As of late, there’s been a spike in chronic traumatic encephalopathy (CTE) diagnosis amongst young athletes, particularly, contact sport athletes. But, what does this mean? 

According to Mayo Clinic, CTE is a Alzhiemer-like brain  disorder that is likely caused by repeated head injuries that kill the nerve cells in the brain. The only way to definitively diagnose someone with the condition is via autopsy of the brain. The disorder often occurs in contact sports or military combat. In fact, three-quarters of those with CTE, played American football. 

Mike Webster, nicknamed “Iron Mike,” is considered the greatest center in NFL history, as he is most known for his time on the field as the anchor of the Steelers’ offensive line. According to Pro Football Hall of Fame, Webster was an “all-pro choice seven times and was selected to the All-AFC team five times from 1978 [to ’82],” and played in nine Pro Bowls where he played the first five games as a starter. Webster is also most known for his brain that sparked a concussion crisis.

In a beautifully written story by The Atlantic, they noted that plenty of players struggled after retiring, but no one struggled worse than Iron Mike. Webster became lethargic and forgetful, and after actions that frightened his family, he wandered off in Pittsburgh where he roamed–he slept under bridges, Amtrak stations, and his truck. When his teeth started falling out, he tried to super glue every fallen tooth back in. He had “wrapped his hands with duct tape and stuck a pen in the tape so he could write thousands of letters. He bought himself a taser and used it on his stomach or his thighs. He zapped himself into unconsciousness, just to get some sleep.” Iron Mike was in the morgue at 50 after 11 years of retirement. 

Initially, when the pathologist conducting the autopsy, Bennet Omalu, started the procedure, he focused on football and brain trauma. Precisely, he thought about a common syndrome popular among boxers; dementia pugilistica, also known as “punch-drunk syndrome,” which is characterized by severe dementia–loss of memory, paranoia, explosive behavior, and delusion–which is caused by repeated blows to the head. However, Omalu was bewildered by what he initially found–Webster’s brain had regular folds of gray matter, no mush, no obvious contusions (typically found in dementia pugilistica), and no shrinkage that is typically found in cases of Alzheimer’s disease. All CT and MRI scans had normal results. Puzzled, Omalu reviewed the hospital report in which death was declared to be accidental–Webster suffered from “depression secondary to post-concussion syndrome,” which Omalu found to be vague. 

From Harrison Martland, a forensic pathologist, 1928 article “Punch Drunk,” he noted that the term most often applies to fighters of the slugging type. They are “usually poor boxers and [take] considerable head punishment, seeking only to land a knockout blow. It is also common in second-rate fighters used for training purposes, who may be knocked down several times a day.” He added that with punch drunk there is “a very definite brain injury due to single or repeated blows on the head or jaw which cause multiple concussion hemorrhages in the deeper portions of the cerebrum.” Yet Martland’s position on punch drunk didn’t seem valued because he didn’t have proof, but neuropathologist J.A.N. Corsellis did, 45 years later.

After cracking open the skulls of 15 former boxers (who all died of natural causes), he titled his brain bank (with his studies and findings, as well as any clinical information he could gather) the “Corsellis Collection”. In “The Aftermath of Boxing,” Corsellis noted that the skulls had “unusual and specific damage to the tissue, with irregular folds in irregular patterns.” There was no doubt that the boxers sustained cerebral damage. This is when punch drunk syndrome progressed to be “dementia pugilistica.”

When examining Webster’s brain, Omalu saw strange dark splotches. He searched, and landed on the Corsellis Collection. The Corsellis brains were “bruised and bashed…Webster’s was not.” Corsellis noted that “many neurofibrillary tangles in the nerve cells of the frontal and temporal cortex [were] particularly marked in the anteromedial temporal gray matter…” in which that meant that there were buildups of protein called tau (which helps transportation of nutrients, but in unhealthy brains the protein forms into clumps). These clumps clog up the brain, killing the healthy cells; cells that are responsible for mood, emotion, and executive functioning. This is what killed the boxers, and what killed Webster.

Now, while Iron Mike is a legendary player, why is any of this important? From CNN, a new study released from Boston University’s CTE Center had found that there were more than 60 cases of CTE in athletes that ranged from 13 to 29 at time of death; the youngest person to be diagnosed with the disorder was a 17 year old football player. Unlike similar past studies, which had examined CTE in primarily professional American football players, the majority of the athletes in this study were amateur athletes who played at the youth, high school, and college levels.

Dr. Steven Broglio, director of the University of Michigan’s Concussion Center described the situation as “like smoking: the more you do it, the more your risk grows.” Furthermore, it is the individual’s choice to participate in contact sports, “the benefits of sport participation, whether it’s contact collision, or something else, far outweigh the risks. But that doesn’t mean there isn’t risk involved when you play a sport.”