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Concussions in Sports & The Role of PET Imaging

In 2002, a neuropathologist named Bennet Omalu discovered that repeated head trauma in football players caused brain damage similar to that of rapidly declining Alzheimer’s patients.

His discovery was spurred by the death of Mike Webber, a former pro-NFL player and Hall of Famer who had, in recent years, become increasingly withdrawn and depressed, showed signs of severe delusion and paranoia, and displayed unusual behavior such as tasering himself to unconsciousness to treat his back pain. He eventually lost or spent all of his money, which left him homeless, alone, and living in a truck. All before he died at the age of 50.

The CT and MRI scans Dr. Omalu performed on Mike Webber’s brain came back normal. There were no folds of gray matter. There were no signs of dementia pugilistica, otherwise known as Punch Drunk Syndrome, which is a condition boxers get after repeated blows to the head. But Dr. Omalu wanted to know more. He just couldn’t fathom how a once healthy football player in his prime had ended up going crazy for no reason.

So, after gaining permission from Mike Webber’s lawyer, Bob Fitzsimmons, Dr. Omalu sliced open Webber’s brain and found spectacular accumulations of brown and red splotches, known as tau proteins. Tau proteins are abnormal deposits that are found in regions of the brain controlling mood, cognition, and motor function. These tau proteins were responsible for the mental instability of Mike Webber, and the subsequent mental instability of Terry Long, who killed himself by drinking antifreeze; of Andre Waters, who shot himself; and of Justin Strzelczyk, a former offensive lineman who began hearing voices and eventually led a car chase through Buffalo, New York at 90 miles an hour until the cops blew out his tires, causing him to swerve into opposing traffic and explode when he crashed into an acid carrying tanker. He was just 36.

The numerous and often unnoticed concussions the football players received during games were causing long term damage; the significant amounts of tau proteins in the men’s brains akin to a 90 year old’s with dementia. Dr. Omalu and his associates concluded that this was a new disease that had never been seen before. They decided to call it chronic traumatic encephalopathy, or CTE.

Dr. Omalu published his findings in the July 2005 edition of Neurosurgery, and the NFL was not pleased. The long battle that was fought between Dr. Omalu and the NFL to fully recognize CTE as a legitimate concern for football players lasted seven years, and was chronicled by Jeanne Marie Laskas in her 2009 GQ article Game Brain. She eventually expanded the article into a book called Concussion, which would later be adapted into a 2015 film starring Will Smith. Maybe you’ve seen it.

Sport concussions are not a new problem, but besides boxing, the long-term effects of multiple concussions during sport hadn’t been discussed much before Dr. Omalu’s findings. And it’s not just football players that suffer. Over 200,000 people receive concussions while playing sports every year. Besides football; soccer, ice hockey, lacrosse, and wrestling all pose high risks of concussions. For men, football is the number one cause of concussion, while in women the number one cause is soccer. And, of course, children are the ones most at risk when they get on the playing field.

Early diagnosis is key when it comes to concussions. Getting hit a second time before the brain is properly healed can cause second impact syndrome, which in the most extreme cases can result in death. If a concussion is thought to have transpired, neurological exams and cognitive tests are used in diagnosis. If bleeding of the brain is suspected or symptoms such as severe headaches, seizures, or repeated vomiting occur, a CT scan may be performed. Past 48 hours, an MRI scan will most likely be done due to its sensitivity for detecting small instances of brain bleeding. MRI’s are also used for patients that exhibit prolonged symptoms of concussion. An athlete that has sustained a concussion should never get back in the game until the doctor gives the go-ahead, which usually takes a few weeks. If this warning is ignored repeatedly, CTE could eventually develop. Currently, only four major professional sports leagues in the U.S. and Canada have concussion policies.

When Dr. Omalu performed his research on Mike Webber and other football player’s brains in the early 2000’s, the only way to discover and diagnose CTE properly was post-mortem, during autopsy. Last year at UCLA, however, new steps were taken in the full understanding of CTE and the possibility of early diagnosis.

Researchers have found a pattern of abnormal protein deposits in the brains of NFL players who had received countless concussions. Following their 2013 study using a chemical marker combined with PET imaging, this time the researchers found the exact same issues with an even larger number of retired and concussion sustaining athletes. They also discovered that athletes with this brain imaging pattern are completely different from healthy people, and not only that, from people suffering from Alzheimer’s as well.

These findings are a huge achievement in the progress of identifying and treating of athletes with innumerable concussions. It could even help doctors discover a way of delaying the advancement of CTE, before symptoms start to take over the lives of those afflicted.

The study involved a test which saw the subjects being injected with a chemical marker called FDDNP, which binds to deposits of neurofibrillary tau “tangles” and amyloid beta “plaques”, which are the hallmarks of Alzheimer’s. With the use of PET imaging, the researchers were then able to pinpoint where in the brain these abnormal proteins accumulated.

The ways in which the tau proteins were deposited were quite different than the distribution patterns found in Alzheimer’s patients, which means that CTE creates a ‘fingerprint’ characteristic with the proteins. The PET imaging patterns were consistent with the same patterns found in people diagnosed with CTE after autopsy.

Further analysis is needed to follow participants over time in order to see if CTE is predictable in its future symptoms, but the UCLA study is just one of several currently being conducted by scientists across the country in hopes of diagnosing CTE early.

Without Dr. Omalu’s studies, the long-term effects of multiple concussions in athletes might have never been discovered or recognized. At the end of the day, concussion prevention and proper treatment is crucial to staving off CTE and significant brain damage in athletic participants. We can only hope that the work done by UCLA and other research institutes with PET imaging can bring us into a new era of knowledge and the handling of concussion-related diseases.


1.) Bennett Omalu, Concussions, and the NFL: How One Doctor Changed Football Forever

2.) UCLA study finds characteristic pattern of protein deposits in brains of retired NFL players who suffered concussions

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