Guest Editorial: Brandi Chastain’s brain
In 1999 Brandi Chastain scored the winning shootout goal in the World Cup soccer final against China, then stripped off her jersey and sank to her knees in exultation, arms thrust skyward.
Another image of Chastain recently emerged: Now 47, a mother and a coach, the soccer star announced that at death she will donate her brain to the Concussion Legacy Foundation at Boston University, where researchers study chronic traumatic encephalopathy, the degenerative brain disease linked to concussions and head trauma.
CTE is a hot-button issue in football and boxing. With awareness rising, more athletes — mainly football players — are promising to donate their brains at death. But Chastain’s announcement is a reminder that CTE may not be a male-only affliction, nor is it limited to the hard hits of football.
No female athletes have been found to have had CTE, The New York Times reports. But CTE research is still in its infancy. Little is known about CTE in women because most of the research has involved men who played contact sports. Yet there is evidence that gender may play an important role in the consequences of concussions.
Even after differences in body mass are factored in, female athletes suffer greater rates of concussion, report more symptoms after concussions, and demonstrate greater impairment during neuropsychological testing after experiencing concussions when compared with their male counterparts. More research is essential to determine whether this gender difference is the result of genetics, the nature of the traumatic forces, hormonal influences, reporting biases or some combination of these factors.
Chastain has acknowledged that she may have suffered several concussions from heading the ball during her career, which ended in 2010. Today she reports occasional bouts of mild disorientation that could be the result of brain injuries.
In soccer, CTE is believed to be caused by heading the ball or by repeated falls. CTE also has been seen in wrestlers, hockey players, rugby players, military members who have experienced blast injuries, patients with epilepsy or autism (probably from repeated headbanging), and even in a circus clown who was recurrently shot from a cannon.
Doctors can’t tell for sure until brain tissue is examined under a microscope during an autopsy. The injured brain shows a pattern of nerve destruction and abnormal tissue accumulation thought to occur after episodes of head acceleration/deceleration.
Chastain’s gift should help medical researchers develop a clinical consensus for the diagnosis of CTE while a patient is still living. That would be based on patient symptoms, physical examination, and laboratory and radiologic tests.
Factors could include the severity of a trauma, the number of injuries suffered and at what age, and how soon after an injury symptoms appeared. Especially promising in diagnosis: The latest imaging devices that explore the central nervous system may be able to identify previously unsuspected brain damage.
Researchers also need prospective, longitudinal epidemiological studies in the general population, including study into a possible genetic predisposition to CTE.
Chastain is still relatively young, and hopefully her donation will not become a reality for several decades. The researchers who ultimately study her brain may not have been born yet. Let’s hope that by the time her donation occurs, scientists will know much more about CTE among women in soccer — and how to prevent it.