football concussion

Football: One Season of Play Linked to Midbrain Damage, Even Without Concussion Interview with:

Adnan Hirad, PhD MD Candidate, Medical Scientist Training Program University of Rochester School of Medicine and Dentistry

Dr. Hirad

Adnan Hirad, PhD
MD Candidate, Medical Scientist Training Program
University of Rochester
School of Medicine and Dentistry What is the background for this study?

Response: Concussion is defined based on the manifestation of observable signs and symptoms (e.g., dizziness, difficulty with concentration, loss of consciousness, inter alia). A non-concussive head injury is when someone hits their head but does not exhibit the signs and symptoms of concussion — IE concussion is defined by observable signs, and sub-concussive is defined as sustaining  head impacts similar (in magnitude and mechanism) to those sustained with concussion without observable signs and/or symptoms. These hits are a problem not only in football, but also with IED/bomb blasts experienced during war and potentially rugby. What are the main findings?

Response: Within a season of football, in the absence of symptomatic concussion, there is reduction in white matter integrity among football player. Those changes are related to the magnitude and number of impacts with high rotational (twisting) force factors.

This is the first time such findings are captured with a study design and hypothesis targeting the midbrain. We also show that those changes are similarly observable in the midbrain of those with concussion compared to controls. What should readers take away from your report?

Response: The midbrain is the epicenter of mTBI injury and can potentially serve as ‘canary in a coal mine’ for injury occurrence, resolution and/or exacerbation for both subconcussion and concussion. What recommendations do you have for future research as a result of this work?

Response: Our study is the first of its kind to take a hypothesis-driven approach to index mild neuro-trauma in the midbrain. We believe that our study would represent a paradigm shift for MRI research into (m)TBI by shifting emphasis from trying to capture the diffuse and un-patterned nature of the injury, to targeted and focused measures with a stereotyped geometry. For these reasons, we believe that our findings would be of interest to broad readership.

No disclosures 


Adnan A. Hirad, Jeffrey J. Bazarian, Kian Merchant-Borna, Frank E. Garcea, Sarah Heilbronner, David Paul, Eric B. Hintz, Edwin van Wijngaarden, Giovanni Schifitto, David W. Wright, Tamara R. Espinoza, Bradford Z. Mahon. A common neural signature of brain injury in concussion and subconcussion. Science Advances, 2019; 5 (8): eaau3460 DOI: 10.1126/sciadv.aau3460

Interactive digital resources associated with this study are at

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Last Updated on August 11, 2019 by Marie Benz MD FAAD