Suicide. Police in Richmond, Virginia officially ruled that the death of former Atlanta Falcons safety Ray Easterling resulted from a self-inflicted gunshot wound. His death ended what his wife described as a twenty-year progression of dementia, insomnia, and depression. His death illustrates the lesser known dangers of concussions

While I don’t know the specific medical facts in Easterling’s case, it is clear that Easterling himself believed that his neurologic decline was caused by concussions he suffered during his NFL career. Easterling was one of the seven former players who sued the league, claiming that the NFL concealed a link between football and brain injuries. It was the first of many similar lawsuits filed against the league.

This tragedy and others like it shed light on one of the least recognized effects of concussions. Dr. Jonathan Edwards, Professor and Chief of Neurology at the Medical University of South Carolina and Director of the MUSC Sports Neurosciences Program, and his team see several hundred sports-related brain injuries each year. “We’re seeing more and more that the symptoms most commonly missed are the personality changes.”

Personality changes after concussions can be difficult to recognize. Often the young athlete will become more emotionally labile. Parents might remark that their son or daughter seems to have a “short fuse” more than before the injury. On the other hand, the athlete might be noted to have a more flat affect than before. Often parents and coaches don’t look for these changes. “Parents don’t bring kids to the doctor complaining of emotional changes. They only notice it when we specifically ask about it.”

I think most of us recognize some of the common symptoms of concussions, such as headaches, dizziness, and nausea. Now sports neurologists are starting to discover the cumulative effects of concussions. Dr. Edwards points to the two main long-term dangers – dementia and depression.

Edwards argues that we have to do a better job of preventing what he calls “low-threshold concussions.” These are serious brain injuries that result from notably minor blows to the head, when the brain of the concussed athlete has yet to return to normal.

Unfortunately there is not one perfect test to truly know when an athlete is safe to return to play. Edwards uses the safety features of an automobile to illustrate that point. “Just because a car has airbags doesn’t mean that you don’t use the brakes. And just because you use the brakes doesn’t mean you shouldn’t wear a seatbelt.”

He stresses that sports neurologists must utilize every tool at their disposal – history, neurologic exam, cognitive testing and comparisons to baseline tests, and assessments of personality changes. “All of them have to resolve and return to normal before the athlete can return to play.”

Edwards points out that the personality changes are often the last symptoms to resolve, usually lasting much longer than headaches. Plus, they are often very subtle. “Unless we ask about these changes in personality, we would never even know.”

I cannot emphasize enough to athletes and parents that we must learn from this story and the findings of Dr. Edwards and his team. Players have to tell their parents about any mood changes. As team physicians, athletic trainers, and coaches, we also have a responsibility to ask players and their families if their personalities are normal or have returned to normal. Edwards suggests that one person might be the most capable of recognizing that there is a problem – more than the other family members or even the athletes themselves. Their mothers.

“Moms just know when their kids are different.” Tweet this quote. 

Note: A modified version on this post appears in the April 26, 2012 issue of The Post and Courier.