On the Table, the Brain Appeared Normal

The pathology cannot be made clearer.   The damage is real and it is serious and it is irreversible.  the extent of the damage varies as it must and the ability to physically compensate also varies.

With the level of atrophy described here it is no surprise that thinking became primitive and murder took place.  In the end the pain became too much and suicide followed.


The bottom line is that concussion must be eliminated from all sports.  This will be impossible in many and at least difficult in others.  Yet forms of concussion free sport certainly exist.  That is true for even boxing and football.


We have not been looking in the past, but that is over now.  Do we really need to watch another Mohamed Ali die?.

The boy was a mere 27 years old.

On the Table, the Brain Appeared Normal

By John Branch

Nov. 9, 2017

 

https://mobile.nytimes.com/2017/11/09/sports/aaron-hernandez-brain-cte.html 

BOSTON — The brain arrived in April, delivered to the basement of the hospital without ceremony, like all the others. There were a few differences with this one — not because it was more important, but because it was more notorious.

It went to the lab outside the city, instead of the one in Boston, where most of the examinations are performed these days, because it was less likely to attract attention that way. Instead of being carried in through the service entrance, it was ushered in secretly through the underground tunnel system. The brain was given a pseudonym, and only three people knew how to identify it.

Other than that, the brain came alone and disconnected from its past, unattached to its celebrity. The sordid details of the man’s rise and fall, the speculation over what went wrong, the debate over justice — all that was left behind for others to assess.

It was just a brain, not large or small, not deformed or extraordinary in appearance, an oblong and gelatinous coil weighing 1,573 grams, or about three and a half pounds, just carved from the skull of a 27-year-old man. The coroner took special care, and it arrived hours later in near-perfect condition.

“They handled everything beautifully,” the neuropathologist said.

The laboratory was a 30-minute drive from the prison where the man hanged himself a night or two earlier. His name was familiar to the scientists, just as he was to people throughout New England and many around the country. Now his brain was about 30 miles north of where the man had most recently worked, in Foxborough, Mass.

They expected a normal brain because of the man’s age.

“I didn’t equate his behavior with the disease,” the neuropathologist said. “I just thought that’s who he was.”

On the table, the brain appeared healthy. The meninges, the layers of translucent membranes that coat and protect the brain, still enveloped it. The brain had a healthy sheen.

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A neuropathologist and her associate examined slices of the brain of a 27-year-old man.CreditBoston University

The brain was sliced into sheaths, maybe a half-inch at a time, starting at the front. That was where the first inkling came that this was not just another 27-year-old brain. Even to the naked eye, the cross sections had substantial gaps in the tissues — fluid-filled ventricles that expanded as the brain tissue itself shrank. A cross section of a healthy 27-year-old brain looks robust, fleshy. This one was hollowed by boomerang-shaped caverns.

“The reason the skull grows is to make room for the growing brain,” the neuropathologist explained. “Everything is packed really tightly. Nature doesn’t leave any gaps.”

The septum pellucidum, a small membrane between the two halves of the brain, was atrophied to the point that it looked withered and fragile, even perforated. When the neuropathologist later went to look for others in a similar condition, the youngest comparable example was a 46-year-old boxer.

The fornix, a C-shaped bundle of nerves, was similarly deteriorated, stripped of its relative heft. The hippocampus, too. Even some of the most famously diseased brains that the neuropathologist had explored, from men who had died decades later, did not have such obvious signs of destruction when examined by the naked eye.

But only under a microscope could the disease be diagnosed with certainty. Wafer-like tissues were immunostained, using antibodies designed to discolor a specific protein — in this case, tau, which clumps and spreads, killing brain cells. That is where the full scope of the damage was apparent.

Tau, stained brown, appeared like bursts of fireworks in the frontal cortex, the part of the brain that controls decision making, impulse and inhibition. The neuropathologist could see it spreading through the brain. It was in the amygdala, the part of the brain that regulates emotions like fear and anxiety, and the temporal lobe. She spotted “a perfect demonstration” of lesions around the tiny blood vessels, a telltale sign. She found previous microhemorrhages and astrocytic scarring around the ventricles.

She declared the case Stage 3 on her own scale of severity, which goes from 1 to 4. It was the most damage she had seen in anyone that age. Among the hundreds of other brains she had examined and graded, the median age of a Stage 3 brain from his profession was 67. Now she had one that was only 27.

What made the brain extraordinary, for the purpose of science, was not just the extent of the damage, but its singular cause. Most brains with that kind of damage have sustained a lifetime of other problems, too, from strokes to other diseases, like Alzheimer’s. Their samples are muddled, and not everything found can be connected to one particular disease.

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The brain of a 27-year old man who hanged himself in April.CreditBoston University

This one looked as if it had been lifted from the pages of a textbook devoted to just one disease.

“It’s rare for us to get a brain of a person this young in such good shape,” the neuropathologist said. “It is a classic case. And it tells us a lot about the disease.”

The brain is no longer a brain, in function or form, because it has been sliced into pieces. Those pieces have been numbered, archived and stored. Scientists still study it, probably will for years, because it is such a perfect, fascinating specimen.

The neuropathologist and her closest associates kept this all to themselves for months, though, until the man’s family agreed to let the results go public. In September, the news came out and the headlines returned, but the neuropathologist did no interviews. She released only a short statement confirming the results of the examination.

“I didn’t want to contribute to the sensationalism,” she said.

But science cannot advance without the cumulative power of research, which was why she was in a university ballroom on Thursday, in front of more than 150 neurologists, pathologists and other scientists.

She stood in the dark and put a PowerPoint presentation on the screen, several dozen slides of images showing an immensely atrophied young brain, the mind of a former star in his field who was also a convicted murderer.

“He had beautiful pathology, if you can call it beautiful,” the neuropathologist had said earlier.

The particulars of the damage that the neuropathologist detailed — the tangled tau proteins, the battered frontal cortex, the shrunken tissues and the enlarged ventricles — have long become familiar to those paying attention to brain science. They are the things that threaten the long-term future of the industry in which the man worked.

This is where his job faces the most scrutiny — under the microscope in darkened labs and in the scientific presentations at academic conferences.

“It’s scientifically interesting,” the neuropathologist said. “To me, it’s a fascinating brain.”