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Sunday, February 23, 2020  Spokane, Washington  Est. May 19, 1883
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Not just Mark: An inside look at the brain injuries common to football players

Brain scans from former footballer Mark Rypien. A gray mark on the scan to the left denotes an area of low blood flow, likely the product of head trauma sustained during Rypien’s professional sports career. The right scan shows a dark area in the middle of Rypien’s cerebellum, suggesting decreased function. (Amen Clinic / Courtesy of Mark Rypien)
Brain scans from former footballer Mark Rypien. A gray mark on the scan to the left denotes an area of low blood flow, likely the product of head trauma sustained during Rypien’s professional sports career. The right scan shows a dark area in the middle of Rypien’s cerebellum, suggesting decreased function. (Amen Clinic / Courtesy of Mark Rypien)

On a scan, it looks like there’s a hole in Mark Rypien’s brain.

It’s not actually there – the gray spot in a sea of rainbow indicates an area of low blood flow. It’s often found in people with alcohol abuse problems or sleep apnea, but in Rypien’s case, it’s likely a sign of head trauma, said his neurologist and psychiatrist, Daniel Amen.

Rypien has had scans at one of Amen’s clinics in Reston, Virginia, and at the Cleveland Clinic in Ohio. The Amen scans, done in October, show lower function in his cerebellum, the area of the brain that controls movement, and in his temporal lobes, which regulate speech and memory.

The SPECT scans Amen uses to diagnose and treat everything from traumatic brain injuries to mental illnesses are controversial in his field, with other leading psychiatrists and neurologists saying those scans can’t treat the range of conditions he claims to be able to improve.

But there’s no doubt Amen is familiar with the brain of football players: He’s studied hundreds of them and published a paper in 2011 documenting how the brains of 97 retired players differed from a healthy comparison group. Overall, the players had lower blood flow to significant portions of their brains, and scored in the bottom 50 percent on nearly every measure of cognitive function.

Or, in plain English: “It’s not a normal brain,” Rypien said.

How do hits on the field translate into brain damage?

Most explanations begin by comparing the human brain to Jell-O.

Your brain floats inside your head, protected by three membranes and the skull. If your head gets hit, or rapidly changes direction, the movement can cause your brain to hit your skull, like Jell-O bouncing against the side of a bowl.

But what actually happens at the moment of impact?

Brains relay information between neurons using a combination of chemical and electrical signals. Neurons connect through their axons, long, spindle-like structures that transmit signals across the brain.

Blows to the head can cause the protective sheath around axons to stretch and tear, disrupting signal transmission and reducing blood flow. The effects depend on the parts of the brain that are impacted.

“No two concussions are ever alike because the blows are different,” said Heidi Peterson, a licensed athletic trainer at the MultiCare Rockwood Sports Medicine Center who created a Spokane-area sports concussion committee last year. “It depends on what part of the brain is rebounding off the skull.”

Damage from a single concussion won’t show on a brain scan, so aside from a patient’s own report, there’s no good way to diagnose or measure the impact. Peterson said that has fueled the perception that concussions aren’t serious injuries; there’s no fractured bone to see on an X-ray to prove that damage is there.

Damage done to neurons causes the immediate symptoms following a blow to the head, which can include memory loss, light sensitivity and nausea.

If a player is able to rest and recover, the damage will usually, though not always, heal completely. But someone who has repeated blows to the head will almost certainly begin to see cumulative and irreversible brain damage. That’s especially true if the brain is reinjured before it’s healed fully.

In players with chronic traumatic encephalopathy, or CTE, the brain begins to decay because of a buildup of tau proteins in brain tissue.

Tau proteins are part of the structure of axons, helping to hold small tube-like structures together. Repetitive blows to the head cause them to detach from the axons and break, forming tangling masses.

“When it breaks, it’ll poke through the membrane, which then causes inflammation,” Amen said.

The protein deposits shrink the brain, causing ongoing damage.

There’s a common perception that mental illnesses are distinct from physical injuries to the brain, but Amen and Peterson said in many cases, that’s a distinction without a difference. Diagnosis with a psychiatric illness, particularly depression, following a traumatic brain injury is common.

Brain damage can impair the parts of the brain that regulate or make neurotransmitters, creating imbalances that are linked to depression. Structural damage to the brain can lead to impulsive behavior, memory loss and other symptoms that mirror mental illnesses.

For players like Rypien, the damage is cumulative.

“Nerve cells get ripped. Blood vessels get torn. Scar tissue gets formed over time,” Amen said.

Unless diagnostic technology advances significantly, Rypien will never know whether he actually has CTE. But he said he plans to donate his brain to the Boston University research bank to be studied after his death.

“I won’t know until I turn my brain in,” he said.

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