Autopsy is such a morbid concept, such a horrible invasion of privacy at a time when loved ones are dealing with the shock waves of grieving.\u00a0 Yet, ironically it is the one good thing that can come out of death, especially the death of a young person.\u00a0 The remarkable findings announced this week of former NFL player Chris Henry\u2019s autopsy will contribute immeasurably to our understanding of brain injury and the risks of playing football. \u00a0Out of the tragedy of Chris Henry\u2019s life and death, the lasting contribution he may make to our world is illuminating the connection between abnormal behavior and brain damage.<\/p>
Mild Traumatic Brain Injury (MTBI) is one of the single most difficult things to diagnose and research in medicine. Its critical symptomotology, that momentary loss of consciousness or awareness, is almost never witnessed by the medical team.\u00a0 The pathology is far too small to be seen on CT scan, and only in the most serious cases are conventional MRI\u2019s showing clear cut evidence.\u00a0 While it has a clear cut pattern of symptoms, other illnesses and conditions come with similar symptoms, making differentiating the condition harder.\u00a0 This issue confounds the long thought gold standard for MTBI diagnosis, neuropsychology.\u00a0 While in severe brain injury cases neuropsychology will demonstrate unequivocal patterns of \u00a0cognitive deficits, in MTBI or (Post Concussion Syndrome \u2013 PCS, a term used interchangeably) the deficits are subtle and could be dismissed as being caused by a myriad of other problems, including depression and poor motivation.\u00a0 Adding to this problem is that depression and poor motivation are the symptoms of MTBI or PCS.\u00a0 Further complicating the diagnostic puzzle is that those with premorbid histories of depression, anxiety, PTSD, or prior MTBI are far more likely to \u00a0be disabled by MTBI.\u00a0 Finally, as many as half of the neuropsychologists practicing today are \u201cnon-believers\u201d in PCS.<\/p>
Now contrast an in vivo (during life) diagnosis of MTBI with an autopsy.\u00a0 In autopsy there is no ambiguity.\u00a0 The microscopic damage can be seen under a microscope.\u00a0 The axonal tracts that may have been compromised, can be examined with the naked eye.\u00a0 Actual residual blood stains can be seen on neural tissue.\u00a0 The diagnosis can be made with a high certainty.\u00a0 What value does it have to diagnose a non-life threatening condition after a person is already dead?\u00a0 It moves the science of brain injury forward by leaps and bounds.\u00a0 Were autopsy an integral part of mild traumatic brain injury research, the skeptics would have to play their sophistic (<\/strong>plausible but fallacious) games elsewhere.<\/p> But here is the problem with making autopsy a more integral part of MTBI research: Since MTBI is a non-fatal condition, it may be decades between the onset of the condition and the autopsy.\u00a0 The movement to enlist NFL players to contribute their brains to a long term autopsy study is a true breakthrough, yet the research it will reveal will not become available for decades.\u00a0 (As a side note, those autopsy\u2019s done in the future generations, will be most illuminative if good records are kept of behavioral issues the players had after their careers ended and accurate records are kept of the concussions they suffered.)<\/p> Occasionally, medical science gets lucky on the misfortune of someone who dies young.\u00a0 That is what happened with Chris Henry. This research was possible because someone with a documented MTBI, died seven months later from an unrelated cause.\u00a0 Again, tragedy becomes fortuitous for medical science.\u00a0 The autopsy revealed:<\/p> Gross inspection of the brain at autopsy was normal; however, microscopic analysis demonstrated what were considered trauma findings of hemosiderin-laden macrophages in the perivascular space and macrophages in the white matter, particularly the section taken from the frontal lobe.<\/p><\/blockquote> All of the foregoing is important because this patient’s PCS was clearly documented.<\/p> The patient had partially returned to work at the time of death, but had encountered problems with diminished cognitive performance in his work as an appraiser. Neuropsychological studies were generally within normal limits although several tests of either speed of processing or short-term memory showed lower than expected performance. This case demonstrates the presence of subtle neuropathological changes in the brain of a patient who sustained a mild TBI and was still symptomatic for the residual effects of the injury 7 months post injury when he unexpectedly died.<\/p><\/blockquote> As discussed above, neuropsychological testing showed issues, but nothing that a skeptic couldn\u2019t dismiss as unrelated or feigned.\u00a0 But you can\u2019t fake the autopsy.<\/p> I have a narrow perspective on the neurosciences, devoting all of my time to representing those with traumatic brain injury. So take this with that bias in mind.<\/p> Nothing is more important to our medical science than to reach a greater understanding about the cause and nature of brain abnormalities, particularly those relating to trauma. <\/strong><\/p><\/blockquote> The U.S. government is now spending billions of dollars on TBI treatment for returning soldiers from Iraq and Afghanistan. \u00a0This hopefully will give us a tremendous data base to understand the nature of the forces, the acute period symptoms, the chronic problems that occur and neurobehavior abnormalities and disability that persist from TBI.\u00a0 Some great data surveillance information could be available, with force sensors in helmets, pre-deployment and post-injury neuropsychological documentation, and long term treatment issues.\u00a0 But as far as I can tell, there is one huge missing element in that focus: autopsy.<\/strong><\/p> It would be a horrible invasion of privacy \u00a0and treading on the grieving process to make it autopsy mandatory, but all efforts and no expense should be spared to autopsy the brains of all American soldiers who die in combat.\u00a0 This is imperative if the soldier suffered any head trauma or PTSD prior to death.\u00a0 One of the wonders of autopsy is that it can sort out the chronic brain damage that existed prior to the fatal event from the brain damage which caused death, such as in Chris Henry\u2019s case.<\/p> The fortuitous breakthrough from tragedy of a death from other causes with a documented prior TBI does not need to be a once in a generation opportunity.\u00a0 Unfortunately, nearly every day an American soldier is being killed who had some previous MTBI.\u00a0 Make those deaths mean something. Hundreds of such autopsies will advance our understanding not just about TBI in general. \u00a0Those autopsies could be of immeasurable value in treating other veterans who come home with TBI.<\/p>