This  February former Chicago Bears safety David Duerson shot himself in the chest. The 50 year-old played in four Pro Bowls and also won a championship with the New York Giants in 1990. When he was found at his home in Sunny Isles Beach, FL, there was a note left behind which said:

“Please, see that my brain is given to the NFL’s brain bank.”

That is exactly what was done, and the results of the tests released yesterday showed “moderately advanced” evidence of chronic traumatic encephalopathy. According to Dr. Ann McKee, a neuropathologist and co-director of the Boston University School of Medicine Center for the Study of Traumatic Encephalopathy: “Dave Duerson had classic pathology of CTE and no evidence of any other disease. He had severe involvement of areas that control judgment, inhibition, impulse control, mood and memory.”

Chronic traumatic encephalopathy is a form of brain damage which is believed to be caused by repeated concussions. Originally described in boxers, and called dementia pugilistica (DP) (commonly called “punch drunk”), symptoms include memory impairment, speech and gait problems, Parkinsonism, tremors and lack of coordination. Early on there may be emotional instability, erratic behavior, depression and problems with impulse control. Eventually it leads to full-blown dementia. Floyd Patterson, Sugar Ray Leonard, and Muhammad Ali are all suspected to be victims of DP.

In 2002, Dr. Bennet Omalu, a forensic pathologist and neuropathologist in Allegheny County, Pennsylvania examined the brains of four professional football players who had histories of repeated concussions. Microscopic findings where identical to those found in DP, and he renamed the condition chronic traumatic encephalopathy.

The disease is characterized by the build-up of a toxic protein called tau in the form of neurofibrillary tangles (NFTs) throughout the brain (brown areas in the picture at left). These tangled clumps of protein are abnormal and found within the nerve cells in the brain. They were first described by Dr. Alois Alzheimer in one of his patients suffering from dementia. These tangles interfere with the normal functioning of the brain and eventually kill brain cells. Although the dementia of CTE is similiar to that seen in patients with Alzeheimers Disease, they are different conditions.

The distribution of the damage is widespread, including the cerebral cortex (which includes the frontal and temporal lobes), the thalamus, hypothalamus, brainstem and spinal cord.

Unfortunately, CTE can only be diagnosed at autopsy using special tests that are not routinely performed.

Boston University, at its Center for the Study of Traumatic Encephalopathy, has thus far studied the brains of 14 former NFL players,  and has found CTE in 13 of those players. They have even found evidence of CTE in younger football players- the youngest being 18 years old.

Dr. Omalu also tested the brain of WWF wrestler Chris Benoit. In 2007, Benoit had killed his wife and son before hanging himself. Dr. Omalu’s studies showed CTE in all areas of Benoit’s brain.

Watch here to see a video about how CSTE researchers are working to make sports safer:

This week the Chicago Tribune reported that former Chicago Bears quarterback Jim McMahon was suffering from memory loss. The Super Bowl XX winning quarterback attributes the problem to be the result of the multiple concussions he had during his football career. McMahon told the Tribune:

“Back then, it was just tape an aspirin to your helmet and you go back in….I’ve worked with some neurosurgeons and it’s a very serious thing, man… My memory’s pretty much gone. There are a lot of times when I walk into a room and forget why I walked in there. I’m going through some studies right now and I am going to do a brain scan. It’s unfortunate what the game does to you.”

What is a concussion?

The brain normally floats inside the skull, surrounded by spinal fluid. The brain has a consistency somewhat like jello, and although somewhat protected by the skull, is not completely protected by the impact of a violent force. Rapid changes in head movement, such a significant blow to the head, can cause the brain to hit against the inner wall of the skull, causing injury to the delicate brain tissue. There is also a chance that blood vessels in the brain can be torn, leading to bleeding in or around the brain.

What is the impact of repeated concussions on athletes?

In June, 2010 we wrote a story about Chris Henry, the NFL football player who was killed when he fell out of a truck. His autopsy revealed that the Cincinnati Bengals wide receiver had had chronic traumatic encephalopathy (CTE) at the time of his death. CTE is a form of brain damage which is believed to be caused by repeated concussions. Symptoms include memory impairment, speech and gait problems, Parkinsonism, tremors and lack of coordination.  Early on there may be emotional instability, erratic behavior, depression and problems with impulse control.

Fortunately the NFL is trying to do something to decrease the impact of concussions on their players. The National Football League and commissioner Roger Goodell set forth a new policy this past season to better monitor football players who suffer concussions. What this concussion policy intends to do is to not allow a player back onto the field until he has fully recovered and been cleared by a neurologist. The policy states:

“The player should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant”.

The activities mentioned above include practices, not just games. Unfortunately, the one thing that may limit the rule’s effectiveness is the attitude of the players themselves. Football still has a “play through the pain in order to achieve glory” attitude where players are not likely to be as open about symptoms  as they should be. What kind of message does this give to our student athletes?

Yesterday, scientists at the Brain Injury Research Institute (BIRI) of West Virginia University, announced that the late Cincinnati Bengals wide receiver,  Chris Henry,  had chronic traumatic encephalopathy (CTE) at the time of his death. Mr. Henry, 26, died on Dec. 17, 2009, after suffering severe head trauma when he either jumped or fell from the back of a moving pickup truck being driven by his fiancée. The two had been involved in a dispute before Henry jumped into the truck.

Chronic traumatic encephalopathy is a form of brain damage which is believed to be caused by repeated concussions. Originally described in boxers, and called dementia pugilistica (DP) (commonly called  “punch drunk”), symptoms include memory impairment, speech and gait problems, Parkinsonism, tremors and lack of coordination.  Early on there may be emotional instability, erratic behavior, depression and problems with impulse control. Eventually it leads to full-blown dementia. Floyd Patterson, Sugar Ray Leonard, and Muhammad Ali are all suspected to be victims of DP.

In 2002, Dr. Bennet Omalu, a forensic pathologist and neuropathologist in Allegheny County, Pennsylvania examined the brains of four professional football players who had histories of repeated concussions. Microscopic findings where identical to those found in DP, and he renamed the condition chronic traumatic encephalopathy.

The disease is characterized by the build-up of a toxic protein called tau in the form of neurofibrillary tangles (NFTs) throughout the brain (brown areas in the picture at left). These tangled clumps of protein are abnormal and found within the nerve cells in the brain. They were first described by Dr. Alois Alzheimer in one of his patients suffering from dementia. These tangles interfere with the normal functioning of the brain and eventually kill brain cells. Although the dementia of CTE is similiar to that seen in patients with Alzeheimers Disease, they are different conditions.

The distribution of the damage is widespread, including the cerebral cortex (which includes the frontal and temporal lobes), the thalamus, hypothalamus, brainstem and spinal cord.

Unfortunately, CTE can only be diagnosed at autopsy using special tests that are not routinely performed.

Boston University, at its Center for the Study of Traumatic Encephalopathy, studied the brains of eleven professional and college football players.  All had evidence of CTE. Eight died suddenly in middle age, and seven experienced “tragic deaths”- three from suicide, two from substance abuse, one during a high-speed police chase and one accidental gunshot while cleaning his gun.

Dr. Omalu also tested the brain of WWF wrestler Chris Benoit.  In 2007, Benoit had killed his wife and son before hanging himself.  Dr. Omalu’s studies showed CTE in all areas of Benoit’s brain.

In a week where two leading quarterbacks were sidelined by concussions, it is interesting to note that the co-chairmen of the league’s committee on brain injuries have resigned. The two, Dr. Ira Casson and Dr. David Viano, had been criticized by the NFL Players Association as being biased in their evaluation of research about the long term impact of concussions in NFL players. The independent and league-sponsored studies linked NFL careers with a heightened risk for dementia and cognitive (thought) decline. Dr. Casson had criticized the studies, saying the sample size was too small and that more research needed to be done before an assessment could be made. According to NFL Commissioner Roger Goodell, who announced the resignations, the committee on brain injuries was formed to evaluate specific types of plays to evaluating possible rules changes “to reduce head impacts and related injuries in a game setting.” We’re all for that!

“Football isn’t a contact sport, it’s a collision sport. Dancing is a contact sport.”
– Vince Lombardi, professional football coach (in Sports in America) by J. Michener

Playing football gave two NFL quarterbacks more than a headache yesterday- it gave them concussions. Arizona Cardinal’s  Quarterback Kurt Warner left the game in the second quarter after being hit from behind by Rams safety Oshiomogho Atogwe. He appeared shaken but stayed in the game for five more plays. As Warner put it: “It was one of those situations where I didn’t feel perfect, so I just wanted to be cautious with it. I actually feel pretty good right now. Just a very, very slight headache. I remember everything that happened. I didn’t get knocked out.”

Meanwhile, Pittsburgh Steeler’s QB Ben Roethlisberger, who faced Warner this year in the Super Bowl, was also injured by taking a knee to the head while being sacked during the Steeler’s game against the Kansas City Chiefs. Roethlisberger left the game right afterward, which was in overtime. This is apparently the fourth concussion of his NFL career. According to Pittsburgh coach Mike Tomlin, “It was a concussion-oriented thing, so I doubt he was going to come back into the football game. I don’t have a lot of information in terms of where he is or his level of availability.”

What is a concussion?

The brain normally floats inside the skull, surrounded by spinal fluid. The brain has a consistency somewhat like jello, and although somewhat protected by the skull, is not completely protected by the impact of a violent force. Rapid changes in head movement, such a significant blow to the head, can cause the brain to hit against the inner wall of the skull, causing injury to the delicate brain tissue. There is also a chance that blood vessels in the brain can be torn, leading to bleeding in or around the brain.

Concussion is a very common problem, with over 1 million concussions occurring in the US each year. Many occur as sports injuries. Symptoms can range from mild to severe. They can include headache, loss of consciousness, and memory loss (amnesia)of events surrounding the injury. Many concussions do not involve loss of consciousness, but victims may appear shocked or stunned or a short period of time.

Symptoms of a more serious head injury include:

* Changed level of alertness (drowsy, hard to arouse, or similar changes)
* Seizures (convulsions)
* Muscle weakness on one or both sides
* Continued confusion
* Persistent unconsciousness (coma)
* Repeated vomiting
* Unequal pupils
* Unusual eye movements
* Walking problems
* Ear ringing
* Impaired balance

The presence of these symptoms requires evaluation by a physician. For mild concussions, treatment is rest, mild analgesics, and observation.
For more information:

Resounding Health(TM) Concussion

Police have not yet concluded that Sahel Kazemi’s death was a suicide and are awaiting additional laboratory tests. They are not, however, looking for another suspect in McNair’s murder.

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