Recent reports that chronic traumatic encephalopathy, aka CTE, has been diagnosed in the living, and former All-Pro and convicted murderer Aaron Hernandez, who committed suicide, had a severe case, will have widespread ramifications.
It could prompt a call for testing of athletes in collision sports from high school to the professional ranks. It could be used as a defense in criminal cases.
Dr. Bennet Omalu, then a pathologist in the Allegheny County (Pa.) coroner’s office, first brought CTE to light in football players in 2002 following his autopsy of the brain of former Pittsburgh Steelers Hall Fame center Mike Webster.
In a report published in the journal Neurosurgery, he revealed CTE was found in the brain of former Minnesota Vikings linebacker Fred McNeill in 2012. He died in 2015.
Dr. Ann McKee, a neuropathologist, and researchers at Boston University revealed Hernandez, 27, who hung himself in prison after being convicted of murdering his friend, Odin Lloyd, had a stage 3 (out of 4) case of CTE. Researchers hadn’t found a similar deterioration in anyone younger than 46.
While most physical injuries absorbed in football are quickly ascertained and often remedied, a broken brain is not easily revealed. Mandatory CTE testing for athletes engaged in sports like football, hockey, wrestling and even soccer (heading the ball), could be a staggering undertaking.
It also could raise questions about individual rights. Therapy may delay further brain deterioration, but for individuals with professional aspirations, CTE could close that door.
While CTE is associated with concussions, researchers also are concerned about repetitive and “subconcussive” impacts, including explosions in the military.
McNeill’s family enlisted Omalu, whose battle with the NFL to recognize his findings was portrayed in the movie “Concussion,” when the former player, who had become a highly regarded attorney, began experiencing memory loss, anger and depression.
Omalu’s experimental breakthrough — along with UCLA researchers — uses positron-emission tomography (PET scan) and a radioactive “tracer” called FDDNP to bind to tau proteins in the brain. Fourteen former NFL players, including Tony Dorsett, the Dallas Cowboys’ Hall of Fame running back, have been tested.
Tau helps the brain function. Without it, neurons collapse, cutting the flow of nutrients and molecules to cells. When autopsying Webster’s brain, Omalu found the tau buildup — tangles and clumps — haphazardly occurred in different regions — unlike Alzheimer’s disease.
Some researchers, though, believe FDDNP makes it difficult to differentiate CTE from Alzheimer’s. Neurologists at Mount Sinai Hospital in New York City are using another compound, Flortaucipir, in their attempts at diagnosis.
Meanwhile, according to the Atlantic magazine, the National Institutes of Health and the National Institute for Neurological Disorders are conducting “the largest and most thorough study of the disease” while seeking a diagnosis. Former football players are undergoing extensive testing, including an MRI, two PET scans, blood, saliva and spinal-fluid collection, and genetic evaluations.
Earlier this year, McKee and her Boston University team published a study in the Journal of the American Medical Association that found CTE in 177 brains of 202 deceased football players from pre-high school to the pros, including 110 of 111 NFL players.
They determined risk increased at each level, as did the severity with “cumulative hits.”
Inside Hernandez’ brain, the New York Times reported, they found, “Tau, stained brown, appeared like bursts of fireworks in the frontal cortex, the part of the brain that controls decision making, impulse and inhibition. The neuropathologist could see it spreading through the brain. It was in the amygdala, the part of the brain that regulates emotions like fear and anxiety, and the temporal lobe. She spotted ‘a perfect demonstration’ of lesions around the tiny blood vessels, a telltale sign. She found previous microhemorrhages and astrocytic scarring around the ventricles.”
For football players accused of violent crimes — at a higher rate than the general population — CTE could offer a possible legal defense. Omalu believes CTE could have been a factor in murders attributed to O.J. Simpson in a civil case. (He was found not guilty in a criminal proceeding.)
Writing in Sports Illustrated, attorney Michael McCann said Hernandez’s lawyers could have mounted an insanity defense that he “suffered a mental defect that rendered him substantially unable to conform his conduct to the requirements of the law, utterly unable to make himself behave as the law requires.”
The CTE revelations have opened up new avenues of medical research, concerns about safeguarding athletes in collision sports and the well-being of servicemen as its tentacles now reach into other areas of society.