The Underidentification of Traumatic Brain Injury (TBI) in Professional Sports

(Editor’s Note: What follows is an excerpt from an article that appeared in October issue on Concussion Litigation Reporter. For the details, subscribe at

By Michael J. Perrotti, PhD.

The public understanding of TBI is so poor that it is officially referred to by the US National Center for Injury Prevention and Control as “the silent epidemic.” In the acute phase, the usual radiological examinations are not sensitive to TBI and diffuse axonal injury (DAI). There is a significant amount of false negatives with CT scans administered in the ER.

Concussion is the acute psychological experience of trauma through head impact, acceleration and an alteration or limited loss of consciousness (LOC)(Parker, 2012). Generally, it is without sufficient neurotrauma to be detected by neuroimaging procedures. Imaging procedures to capture perfusion and microscopic blood flow problems are not routinely done.

The problem of repeated, sub concussive hits on NFL players was recently described by researchers at Department of Veterans Affairs and Boston University who found that 96% of former NFL players tested for evidence of degenerative brain disease with 79% of all football players tested—who played at all levels—showing signs of the disease. The researchers tested the brains of 165 former football players who competed at the high school, college, semi-pro or professional level. Of those tested, 131 showed signs of chronic traumatic encephalopathy (CTE). The findings show that 40% of those who tested positive were the offensive and defensive linemen who came into contact with one another on every play of the game. This finding supports past research suggesting that it is the repeat, more minor head trauma that occurs regularly in football that may pose the greatest risk to players, as opposed to just the sometimes violent collisions that cause concussions. There is a limitation to the research in that individuals and families who agreed to the testing are more likely those who suspected they might have the disease. CTE can only be diagnosed after death.

Concussions themselves are not “one time” events. There is a first injury (blow to the head) and second injury which is the cascade of damaging neurobiological events and neurocellular post-injury. (Leiningeretal, 1990), found that even the most sensitive neuropsychological tests do not tap some subtle processing neurological deficits.

There is a common misconception that concussion is a condition that  …

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