wr Chris Henry - evidence of prior brain damage

[transient]

That was NOT the case's coroner's report. It was an opinion of a neurosurgeon and a pathologist who was asked to review the slides by Henry's mother. In fact these docs, who are completely uninvovled with Henry's care, made this announcement with her at their sides.

 

You see where this is going? Be skeptical.

 

Mom better be cautious, lest they find she or pops shook him a little too hard as a kid.

[stuckincincy]

The thing is, Henry was only 26. What they're describing is normally a longterm consequence of repeated head trauma. Think Mohammed Ali who has what was previously referred to as dementia pugilistica. The onset was while he was boxing, but the full effects were long after his career was over. Makes me wonder if Henry didn't experience repeated head trauma as a child or have some early form of underlying genetic or other neurodegenerative disease.

 

Common sense - hit something repeatedly hard, and it gets damaged. It can be your body or you car or your house, whatever.

[BillsFanM.D.]

if the changes they saw were frontal in nature, it is not a giant leap at all to say that a person would be likely to have poor executive functioning, impulsivity, and other mood or behavioral problems

 

re: frontal lobe stuff....this trauma is a bit more abrupt but the example explains the concern with frontal lobe injuries.

 

http://en.wikipedia.org/wiki/Phineas_Gage

[el Tigre]

I am so sick of congress and doctors throwing their two cents in this. Ask any NFL football player about Brain Damage and the sport they play. they all recognize the risks and don't care.

 

Besides there isn't any concrete evidence for it anyway.

I agree! I hate it when doctors feel the need to throw their 2 cents in on medical issues!

[Doc]

Encephalopathy is not soley a clinical diagnosis, it can be made on the basis of imaging or on tissue obtained from a biopsy or autopsy as well (think of bovine spongiform encephalopathy or "Mad Cow disease"), therefore it can be made on a dead person. In terms of chronic changes, it could be seen if the person suffered repeated injury during his early years and sufficient time had passed. As I had said earlier, if the changes they saw were frontal in nature, it is not a giant leap at all to say that a person would be likely to have poor executive functioning, impulsivity, and other mood or behavioral problems that could lead to them taking risks that a normal person would not. The front part of the brain is responsible for these functions. It's the same as a person with a stroke in the left side of the brain losing the function of the right side of their body.

Well stated, although encephalopathy leading to poor impulse control is a little more esoteric than a stroke. However it cannot be excluded as a major cause, especially when there's histologic evidence of it.

Encepahlopathy is a clinical diagnosis--it therefore cannot be made on a dead person. Seeing chronic changes of repeated head trauma on a 26 year old is dubious. Making the link to his behavior that fateful day requires a quantum leap of faith---even on the doc who is making this claim.

"Encephalopathy is a clinical diagnosis?" If only you'd just misdiagnosed an ACL tear from your TV.

[transient]

Well stated, although encephalopathy leading to poor impulse control is a little more esoteric than a stroke. However it cannot be excluded as a major cause, especially when there's histologic evidence of it.

 

 

Agreed. I was trying to use the more common condition of a stroke to demonstrate how an injury to an area of the brain can affect well established brain functionality.

[cåblelady]

very sad

[Mr. WEO]

Well stated, although encephalopathy leading to poor impulse control is a little more esoteric than a stroke. However it cannot be excluded as a major cause, especially when there's histologic evidence of it.

 

"Encephalopathy is a clinical diagnosis?" If only you'd just misdiagnosed an ACL tear from your TV.

Wow....

 

Anyway, Yes, it is. It's a clinical syndrome and has many causes. One is brain injury. A pathology slide will not tell you if a patient was encephalopathic at the time of death--or at any time. "Mad cow" or BSE is described on pathology--the "E" because the individual was actually enchepalopathic. Hence the name.

 

Come on doc, you must have been present for part of med school and residency. It's hard to believe you're arguing this one. Wait--no it's not!

 

By the way--you're the one who jumped in on the "ACL injury".

[DarthICE]

Henry take a lot of head shots?? Any concussions? You're right--he was only 26.

 

Hard to imagine the subtle changes in the brain morphology associated with this disease would be detectable after the guy suffers an acute, massive, fatal brain injury. And to suggest that this is why he jumped on the truck?

 

I'm calling a bit of bullsh*t on this report.

 

 

As am I, its pure bull ****.

[Doc]

Wow....

 

Anyway, Yes, it is. It's a clinical syndrome and has many causes. One is brain injury. A pathology slide will not tell you if a patient was encephalopathic at the time of death--or at any time. "Mad cow" or BSE is described on pathology--the "E" because the individual was actually enchepalopathic. Hence the name.

 

Come on doc, you must have been present for part of med school and residency. It's hard to believe you're arguing this one. Wait--no it's not!

Oy. One can most certainly diagnose that encephalopathy (certain types, not all of them) was present on autopsy. Using the aforementioned BSE (and the human form, variant Creutzfeldt-Jakob disease), there are actual holes in the cortex and spinal cords of cows (humans), hence the "spongiform" term. In Wernicke's encephalopathy, there are lesions and atrophy in the mammillary bodies, among other structures. In hypoxic encephopathy, there can be generalized cortical atrophy, like in Terri Schiavo's case. That a neurosurgeon and ME (of which you are neither) said that Henry suffered from chronic traumatic encepthalopathy, based on microscopic analysis should have made you think twice. But hey, send a letter to them at the Brain Injury Research Institute telling them that they're FOS, and ask them what part of med school they missed.

[transient]

Wow....

 

Anyway, Yes, it is. It's a clinical syndrome and has many causes. One is brain injury. A pathology slide will not tell you if a patient was encephalopathic at the time of death--or at any time. "Mad cow" or BSE is described on pathology--the "E" because the individual was actually enchepalopathic. Hence the name.

 

Come on doc, you must have been present for part of med school and residency. It's hard to believe you're arguing this one. Wait--no it's not!

 

By the way--you're the one who jumped in on the "ACL injury".

 

Don't confuse someone being encephalopathic (exhibiting confusion or "global brain dysfunction") with the underlying etiology (or encephalopathy). You can have early stages of an encephalopathy without being frankly encephalopathic. You can't tell by biopsy or autopsy if a person was exhibiting symptoms, but in specific conditions where structural changes are present such as traumatic encephalopathy you can certainly tell if they had underlying evidence of the condition. And for the record, the "E" is for encephalopathY not encephalopathIC, as in a pathology (disease, condition, or abnormality) of the encephalon (brain). If a person was in the early stages of Mad Cow and got hit by a bus, it would not change the fact that they had the pathologic condition, even if they were not yet encephalopathic.

[Steely Dan]

Henry had the brain injury, I'm sure of that but I don't buy the bad behaviors being directly linked to it. Sometimes a guy is just an A-hole.

 

If this was the cause of his behavior then he couldn't have been "turning his life around" as so many people say he was, he'd be powerless to do so. I think this can cause neurological problems, like Mike Websters*, but using it to excuse someone for being an A-hole is something I'm very skeptical about. There are a lot of A-holes who've never had head trauma. More importantly though, IMO, is that the vast majority of football players walk away from the game without violent tendencies and are able to cope with life in general effectively. Steve Tasker, Bruce Smith, Thurman Thomas, Darryl Talley, etc. etc. Offensive and defensive linemen bang heads on every play and, I'm only going by my perception, it doesn't seem there is a radical difference in their positions in regards to the number of violence related cases among football players. There are many boxers who have led productive lives after boxing too. George Forman went from being an A-hole to being a much better person after his career.

 

I can already hear the defense attorney's licking their chops. How long will it be before somebody says OJ's behavior was the result of constant head banging. It wasn't OJ that beat his wife and killed Ron and Nicole, it was his battered brain. MV only found joy in torturing and killing dogs because he played football and suffered head injuries. Rae Carruth planned his girlfriends murder and helped execute it due to head injuries. Travis Henry is a dope dealer due to head injuries.

 

I'm inclined to believe that the A-hole tendencies of some players are the result of being coddled for the majority of their lives because they are star athletes.

 

I'd be very interested in finding out how many of the guys that were found to have had this had uncontrollable problems in their lives.

 

 

*from the article;

 

CTE carries specific neurobehavioral symptoms, Bailes said – typically, failure at personal and business relationships, use of drugs and alcohol, depression and suicide.

 

These things should be showing up in the majority of players if the cause and effect is to be believed. JMO

[Mr. WEO]

Oy. One can most certainly diagnose that encephalopathy (certain types, not all of them) was present on autopsy. Using the aforementioned BSE (and the human form, variant Creutzfeldt-Jakob disease), there are actual holes in the cortex and spinal cords of cows (humans), hence the "spongiform" term. In Wernicke's encephalopathy, there are lesions and atrophy in the mammillary bodies, among other structures. In hypoxic encephopathy, there can be generalized cortical atrophy, like in Terri Schiavo's case. That a neurosurgeon and ME (of which you are neither) said that Henry suffered from chronic traumatic encepthalopathy, based on microscopic analysis should have made you think twice. But hey, send a letter to them at the Brain Injury Research Institute telling them that they're FOS, and ask them what part of med school they missed.

Encephalopathy caused by infection, liver failure, kidney failure are fully reversable in most cases and therefore will leave no pathologic damage to the brain. These are toxin related diseases.

 

Wernicke's encepaholpathy is caused by thiamine deficiency and when presenting acutely and treated appropriately, is completely reversible and will leave no mark on the brain.

 

In fact most etiologies of encepahlopathy diagnosed and treated early will have the same outcome, with no "brain damage". I don't disagree that any etiology left untreated will leave pathologic evidence in the brain and be irreversible.

 

However, Henry was a young guy with very low miles on him and NO history of head injury or concussion in college or the pros (he was hardly ever on the field!). And it was certainly not "encephalopathy" that made him jump on the truck. And if that is the case--what is the point of these two docs coming forth with their "diagnosis"? I'm assuming the family brought them in for a reason. "Doctor, is this an injured brain?". "Oh yes, yes it is. Let's announce this att a press conference." If you want a certain dagnosis, you go to a certain doctor. Happens a lot in medicine, doc.

 

Check out the doc's theory of how Henry may have developed such an advanced state of the disease which left permanent pathologic changes to his brain, despite no history of head trauma. If Henry got it that way, then every player's got it, I guess. Ditto anyone who rides a cab in Manhattan.

 

Transient<

 

I will concede that the most rare of all human diseases may have already caused brain injury well before the patient is symptomatic, but as above, nearly all other causes are overtly symptomatic and the permanent damage (pathological change) is a later sequela of the disease.

[Adam]

Some people think that others are just here for their entertainment. When they are used up, scoop them up, bury them and bring on the next victim.

 

Concussions are serious business, one of the most serious injuries you can have. People that think otherwise should be brushed aside until they grow up and are able to live in the grown up world.

[shrader]

*from the article;

 

CTE carries specific neurobehavioral symptoms, Bailes said – typically, failure at personal and business relationships, use of drugs and alcohol, depression and suicide.

 

These things should be showing up in the majority of players if the cause and effect is to be believed. JMO

 

It's not that simple. The idea is that these types of injuries put you at risk of developing that type of condition. Even if it is a risk factor, it is no guarantee. All obese people don't wind up developing diabetes and all smokers don't suffer some sort of cardiovascular disease, but those are definitely risk factors for those conditions. It wouldn't have to be the majority of players developing those symptoms, just a significantly higher rate than the normal population.

[Mr. WEO]

It's not that simple. The idea is that these types of injuries put you at risk of developing that type of condition. Even if it is a risk factor, it is no guarantee. All obese people don't wind up developing diabetes and all smokers don't suffer some sort of cardiovascular disease, but those are definitely risk factors for those conditions. It wouldn't have to be the majority of players developing those symptoms, just a significantly higher rate than the normal population.

The symptoms you list are nonspecific and common to several psychological diseases that have no pathological lesions.

 

I would tend to agree with you if there was any evidence, antemortem, that Henry had any injury. Other than "moving fast and suddenly stopping", which every football player does regularly, it's...unusual to find evidence of chronic brain damage in a healthy young man.

 

At least one third of all morbidly obese individuals have type 2 diabetes. The majority of heavy smokers will develop a smoking related disease. Those are large numbers, not rarities. Since all NFL players are exposed to at least as much injury as Henry, many, if not most, should exhibit the same behavior and the same brain pathology.

 

Besides, these guys are hedging any conclusion. They are just "tossing it out there".

[stuckincincy]

The symptoms you list are nonspecific and common to several psychological diseases that have no pathological lesions.

 

I would tend to agree with you if there was any evidence, antemortem, that Henry had any injury. Other than "moving fast and suddenly stopping", which every football player does regularly, it's...unusual to find evidence of chronic brain damage in a healthy young man.

 

At least one third of all morbidly obese individuals have type 2 diabetes. The majority of heavy smokers will develop a smoking related disease. Those are large numbers, not rarities. Since all NFL players are exposed to at least as much injury as Henry, many, if not most, should exhibit the same behavior and the same brain pathology.

 

Besides, these guys are hedging any conclusion. They are just "tossing it out there".

 

 

Why anyone would bring diabetes into this thread escapes me...

[transient]

Encephalopathy caused by infection, liver failure, kidney failure are fully reversable in most cases and therefore will leave no pathologic damage to the brain. These are toxin related diseases.

 

Wernicke's encepaholpathy is caused by thiamine deficiency and when presenting acutely and treated appropriately, is completely reversible and will leave no mark on the brain.

 

In fact most etiologies of encepahlopathy diagnosed and treated early will have the same outcome, with no "brain damage". I don't disagree that any etiology left untreated will leave pathologic evidence in the brain and be irreversible.

 

However, Henry was a young guy with very low miles on him and NO history of head injury or concussion in college or the pros (he was hardly ever on the field!). And it was certainly not "encephalopathy" that made him jump on the truck. And if that is the case--what is the point of these two docs coming forth with their "diagnosis"? I'm assuming the family brought them in for a reason. "Doctor, is this an injured brain?". "Oh yes, yes it is. Let's announce this att a press conference." If you want a certain dagnosis, you go to a certain doctor. Happens a lot in medicine, doc.

 

Check out the doc's theory of how Henry may have developed such an advanced state of the disease which left permanent pathologic changes to his brain, despite no history of head trauma. If Henry got it that way, then every player's got it, I guess. Ditto anyone who rides a cab in Manhattan.

 

Transient<

 

I will concede that the most rare of all human diseases may have already caused brain injury well before the patient is symptomatic, but as above, nearly all other causes are overtly symptomatic and the permanent damage (pathological change) is a later sequela of the disease.

 

WEO, all of the causes of encephalopathy you listed above cause dysfunction in the brain, and you happened to select those that are reversible to attempt to prove your point. If you were to biopsy a person's brain that was acutely encephalopathic in any one of those conditions you would find acute changes be they metabolic, inflammatory, edematous, etc if you were looking in the right place. If you WERE to biopsy them, you would ALSO get sued for malpractice, as they are all treatable conditions with a reversible cause. To suggest they universally leave no residual brain damage is also incorrect, as evidenced by the fact that people with meningitis have an increased tendency to have seizures as well as hearing deficits, especially if they had this at a young age. Regardless, I am not disagreeing with the treatable or generally reversible nature of the examples you provided. To suggest that they represent the majority of the causes of encephalopathy is wrong. They are some of the more common causes, however there are countless genetic causes that result in accumulated changes in the brain over time that can occur in people who are apparently of normal intelligence and functioning at birth and into their adult lives; there are conditions that are as a result of improper proteins within the brain; there are conditions that strip the coating off of nerves, as well as infections that can do the same that are not treatable; there are changes due to hypertension that are not necessarily acutely symptomatic, but that can be seen on an MRI... I could go on endlessly. The fact is, you mention acute causes of encephalopathy and state these are the majority, but there are numerous causes of progressive encephalopathy (slow onset changes to the brain that accumulate over time), of which traumatic encephalopathy is one.

 

In my initial post, my statement was that Henry was awfully young to have those findings, and that I didn't think 4-5 years in the NFL would cause that. This was meant more as an "I wonder what happened to this guy earlier in his life before he became a pro football player" kind of statement. For all we know he and his delinquent friends donned baseball helmets and hit one another in the head with a bat after school from the time they were 12. Also, everyone's biology is different. He could have an underlying predisposition to a degenerative disease such as frontotemporal dementia that usually presents in a person's 50s, and similarly results in people becoming disinhibited and exhibiting poor judgement, and his chosen profession hastened it's progression by causing trauma in areas that were already susceptible thereby exacerbating it. Who knows. The fact is if other players want to use this as an excuse someone would have to biopsy their brain to conclusively demonstrate evidence of disease, something I doubt many players would be excited to have done.

 

The thing is it's not a stretch, as several have mentioned, to think that in a population of people who have spent their lives running into things at full speed that this condition would be more prevalent. It's also not hard to believe that a sport like football would have a higher number of naturally aggressive, disinhibited a-holes succeeding given the very nature of the sport. Calling BS on Henry's mother's motive for doing this is different than calling BS on the fact that there was evidence of an underlying condition. Was it severe enough to affect Henry's decision making? Who knows, but the presence of it certainly didn't make him a more rational, thoughtful person.

[Mr. WEO]

WEO, all of the causes of encephalopathy you listed above cause dysfunction in the brain, and you happened to select those that are reversible to attempt to prove your point. If you were to biopsy a person's brain that was acutely encephalopathic in any one of those conditions you would find acute changes be they metabolic, inflammatory, edematous, etc if you were looking in the right place. If you WERE to biopsy them, you would ALSO get sued for malpractice, as they are all treatable conditions with a reversible cause. To suggest they universally leave no residual brain damage is also incorrect, as evidenced by the fact that people with meningitis have an increased tendency to have seizures as well as hearing deficits, especially if they had this at a young age. Regardless, I am not disagreeing with the treatable or generally reversible nature of the examples you provided. To suggest that they represent the majority of the causes of encephalopathy is wrong. They are some of the more common causes, however there are countless genetic causes that result in accumulated changes in the brain over time that can occur in people who are apparently of normal intelligence and functioning at birth and into their adult lives; there are conditions that are as a result of improper proteins within the brain; there are conditions that strip the coating off of nerves, as well as infections that can do the same that are not treatable; there are changes due to hypertension that are not necessarily acutely symptomatic, but that can be seen on an MRI... I could go on endlessly. The fact is, you mention acute causes of encephalopathy and state these are the majority, but there are numerous causes of progressive encephalopathy (slow onset changes to the brain that accumulate over time), of which traumatic encephalopathy is one.

 

In my initial post, my statement was that Henry was awfully young to have those findings, and that I didn't think 4-5 years in the NFL would cause that. This was meant more as an "I wonder what happened to this guy earlier in his life before he became a pro football player" kind of statement. For all we know he and his delinquent friends donned baseball helmets and hit one another in the head with a bat after school from the time they were 12. Also, everyone's biology is different. He could have an underlying predisposition to a degenerative disease such as frontotemporal dementia that usually presents in a person's 50s, and similarly results in people becoming disinhibited and exhibiting poor judgement, and his chosen profession hastened it's progression by causing trauma in areas that were already susceptible thereby exacerbating it. Who knows. The fact is if other players want to use this as an excuse someone would have to biopsy their brain to conclusively demonstrate evidence of disease, something I doubt many players would be excited to have done.

 

The thing is it's not a stretch, as several have mentioned, to think that in a population of people who have spent their lives running into things at full speed that this condition would be more prevalent. It's also not hard to believe that a sport like football would have a higher number of naturally aggressive, disinhibited a-holes succeeding given the very nature of the sport. Calling BS on Henry's mother's motive for doing this is different than calling BS on the fact that there was evidence of an underlying condition. Was it severe enough to affect Henry's decision making? Who knows, but the presence of it certainly didn't make him a more rational, thoughtful person.

I didn't select them---they are the diseases that most commonly cause encephalopathy in non elderly patients. All might show acute brain pathology (no need to biopsy them!), but most are reversible if diagnosed and treated in a timely fashion. Meninigitis of course can do irreparable damage to the central nervous system if not successfully treated.

 

There are not countless (which are all rare) genetic diseases that cause encephalopathy and these certainly do not make of the majority of cases, nor do other diseases such as hypertension---unless you are defining "encephalopathy" now as any pathologic condition of the brain. You would then have to include malignancy as one of the most common causes. This is not how the term is used.

 

I initially called BS on the motivation of the docs and the family coming forth with this. Also, I am still skepitcal that you could take a severely, acutely traumatized brain (massive hemmorhage and edema) and find a few noninjured areas that happened to have the very surprising findings of chronic disease that the family was looking for. What lead the family to think that he, at age 26, had such a devestating and chronically debilitating disease? How hard was it for these docs to find just what they were looking for?

 

Sorry, that's just me.

[Doc]

I didn't select them---they are the diseases that most commonly cause encephalopathy in non elderly patients. All might show acute brain pathology (no need to biopsy them!), but most are reversible if diagnosed and treated in a timely fashion. Meninigitis of course can do irreparable damage to the central nervous system if not successfully treated.

 

There are not countless (which are all rare) genetic diseases that cause encephalopathy and these certainly do not make of the majority of cases, nor do other diseases such as hypertension---unless you are defining "encephalopathy" now as any pathologic condition of the brain. You would then have to include malignancy as one of the most common causes. This is not how the term is used.

 

I initially called BS on the motivation of the docs and the family coming forth with this. Also, I am still skepitcal that you could take a severely, acutely traumatized brain (massive hemmorhage and edema) and find a few noninjured areas that happened to have the very surprising findings of chronic disease that the family was looking for. What lead the family to think that he, at age 26, had such a devestating and chronically debilitating disease? How hard was it for these docs to find just what they were looking for?

 

Sorry, that's just me.

That certain types of encephalopathy can leave changes in the CNS is inarguable. And yes many are diagnosed clinically (and in Henry's case, as far as we know, there was no clinical diagnosis for his behavior). I just don't see why these 2 doctors would fabricate their findings. Perhaps the family is angling for a lawsuit against the NFL, and if they were, that will tell us more. But I don't see it, and I don't see them winning a lawsuit, if they were to bring one.