A Jiu-Jitsu practitioner of 32 years has died in Brasília, Brazil after suffering a concussion due to a overly applied “rear naked choke” during a class on the 21st of September. The family claims that Napoleao José Alves was taken to a public hospital for two days after the choke and did not receive any special care because the case was not considered serious. A few days later, he was pronounced brain dead.

In a statement, the Brazilian health department says that he checked in a health unit in the day September 26 and that tests showed that the man had a concussion.
The family claims that Napoleao went 15 minutes recovering after the choke and then went home. Feeling bad, he was taken to the Regional Hospital of Taguatinga (HRT) for two days in a row, but did not receive care.
A nurse said said that tests ruled out the possibility of stroke.

Maria Alves, sister of the Jiu-Jitsu practitioner stated to O Globo:

“On Wednesday we went to the hospital and were asked to come back another day because it wasn’t an emergency. On Thursday tried to go to an orthopedist because of severe headaches and they referred us to a general practitioner, who requested an examination of skull and ruled out a serious condition. On Saturday we went back to the hospital because he was feeling ill and that he had a stroke in Radiology. He was taken to the emergency room and then the doctors said that the case was not serious and we had to wait an hour and 40 minutes to be treated “

Napoleao’s family members

On the same day, on 30 September, the jiu-jitsu practitioner was transferred to the Base Hospital and went straight to the ICU, but didn’t make it. The death certificate points, among the causes, to cerebral ischemia. This happens when there is decreased blood flow in the body, affecting the functioning of the brain, and can cause a stroke.
The report of the Forensic Medicine Institute, which will take 30 days, will point out what actually caused the man’s death. The family says wait for justice.

The family said that Napoleao started training BJJ only in August of this year.

Dangers of chokeholds

A chokehold can cause syncope, or temporary loss of consciousness, at which point the choke is released. Common chokeholds in grappling used to accomplish a choke-out are known as the rear naked choke, arm triangle, triangle choke, and the guillotine.

The mechanics behind choke-outs are disputed. It has been explained as resulting from directly constraining blood flow to the brain. A competing theory involves compression of the baroreceptors of the carotid artery, confusing the body into thinking blood pressure has risen. Due to the baroreflex, this causes vasodilation, or widening of the brain’s blood vessels intended to relieve high pressure. Since no blood pressure increase has actually occurred, the dilation causes a dramatic decrease in blood pressure to the brain, or brain ischemia, which then causes loss of consciousness.

There is debate over the dangers of choke-outs. After 4 to 6 minutes of sustained cerebral anoxia, permanent brain damage will begin to occur, but the long-term effects of a controlled choke-out for less than 4 minutes (as most are applied for mere seconds and released when unconsciousness is achieved) are disputed. However, everyone should note that generally loss of oxygen is never safe and always (even if minimal) causes death of brain cells. There is always risk of short-term memory loss, hemorrhage and harm to the retina, concussions from falling when unconscious, stroke, seizures, permanent brain damage, coma, and even death.

Some argue that when pressure is applied to the carotid artery, the baroreceptors send a signal to the brain and the heart via the vagus nerve. This signal tells the heart to reduce volume of blood per heartbeat, typically up to one-third, in order to further relieve high pressure. There is a slight chance of the rate dropping to zero, or flatline (asystole). However, there are several studies that showed choking out will result in a few seconds of flat line EEG for a few seconds at least in half of the subjects. This might suggest that choking out or syncope is not as safe as it was assumed to be previously.

Some argue that with thousands of tournaments since the sport of Judo began in 1882, hundreds of thousands of chokes have been applied, and the probability of hundreds if not thousands of choke-outs, with no reported deaths due to chokes, the chances of asystole are slim. It might be true that no direct death has reported as a result of chokes but there are numerous reports of these chokes turned out to strokes leaving the subject with permanent brain damage or possible more elaborated long-term effects.