Shattered Minds: What you need to know.
Dr. Robert G. Lahita M.D., Ph.D.
A young lady who loves horses fell off her horse for the third time and began to have seizures shortly after. Rushed to the hospital, she had a normal CT scan of her head, but an electroencephalogram (EEG) showed she had post-concussive syndrome.
The primary concern for this young lady is the abnormal EEG. Traumatic brain injury is the result of repetitive head impacts, and she had fallen off her horse for the third time. Some young people suffer brain injuries because of traffic accidents, sports like football and soccer, and falls for a variety of reasons. But TBI is not just relegated to young people and can occur in older individuals as well.
When this happens, there are alterations in the neurobiological processes that might affect the entire body. Cardiac abnormalities such as dysfunction of the nervous system (high blood pressure and more heart attacks), systemic inflammation (throughout the body), and modifications of the brain-gut connections occur. People with this condition have an elevated risk of cognitive dysfunction (even dementia), post-traumatic stress disorder, depression, and other psychiatric illnesses. (Ross Zafonte DO, Medscape Cardiology 2023)
In short, TBI is a significant cause of long-term disability and premature death. Studies have tried to associate TBI with conditions like Parkinson’s disease, Alzheimer's disease, and chronic traumatic encephalopathy (CTE). The latter situation is critical to understand.
Analysis of brains from athletes and military personnel who have experienced TBI shows shrinkage of parts of the brain during neurobiological exams (from autopsy on dead individuals). A portion of the brain is the blood-brain barrier, a network of blood vessels and tissue comprised of closely spaced cells. It is delicate and keeps harmful substances from reaching the brain. This barrier is breached in TBI, especially CTE. The blood brain barrier is critical as a filter and it can be breached in many illnesses, but most prominently in TBI.
Most savvy parents know about TBI, especially if their young children were in little leagues like football or soccer. All those children and adults with CTE played at the amateur level in youth, high school, or college sports and 71% were found to have mild disease. (Boston University, JAMA Neurology 2023).
Brains for study usually come from studies of older athletes. It is difficult to get young brains to study. However, the case series in the paper I am citing examined 152 brains of athletes who played contact sports and died before the age of 30. Donors of brains died between the ages of 13 and 29 years of age: 92.8% were males, and 73% were white. Tragically, In over 57.2% of cases, suicide was the cause of death.
There is an entire list of NFL players, both young and old, who had CTE on pathologic examination.
But CTE can occur in many sports, not just football. 71.4% of cases played amateur sports, such as football (60.9%), soccer (17.2%), hockey (7.8%), and wrestling (7%). So, this is a significant problem for parents, children, and young men and women who want to go into professional sports.
Doctors are addressing this now. New helmets are designed to protect the head in all sports, but even that is controversial. You can wear a special protective helmet, but if the head hits a hard object many times (like a hard surface), the brain moves back and forth, and there are likely to be microscopic hemorrhages and various degrees of damage to the blood-brain barrier (mentioned above). Our lady’s seizure activity was most likely because of an injury to her blood-brain wall.
Aside from CTE, which is a known cause of brain damage, TBI is associated more recently with heart disease. Studies showed that people as young as 18-40 years of age were more likely to develop high blood pressure, high cholesterol and fat in the blood, obesity, and diabetes within five years of their head injury. We know that aging results in an increased risk for heart disease, but these are very young people, and the data are worrisome for these young people suffering from TBI over time.
Realize that these conditions enhance the risk of heart disease as we age. Still, these studies show that brain injury can play a significant role in accelerating cardiovascular disease.