all recognize, however, that pain and suffering, loss of earning capacity and future medical care are critical issues that lawyers argue about. Rock is an entertainer in his prime, likely commanding generous compensation.

“Delayed homicides and the proximate cause” addresses even more dire implications of physical violence, according to Peter Linn and James R. Gill’s 2009 article in the American Journal of Forensic Medical Pathology. The authors explore delayed homicides due to “complications of remote injuries inflicted by ‘the hands of another.’ ” Based on a study in New York City over a two-year period, the authors found that 1,211 homicides occurred, with 42 deaths attributed to injuries sustained more than a year before death. They describe, for example, the occurrence of “seizure disorder due to remote trauma.”

The National Association of Medical Examiners issued a position paper in the electronic publication Epilepsia recommending death investigation on a more regular basis for persons dying of epilepsy, to “ . . . improve the precision of death certificate data available for public health surveillance of epilepsy-related deaths.”

Supposedly, Will Smith attacked Rock because the comedian likened Smith’s wife to GI Jane, as both individuals sported noticeably short hair. Smith took this as an insult to his wife, although he first laughed at the joke. There are different forms of alopecia, including a sudden hair loss following a medically or emotionally traumatic event.

Rock appears to be free of baldness, but he could develop alopecia in the wake of this emotionally and physically traumatic experience. Could Smith’s outburst foster alopecia among shocked witnesses? That prospect appears theoretically possible. Violence can make the human body do strange things.

Scott T. Anderson, M.D. ([email protected]), is a clinical professor at the University of California Davis Medical School. This column is informational and does not constitute medical advice.

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