transient

I'm not denying that the encephalopathies you are focusing on are common, and if you are looking at this purely from the standpoint of incidence then yes, you are correct. However, CTE is not common, and is not really comparable to the more common entities you are describing. CTE is a primary encephalopathy. It's effects are cummulative, and symptoms generally correlate with severity of histologic findings. To say that most encephalopathies are treatable is incorrect from an etiology standpoint, as most primary encephalopathies are not at all treatable. To say that the most common secondary encephalopathies are treatable is more accurate. It's a matter of perspective. From a pure numbers standpoint you win, but you do so by comparing things that are not really comparable. The thing is, the term encephalopathy is really broad and you are arguing it through a very narrow viewpoint, though the incidence of the limited number of conditions you are talking about may allow you to feel justified in doing so. Also, to say that the above acute diseases affect only a specific area of the brain is technically wrong. Renal failure and hepatic failure, as examples, lead to systemic changes, namely an elevation in the level of waste products in the blood... blood that is flowing through the entire body and causing metabolic changes in the entire body. Certain areas of the brain are more susceptible to these toxins, and therefore become dysfunctional, however the changes induced are brain (and body) wide -- that was my point in saying that if you biopsied the brain of a patient with acute hepatic encephalopathy, for instance, that you could see changes everywhere, it doesn't mean that the symptoms were necessarily coming from the area of biopsy; and I wasn't seriously suggesting that it should be done. When it comes to people being encephalopathIC, the fact is it cannot be a focal process affecting only a specific area of the brain. In general, it needs to affect BOTH hemispheres, otherwise you would not have the delirium and fluctuations in consciousness that frequently accompany it, you would lose only the focal functioning. People with acute strokes, unless they have injury in both hemispheres, rarely have an alteration in their level of consciousness (in the acute setting, not applicable after there has been swelling). That is not to say they tend to external stimuli correctly, but that they are wide awake and alert (also doesn't apply to the certain areas of the brainstem or thalamus, as this can cause signficant changes in level of consciousness). Finally, with chronic hypertension there are commonly white matter changes on MRI (when severe referred to as leukoaraiosis) that frequently precede the lacunar and larger strokes you are refering to, and the condition is technically an encephalopathy (though admittedly it is currently poorly described and may turn out to be more accurately described as a vasculopathy).

The medical examiner is there to determine the immediate cause of death. You don't need to do an exhaustive microscopic exam of a brain to figure out what killed the guy after he fell of a truck and fractured his skull. You can tell that on a gross exam. Given that, any histologic exam would not have needed to be done urgently, and likely would not have been done by the ME himself, though it could have been. Also, depending on the staining they did, the processing can take some time, again, not likely to be related to cause of death so you can make the declaration of cause of death without having the results of the staining available. Most likely in this case, the doctors who you so quickly dismiss who are in charge of an institute that does research into brain injury probably asked for tissue to examine as Henry is a professional athlete who plays a violent contact sport. His mother would have had to give consent for that as next of kin, thus her involvement. The announcement was probably because they didn't expect the results they found, and before being able to do so, they again would have needed to get approval from his mother. This is currently a huge area of research. There has been nothing that I saw indicated about a lawsuit. With regard to the doctors searching until they find something, an encephalopathy is a global process, and as such any area that was not damaged by the fall would potentially have these changes them. "Normal" tissue would have been sampled as an internal control by the ME or pathologist, and if samples were requested by the doctors at the Brain Injury Research Institute, they certainly would have asked for samples that were both from the acute injury and "normal" controls. Sorting this out from the acutely injured regions is not at all difficult. Finally, in response to your assertion that the conditions you identified earlier are THE ones that cause encephalopathy, they are one subset of a large group and are appropriately called toxic-metabolic encephalopathies. They are not even PRIMARY encephalopathies, meaning they are not due to changes taking place in the brain that are due to a primarily neurologic cause. They are due to transient metabolic disturbances, infections, inflammation, etc that affects global brain function. They may be the most commonly seen, but they are not a majority in terms of number of etiologies. There are a whole host of things you are discounting that ARE primary neurologic conditions that are more analogous to traumatic encephalopathy than the examples that you continue to tout. Apples and oranges. As I tried to explain before, an encephalopathy is a disease or condition that affects the brain on a grand scale, it is not the confusion that it causes in the person. It is expected to be seen throughout the brain, not focally like a tumor or metastasis as you suggested would need to be included based on my description. As for discounting the idea of hypertension causing this, there is an actual entity called hypertensive encephalopathy, AND there is also a phenomenon of brain injury seen in people with chronic hypertension that affects small blood vessels diffusely that can be seen on MRI that is technically an encephalopathy. You can continue to call BS if you like, but you are wrong. Edit: I guess I type slower and say things less succinctly than Doc.

WEO, all of the causes of encephalopathy you listed above cause dysfunction in the brain, and you happened to select those that are reversible to attempt to prove your point. If you were to biopsy a person's brain that was acutely encephalopathic in any one of those conditions you would find acute changes be they metabolic, inflammatory, edematous, etc if you were looking in the right place. If you WERE to biopsy them, you would ALSO get sued for malpractice, as they are all treatable conditions with a reversible cause. To suggest they universally leave no residual brain damage is also incorrect, as evidenced by the fact that people with meningitis have an increased tendency to have seizures as well as hearing deficits, especially if they had this at a young age. Regardless, I am not disagreeing with the treatable or generally reversible nature of the examples you provided. To suggest that they represent the majority of the causes of encephalopathy is wrong. They are some of the more common causes, however there are countless genetic causes that result in accumulated changes in the brain over time that can occur in people who are apparently of normal intelligence and functioning at birth and into their adult lives; there are conditions that are as a result of improper proteins within the brain; there are conditions that strip the coating off of nerves, as well as infections that can do the same that are not treatable; there are changes due to hypertension that are not necessarily acutely symptomatic, but that can be seen on an MRI... I could go on endlessly. The fact is, you mention acute causes of encephalopathy and state these are the majority, but there are numerous causes of progressive encephalopathy (slow onset changes to the brain that accumulate over time), of which traumatic encephalopathy is one. In my initial post, my statement was that Henry was awfully young to have those findings, and that I didn't think 4-5 years in the NFL would cause that. This was meant more as an "I wonder what happened to this guy earlier in his life before he became a pro football player" kind of statement. For all we know he and his delinquent friends donned baseball helmets and hit one another in the head with a bat after school from the time they were 12. Also, everyone's biology is different. He could have an underlying predisposition to a degenerative disease such as frontotemporal dementia that usually presents in a person's 50s, and similarly results in people becoming disinhibited and exhibiting poor judgement, and his chosen profession hastened it's progression by causing trauma in areas that were already susceptible thereby exacerbating it. Who knows. The fact is if other players want to use this as an excuse someone would have to biopsy their brain to conclusively demonstrate evidence of disease, something I doubt many players would be excited to have done. The thing is it's not a stretch, as several have mentioned, to think that in a population of people who have spent their lives running into things at full speed that this condition would be more prevalent. It's also not hard to believe that a sport like football would have a higher number of naturally aggressive, disinhibited a-holes succeeding given the very nature of the sport. Calling BS on Henry's mother's motive for doing this is different than calling BS on the fact that there was evidence of an underlying condition. Was it severe enough to affect Henry's decision making? Who knows, but the presence of it certainly didn't make him a more rational, thoughtful person.

Don't confuse someone being encephalopathic (exhibiting confusion or "global brain dysfunction") with the underlying etiology (or encephalopathy). You can have early stages of an encephalopathy without being frankly encephalopathic. You can't tell by biopsy or autopsy if a person was exhibiting symptoms, but in specific conditions where structural changes are present such as traumatic encephalopathy you can certainly tell if they had underlying evidence of the condition. And for the record, the "E" is for encephalopathY not encephalopathIC, as in a pathology (disease, condition, or abnormality) of the encephalon (brain). If a person was in the early stages of Mad Cow and got hit by a bus, it would not change the fact that they had the pathologic condition, even if they were not yet encephalopathic.

Agreed. I was trying to use the more common condition of a stroke to demonstrate how an injury to an area of the brain can affect well established brain functionality.

Mom better be cautious, lest they find she or pops shook him a little too hard as a kid.

Encephalopathy is not soley a clinical diagnosis, it can be made on the basis of imaging or on tissue obtained from a biopsy or autopsy as well (think of bovine spongiform encephalopathy or "Mad Cow disease"), therefore it can be made on a dead person. In terms of chronic changes, it could be seen if the person suffered repeated injury during his early years and sufficient time had passed. As I had said earlier, if the changes they saw were frontal in nature, it is not a giant leap at all to say that a person would be likely to have poor executive functioning, impulsivity, and other mood or behavioral problems that could lead to them taking risks that a normal person would not. The front part of the brain is responsible for these functions. It's the same as a person with a stroke in the left side of the brain losing the function of the right side of their body.

Not to mention that much of it is new. Think of LaFontaine in 96-97 and how new the idea of post-concussion syndrome was. Prior to that it was common for players with a mild concussion to go right back into the game, or sit out for the rest of the game before playing the next night. IIRC, Jim Kelly threw a TD in his last game that he doesn't remember. The fact of the matter is science is only starting to catch up. It's hard for players to understand the potential consequences of their decisions to play injured or hide head injuries when science and medicine are only now starting to uncover their true impact (no pun intended). Imagine trying to comprehend as a football player that even if you don't have obvious evidence of a concussion, the simple fact that you continually run in to things as part of your job will most likely impact your brain function later in life. Soldiers who have been in the vicinity of large explosions without any obvious physical trauma are now showing signs of traumatic brain injury due to the concussive waves. We've got a lot to learn.

From a pathology perspective they should be able to see both acute and chronic changes and sort them out. The chronic changes are essentially a form of scarring that occurs slowly and gradually, or deposits in brain tissue that are not normally seen until later in life, and would not be related to or even expected from the acute trauma. If the damage is widespread, or is significant in the front parts of the brain, the effect can be increased impulsivity, poor decision making or "executive function," or a whole host of mood related and behavior related problems. I'm not so much calling BS as I am wondering what was going on to cause this in his brain at such an early age. 4-5 years in the NFL probably wouldn't cause these changes to show up prominently at this point in time.

The thing is, Henry was only 26. What they're describing is normally a longterm consequence of repeated head trauma. Think Mohammed Ali who has what was previously referred to as dementia pugilistica. The onset was while he was boxing, but the full effects were long after his career was over. Makes me wonder if Henry didn't experience repeated head trauma as a child or have some early form of underlying genetic or other neurodegenerative disease.

The most telling thing for me for both Losman and Edwards is the fact that they had a modest degree of early success followed by a precipitous downturn with the common denominator being coaching. Neither one may have the talent to be a ProBowl QB, but we were certainly never going to find out with DJ at the helm.

I have a little gray terrorist that I love... wait... no, that's a terrier. My mistake. Just what do these terrorists look like? Are there any girls in this gaggle of terrorists, and if so are we talking physical love, or emotional love?

I'm thinking in the 6-8 win range, realistically, with the wins backloaded as this team gains some experience and the schemes start to make sense to them. The OL looked bad last year... everyone knows that, but come on, the offense looked like it was designed by Rainman. "No, no, no. I don't want anything complicated... definitely not anything complicated. There are five offensive linemen. Six if you count the tight end. Seven if you go double tight. Yeah, definitely seven offensive linemen. Let's make the quarterback coach the offensive coordinator. Uh-oh, only six offensive linemen cuz I cut the left tackle. Uh-oh, now we gotta use Karl Malone's son who's only played organized football for three weeks. I'm going to Kmart to buy underwear, then watch Wapner." How can the offense NOT be better. And even if they're not statistically better, nothing could be more painful than watching that ill conceived atrocity from last year. NOTHING. EVER. And even if the defense gives up an average of 150 yards rushing per game, it will still be an improvement over last season. This season will be entertaining to me if there are signs of life by mid season and some of the young guys start to produce. Better yet, the current coaching staff is not wedded to old regime players so the best should play. As Gailey's been saying, the roster will sort itself out. As long as the trajectory is clearly upward, things are better.

Modrak may ultimately end up getting the ax. Firing him this offseason would have been difficult considering Nix had to get a coaching staff together, and then sit down and evaluate the team's needs with Gailey after he was hired, leaving little time to reorganize the scouting department and comprehensively plan for the draft. At this juncture I'm willing to give Nix the benefit of the doubt as a talent evaluator. I'm sure he trusts his own instincts, thereby reducing the weight of Modrak's input already. Based on their recent approach, I and numerous others on TSW are of the belief that Nix thinks there is more talent on this team than what the woeful coaching staff was able to showcase. If this is true AND your argument is correct (which, for the record I do not believe to be the case), then Nix firing Modrak makes even less sense, since he would have been the person responsible for acquiring that talent. Wouldn't it make more sense to wait and see if the young players develop with better coaching or are actual busts before firing the person responsible for bringing them in?

Fox's article is speculative, at best. Just because they assign responsibility of prior drafts to him doesn't mean they're right. No one from the Bill's organization is even quoted in that article. The remaining articles you tagged feature him talking about the characteristics of players in the draft, albeit with less colorful language than what Dwight Adams used to ("He plays the game like his hair's on fire"). His role is presumably similar to Dwight's, unfortunately for him he's filled it during one of the most painful times in Bills recent history in terms of front office leadership and vision. Dwight scouted players, he didn't pick them. Organizing a draft board is different from deviating from it in the end. I'm not a Modrak apologist, I just don't know how much responsibility is directly his. If he is ranking positions based on characteristics that his GM (during the years he had one) or coach are searching for, then Maybin (undersized and supposedly fast... ring any god awful Tampa-2 bells) would likely be graded higher than other DEs such as Orakpo, as an example. If he was putting together the board purely on talent regardless of system, then the responsibilty rests with him. Also, if the team is drafting for need and reaching instead of taking the best player available or trading down for value, you can't blame him if the team selects their highest ranked prospect at said position and bypasses players he had ranked higher. If he happens to, again, have the position rank order skewed that compounds the problem and is his fault (and not the player's... can anybody say... DONTE). Unless he is the person pushing the player at that spot or ultimately making the final decision, the drafts are not "his" as FOX would indicate.

They were both hyped, no doubt. The fact of the matter was, picking either at four shouldn't have raised eyebrows as they were both projected as possible top 10 picks. Williams was an undeniably HUGE bust. Personally, though, I don't think McKinnie has played like what you would expect of a top 10 either, certainly not early on in his career, anyway.

I don't think there was a concensus top LT that year. Both were very hyped. Williams was the media darling, so ESPN was all over him. McKinnie was painted as a bit of a malcontent, and only furthered that impression with his holdout. While it is no contest as to which one of them was the better pick in hindsight, neither one of them has realistically lived up to their pre-draft billing or thier draft position.

He hadn't gotten to that chapter in "NFL offenses for Dummies" when Schonert spilled coffee on it, prompting his firing.

Is that so he doesn't break your nose/cheek when he tries to punch you in the face, or is it only his own teammates that have to worry about that? Personally, I don't care if players hurt themselves tripping over their dogs or break their necks base-jumping, it's their life. The circumstances are immaterial. If they violate their contract by hurting themselves, they don't get paid and/or they get fined, it's their risk. As a fan, it sucks if it's an important player, but whatever. I think I'd tend to ignore it if my boss told me I couldn't play a pick-up game with the boys during my free time, too. If I happened to do it and messed myself up to the point I couldn't perform my job, then it's a risk I took. Accidents happen. Now if you'll excuse me, it's off the soapbox and back to the bubble wrapped cocoon of safety.

I'm of the opinion that Nix knows value, and that holding on to Lynch and putting him in a position to showcase his talents to potentially trade him for a higher round pick next offseason is more what he is going for. Let him be on his best behavior this season to let some of the character issue talk die down, and let's see how this year pans out. Maybe even put a bug in his agent's ear that this would be in both of their best interest. If he gets suspended, or if he sits and pouts, the Bills have already put themselves in a position to deal with life without him, so right now it is about getting value. And if he turns it around and looks good in this offense, you can always trade Jackson next year.

Way to ignore the part in the first post about how he felt they were both nice people, and the part in the second post about how she seemed nice and smart. Keep flexing those beer muscles from behind the keyboard, there, tough guy.

I dated a girl whose younger brother's tee-ball team was coached by Joe Devlin... you'd have thought he was coaching inmates instead of little kids. Couldn't have acted like a bigger ass if he tried. Who intimidates opposing players and coaches in a tee-ball league?

Didn't they sing a song about a bullfrog?

...and the right coaching staff, cuz you can also draft the next HOF QB first overall and destroy him by surrounding him with ineptitude and getting him killed. (Before we get out the torches, I'm in NO WAY suggesting anyone currently on the roster is headed to the HOF)

Was it over when the Germans bombed Pearl Harbor? Hell no! Have fun storming the castle! Do you think they have a chance? It would take a miracle.