My cognitive function has been significantly altered since suffering a series of major hockey-related concussions during my 20s. We didn’t know much about concussions back then. However, even today’s “conservative approach” and “concussion protocol” may too turn out to be another round of false security that we will further regret in the future.

While it may protect against direct impact, helmets do little to protect against the various secondary physical forces (example: shearing forces of differential tissue deceleration) that can cause permanent neuroanatomic damage to the brain, including those found in TBI, diffuse axonal injury and CTE. Spuriously, the vast majority of people who eventually will end up with CTE can look normal by every imaging and blood tests for decades after the injury; thus, normal tests in the early years can be misleadingly reassuring.

On a separate note, in the last 3 MRIs shown to me by friends whose kids suffered sports-related concussions that were bad enough to miss school time, I noticed an anatomic shape variation in a part of the brain that regulates mood, memory, vision, sleep and headache. As a radiologist, I have never seen it described in the medical literature and my neurologist colleague at Stanford hadn’t heard of it either. Since these cases did not have baseline scans, I don’t know if the concussion caused this variation. I also don’t know if the kids had this particular variation before the trauma — it can be congenital — and this predisposed them to manifest more severe symptoms after impact. It’s too small a sample size for me to be concerned at this point, but I’m going to look for this finding in MRIs of other kids that develop concussions, and if the pattern persists, I may fund a formal study at Stanford.

I am concerned how little we know about the biology of concussions in 2017.