The scene at Michigan Stadium on Saturday was not what we’ve come to expect in 2014, and that’s a good thing. In the fourth quarter of a college football game between the University of Michigan and the University of Minnesota, Michigan quarterback Shane Morris was knocked to the ground by a helmet-first tackle directly under his chin. Morris exhibited signs of a concussion: he winced and walked gingerly towards the sideline before collapsing into a teammate’s arms. Apparently Michigan’s coaches and medical staff didn’t see, or figured his behavior was the result of a leg injury sustained earlier in the game. Either way, Morris returned to the game for the next play. “This seems a little dangerous to me,” the announcer said of the decision. Morris was then sidelined after that, but a few plays later re-entered the game. In the aftermath, Michigan has been roundly criticized by for its handling of the situation.
Media coverage of Ray Rice, Adrian Peterson, and other lesser known National Football League (NFL) players involved in domestic abuse cases have pushed the larger problem facing the game—chronic traumatic encephalopathy (CTE)—to the back burner.
In a recent New York Times column, writer Michael Powell notes that barely anyone noticed “the John Abraham sideshow down in Phoenix.” Abraham, a 36-year-old veteran linebacker, suffered a concussion in the season’s first game. Afterward, ESPN reported that he had been struggling with memory loss for more than a year.
The global burden of stroke is immense and growing, a new report suggests, making it one of the biggest public-health problems worldwide in terms of both death and disability. Experts have called for a three-pronged approach encompassing prevention, acute treatment and recovery/rehabilitation to stem the tide. Yet despite billions of dollars invested in research over the last few decades, little progress has been made in preventing or treating stroke. Perhaps nowhere is this failure clearer than in the emergent treatment of stroke.
The clot-busting drug known as tPA (tissue plasminogen factor) was approved in the U.S. in 1996, and remains the only treatment for acute ischemic stroke (strokes caused by a blood clot or narrowing of a blood vessel–see image). tPA has been shown to be highly effective in sparing brain damage and reducing disability when used appropriately in the right group of patients, but the drug is widely underused.
That situation is slowly improving–a study published in 2013 found nearly twice as many stroke patients received tPA in 2011 than in 2003. Still, only about 7 percent of stroke patients receive the drug. A growing chorus of experts are saying that’s because of outdated guidelines that are too restrictive in delineating which patients are eligible for tPA therapy.
When it comes to football’s concussion crisis, a picture has been painted with two clear sides. On one side are the concerned parents, media, and researchers. On the other are the players, who continue blocking and tackling, dismissive of the potential neurological effects.
Football players like John Arena prove it’s not so clear cut. The All-Conference senior linebacker at Johns Hopkins finished this past season with 48 tackles for the 10-1 Blue Jays. He has no regrets about his 13 years playing the sport. At the same time, he’s aware of the dangers of concussions. A neuroscience major with a 4.0 GPA, Arena was named the Academic All-American of the Year for Division III football. For the past year he has worked in a neuropathology lab at Hopkins studying traumatic brain injury.
Studies have shown that as many as 40 percent of patients believed to be in a persistent vegetative state are misdiagnosed and are actually minimally conscious. Why is this? What should be done? Experts tackled these complex and difficult questions at an International Neuroethics Society (INS) event in San Diego last Friday.
There are several levels of consciousness involving awakeness and awareness. Patients in a coma are neither awake nor aware. Those in a vegetative state are awake, but not aware. Minimally conscious patients are awake with intermittent periods of awareness. There is also locked-in syndrome, in which patients are awake and aware but unable to move or communicate verbally.
Too often, patients are labeled as vegetative when in fact they are minimally conscious. Sometimes, the initial assessment is not wrong. According to Dana Alliance member Joe Fins, M.D., many who suffer a traumatic brain injury or other devastating health event that leaves them in a vegetative state remain in that state upon leaving the hospital three to four weeks later. But it is not uncommon for a patient to improve to minimally conscious some time after.