Dr. Nitkin Sethi, a respected ringside physician and neurologist in New York, wrote an interesting letter to the Journal Neurology discussing MRI findings that are often minimized by radiologists but could be concerning for combat sports athletes.
When your physician orders an MRI they often don’t see the raw data generated. Instead this is reviewed by a radiologist who authors a report summarizing what is observed.
Dr. Sethi noted that MRI reports he reviews for fighters often show FLAIR white matter hyperintensities. Treating radiologists often report these as “non specific findings” seen in fairly routine conditions such as migrains.
When an athletic commission reviews a fighter’s MRI report for licensing purposes they will have no concerns if the treating radiologist expressed nothing of note.
Dr. Sethi notes, however, that in his years of experience these findings, while consistent with other conditions, could also be “a biomarker of concussive brain injuries“. Appreciating this Dr. Sethi notes that when these findings are made in combat sports athletes treating and overseeing physicians should be aware of this and “should be a priority when counseling and prognosticating about brain health, CTE, and decisions about retirement“.
Dr. Sethi’s letter reads as follows:
I shared this observation on Twitter where several other doctors and ringside physicians weighed in with the below worthwhile comments:
The Trillion dollar question is when is an athlete about the cross the threshold of no return when it comes to too much career brain trauma and CTE? The answer is not known.
Until the answer is known the smoking analogy is apt. Cigarettes are linked to cancer. How many you can smoke before getting the disease is an unknown number. One that varies for everyone. All that can be said for certain is less is more. The same can be said for hits to the head and CTE.