Brain injury is a condition that involves microscopic damage to brain tissue that can only be seen in life through the lens of the patterns of the injured person’s life. Chris Henry, the former NFL wide receiver whose autopsy results confirmed he was living with brain damage, may have finally made that clear. See yesterday’s blog http://waiting.com/blog/2010/06/former-nfl-player-henrys-autopsy-reveals-evidence-of-brain-damage.html Mike Wilbon of Espn’s PTI (http://espn.go.com/espnradio/show?showId=pti) called the Henry story the most important sports story of the day and even went so far as to say that because of this story, his two year old child would never play football. This story is important not just because it warns us of the dangers of playing football, but because it tells us we must think “brain injury” when looking at the patterns of troubled people’s lives. This story also tells us that it is time that autopsy returned to head of the research class in understanding about all pathology, but especially that in the brain.
Since I posted yesterday’s blog, I have done some research on Chris Henry’s life, not just to see the pattern of behavior issues, but also to see if anyone had ever considered a diagnosis of “brain damage” at any time prior to his death. I could find no references to any physician, trainer, NFL official or commentator (including myself) ever suggesting that Henry was suffering from Post Concussion Syndrome. When doctors make a diagnosis, they should engage in something called a differential diagnosis, which involves a consideration of all the possible diseases. I always think of this as a Doctor House (from the TV series) process of putting diseases on a whiteboard, then crossing out the ones that don’t fit. I strongly suspect that no doctor had ever put TBI on Chris Henry’s whiteboard, or if they ever did, quickly dismissed it because there was no single concussion that he was treated for.
Here (with the easy job of Monday morning quarterbacking the diagnosis) is how I picture Dr. House and his cast approaching the problem. It is the fall of 2009 and Henry is again asking Commissioner Goodell for reinstatement and Goodell orders a full assessment on Henry. Because Henry is such a special case, Goodell enlists the services of Dr. House. (If you are not familiar with the show, the cast and plot is explained here: http://en.wikipedia.org/wiki/House_%28TV_series%29 ) House pulls his team together and starts writing on the whiteboard the following potential conditions:
- Nutcase;
- Jerk;
- Spoiled jock; and
- Bi-polar.
Dr. “Thirteen” Hadley throws out “brain injury.” He is a football player she says, a wide receiver, he does get hit often. Dr. Chase states “it can’t be brain damage, the CT was clean.” (He actually did say that in an episode in Season 6 http://www.tv.com/house/moving-the-chains/episode/1320924/summary.html?tag=ep_guide;summary ). Dr. Foreman, a neurologist, puzzled by Thirteen’s suggestion, argues that Henry was never knocked out. Dr. Taub points out that according to the CDC you can have brain injury without ever losing consciousness and that CT’s show virtually no evidence of brain damage when done post-acutely. House steps in and orders an MRI.
After the commercial, our cast reassembles, normal MRI in hand and now Dr. Foreman derisively dismisses the TBI theory, stating that this is all psychiatric and Henry should be shipped off for an inpatient evaluation at a psychiatric hospital. House who has some experience with such places says to hold off on that until they have ruled out all “organic causes.”
Taub raises the possibility of Carbon Monoxide poisoning or toxins and House dispatches Chase and Foreman to search Henry’s apartment, where they find nothing. Meanwhile, Thirteen has not abandoned her initial theory of TBI and pours over the history of Henry’s on the field and off the field problems in his NFL file (for a detailed history see http://en.wikipedia.org/wiki/Chris_Henry_%28wide_receiver%29 ). Here is what she finds:
- During Henry’s sophomore season in college at West Virginia , he was ejected from a game at Rutgers University due to multiple unsportsmanlike conduct penalties and was suspended for the season finale against the University of Pittsburgh. His former Mountaineers coach, Rich Rodriguez, stated that he was “an embarrassment to himself and the program” for his conduct.[6]
- On December 15, 2005, Henry was pulled over in northern Kentucky for speeding. During a search, marijuana was found in his shoes. He was also driving without a valid driver’s license or valid insurance.[19] He pleaded guilty and avoided a jail sentence.
- One month later, on January 30, 2006 he was arrested in Orlando, Florida for multiple gun charges including concealment and aggravated assault with a firearm.[20] He was reported to have been wearing his #15 Bengals jersey at the time of his arrest. He pleaded guilty to this charge and avoided jail time.
- On April 29, Henry allowed three underage females (ages 18, 16 and 15) to consume alcohol at a hotel in Covington, Kentucky.[21] One of the three, an 18-year-old woman, accused Henry of sexually assaulting her; she later retracted her story and was charged with filing a false police report.[22] On January 25, 2007, Henry pleaded guilty to a misdemeanor violation of a city ordinance commonly referred to as a “keg law.” He was sentenced to 90 days in jail, with all but two of those days being suspended.[21]
- He was pulled over on Interstate 275 in Ohio on June 3 at 1:18 A.M. by Ohio Highway Patrol trooper Michael Shimko for surmised drunk driving. He voluntarily submitted to a breathalyzer test at 2:06 A.M. at the Milford Police Department and registered a .092 blood-alcohol level, .012 above the level permitted in the state of Ohio.[23]
- Henry allegedly assaulted a valet attendant at Newport on the Levee in Newport, Kentucky on November 6, 2007.[26] He was arrested for a second time in Orlando on December 3 for violating his probation he was on from a January 30, 2006 arrest. On February 21, 2008, he was found not guilty.
- On March 31, 2008, Henry punched a man named Gregory Meyer, 18, and threw a beer bottle through the window of his car. Henry claimed it was a case of mistaken identity and also that he thought it was somebody else that owed him money. Henry was waived by the Bengals a day after this arrest and was then served a house arrest sentence.
What Thirteen concludes from this conduct history is that Henry never seems to grasp that there are rules or that there will be consequences to his actions. Even if he does, he doesn’t seem to be able to conform his actions. The multiple unsportsmanlike conduct penalties in one game in college stands out as a precursor of all that followed.
Thirteen Googles “criminal behavior and tbi”. What she finds is the article Acquired Brain Injury and Criminal Behavior by Inés Monguió, Ph.D http://www.uninet.edu/union99/congress/confs/hi/03Monguio.html and our blog http://www.subtlebraininjury.com/blog/2010/04/more-on-roethlisberger-tbi-and-the-criminal-law.html
What she finds in Dr. Monguió’s paper:
Brain injury, particularly to the frontal lobes or to the connecting circuits of frontal areas to other brain centers, can affect the ability to form criminal intent. Deficits in executive function result in poor self monitoring, planning, judgment, and forethought. The rigidity or impulsivity often seen in traumatic brain injuries make the formation of criminal intent quite a challenge for the individual. Following are general areas to consider when evaluating a criminal defendant to provide information during the trial. The question of legal insanity will be explored in more detail as neuropsychological data may provide information to the courts regarding a defendant’s state of mind at the time of the commission of the crime.
She compares the paper to Henry’s behavior and finds poor self-monitoring, judgment, forethought, as well as impulsivity. Thirteen renews her argument for TBI. House points out that you need a traumatic event for a Traumatic Brain Injury. Where was the event? Thirteen, argues back that repeated sub-clinical blows, like boxers receive, can cause long term encephalopathy, without a specific concussion – Muhammad Ali was never knocked out. She argues for a neuropsychological assessment.
This of course would be one of those episodes where House couldn’t walk in at the last instant with the miracle cure. In the “fact is stranger than fiction” category, Henry actually dies of a traumatic brain injury when he falls from the back of his fiancé’s truck after another neurobehavioral event, a domestic squabble. All of the circumstances leading up to his death point to brain injury – temper control, violence and judgment in getting into the back of the pickup. We would hope that this would be one of those cases where House, haunted by the death he couldn’t solve. would order the autopsy.
Fortunately for the future of TBI research, the autopsy was ordered here. The best thing that has come out of the NFL head injury awareness program is the move to enlist current and former players in this autopsy project. What we don’t yet have and maybe never will is the answer as to what to do when the in vivo (during life) half of the diagnostic tree points to TBI in someone who makes his living getting hit. Would treatment for TBI have saved Chris Henry’s career, his life? Probably not the first, potentially the second.