There are two litmus tests for determining whether there has been a traumatic brain injury: autopsy and behavioral changes. Chris Henry, formerly of the Bengals, now deceased, has positive evidence of both. An autopsy performed on the troubled former player who was killed last year when he fell out of the back of his girlfriend’s pickup has been reported to be positive for brain damage. See http://www.nytimes.com/2010/06/29/sports/football/29henry.html?src=mv Henry’s brain has been found to have chronic traumatic encephalopathy (CTE), meaning that his brain shows damage which was caused by long term exposure to traumatic forces. The subject of CTE has been swirling around the NFL since last winter’s Congressional hearing on the NFL and brain injury. We have blogged on this topic often but see https://waiting.com/blog/2010/01/nfl-concussion-hearings-in-congress-moving-past-the-need-for-perfect-proof-of-brain-damage.html
Despite the calls for a litmus test for determining TBI in combat, sports and in accident cases, the only way to conclusively determine damage to the microscopic cells of the brain, has been through autopsy. Most of what we have learned about brain injury pathology has been through autopsy and little has changed about that despite advances in neuroimaging, including PET, MRI, FMRI and CT. In autopsy, you can examine damaged brain tissue under a microscope. In contrast, the best an MRI can do is see things the size of the point of a ball point pen. Thousands of damaged brain cells can exist in close proximity to each other, yet such damage not reach be large enough to see on any neuroimaging technique.
Since autopsy is a bit final what that leaves us in diagnosing brain injury is the evaluating the way in which the brain is functioning. While neuropsychology is a science based on the theory that such changes can be measured, the reality is that most brain injury disability is the result of the synergistic loading of cognitive emotional and behavioral challenges. There is rarely a substantial pure cognitive change in someone with less than a severe brain injury. Only under real world stress (not a laboratory setting such as during a neuropsychological assessment) can the functional changes be fully appreciated. Thus, diagnosis must be made based upon the clinician’s evaluation of the patient’s behavioral change. Listening to the patient and those who have interacted with him or her outside the doctor’s office are key to the diagnosis of TBI.
If the possibility of trauma had been considered with Chris Henry, the diagnosis of TBI would have been straightforward. If you know anything about Chris Henry, he has the precise behavioral telltales that would point to TBI. One could even argue that his death, was the result of such a meltdown. Where the surprise in the case arises is that he does not have either a long professional career or a documented history of concussion. This is not like Ben Roethlisberger where you can pinpoint at least one significant TBI – the motor cycle accident. At least according to current reports, Henry was never knocked out or taken out of play as a result of a concussion.
On the other hand, Henry played one of the two positions most vulnerable to concussive forces – wide receiver. Like a quarterback, wide receivers put themselves in defenseless positions, where the torque on the head and neck from being “blindsided” can be extraordinary and the body has no counter momentum to absorb the force. Also, like a quarterback, wide receivers concentration at the time of a hit has to be entirely away from the hit, but on the ball.
What is most disconcerting to the NFL about the discovery of CTE in Henry’s brain is the inference that even a partial career of routine hits, can not only result in microscopic residue in the brain, but materially alter behavior in such disturbing ways. One suggestion last year (not adopted) to avoid TBI in football was to outlaw the three point stance. While anything that reduces contact will help, it is the quarterbacks and the wide receivers that need the greatest protection. In the twin tales of Henry and Roethlisberger, perhaps light as to the true danger of the blindsided hit can be shed.
