The high-definition MRI showed small areas of bleeding on Richy Klepal's brain, a condition commonly known as a Duret hemorrhage, and usually only discovered during autopsies.
"The outcome is almost universally fatal," reads a summation of the hemorrhage in Imaging Science Today.
So five days before his 18th birthday, Richy went to Florida Orthopaedic Institute with his mother and girlfriend for a followup appointment. There was much to discuss but a single important recommendation: Richy, a star offensive tackle at Plant High School who was headed to Florida State upon graduation, must stop playing football.
"This is a 17-year-old Caucasian male with repeated mild traumatic brain injuries," Dr. Marc Hilgers wrote in the report after the Sept. 19 visit. "The current findings confirm our decision and the decision of the athlete to step back from playing football and to focus on his academic career."
"It scared me to death," said Richy's mother, Amy. "We could have lost him over this."
News of Richy's decision resonated during a time of greater public awareness of football-related concussions and traumatic brain injuries. About 5,500 plaintiffs, including 4,000 former NFL players, have filed concussion-related lawsuits against the league, accusing it of withholding information about the link between head trauma and permanent brain injuries.
But the wages of the game made a particularly tragic example of Richy, one of the youngest football stars ever forced into early retirement.
His career lasted four years. At least one concussion for every season.
"I was being stupid and went headfirst. I never went to the doctor, though. I just sat out and was good to go the next day. So it was relatively minor. I didn't know if it was a concussion or not but later on they counted it. … It was probably my fault." — Richy Klepal
No one gave much thought to the first one, the product of an unspectacular collision during a special teams drill in a late-season practice in 2009.
Then a burly freshman offensive lineman at Plant, Richy had gotten the itch for contact — familiar to anyone accustomed to the boredom of football practice — during some repetitions with the varsity.
Coaches blew the whistle and Richy sprinted downfield, looking for someone to hit. As Richy approached his target, he leaned forward, then hurled all of his 230 pounds into an older and stronger teammate.
The rookie got the worst of it.
"I don't remember much about it," he said. "But I was in a lot of pain."
Disoriented, Richy slowly picked himself off the turf and headed for the sideline. He was done with practice — until the next day.
Neither Richy nor his parents and coaches realized it at the time, but he had suffered a traumatic brain injury more commonly referred to as a concussion. Because he didn't exhibit any of the symptoms — headaches, nausea, loss of concentration — the injury went undiagnosed until three years later.
By that time, Richy had tallied at least four more documented concussions, a total that placed him at increased risk for early dementia, memory loss and permanent brain damage, among a host of other grim possibilities.
"My sophomore year was probably my biggest year for concussions because I was on varsity but I was starting, so they had me going up against the best defensive linemen. I was getting my butt kicked a fair amount." — Richy Klepal
Practice again, this time in mid August 2010.
Imagine two players crouching in a three-point stance, facing each other from opposite ends of a 2- by 4-foot board. When the whistle blows, a player attempts to drive his opponent backward or to the ground.
Coaches call these "board drills," an exercise meant to teach players to keep their feet wide while blocking and to gain leverage while staying lower than their opponent.
Richy was practicing against the best of Plant's powerhouse program now. He was a sophomore who needed to toughen up and refine his blocking technique against college-bound senior stars such as James Wilder Jr., (Florida State) and Bobby Richardson (Indiana).
"I was bigger but muscularwise, I wasn't completely developed," said Richy, who had gained 30 pounds since the previous season. "I had a lot to learn."
During one of those board drills, against one of those boys who looked an awful lot like a man, Richy took a blow to the head.
"My vision immediately got blurred, and I'm pretty sure I fell," he recalled.
He was diagnosed with a concussion and forced to sit out nearly three weeks. He returned in time for the second game of the season.
Thus began the varsity football career of the kid who grew up in a family with Midwest roots that revered basketball.
He inherited the love of the game from his father, Rick Klepal, who graduated from Indiana University and counts former Hoosiers basketball coach Bob Knight as a friend.
Richy played in a number of youth basketball leagues and was flown to camps across the country, even Texas Tech when Knight coached in the twilight of his Hall of Fame career.
"He was a basketball player long before he was a football player," Rick Klepal said. "I tried not to push him. But it just happened by osmosis and him living under the same roof as me."
Already bigger than most of his peers, Richy decided to give football a try because that's what hulking boys in Florida are supposed to do. His mother signed him up with the South Tampa Seahawks of the Tampa Bay Youth Football League.
It turned out Richy was too big for youth football: He failed to get under the weight limit most weeks and was forced to play with older kids when he did.
He seemed destined to spend most of his athletic life on the hardwood, even playing on a summer league team that won a national championship before he entered ninth grade.
However, in Florida, in Tampa — and especially at Plant — football takes a backseat to nothing.
The game seemed like destiny for Richy, who was now 6 feet 4 and filling out that massive frame.
"One (concussion) is bad. Two is really bad. And three is 'Oh, my God.' " — Dr. Marc Hilgers
By the end of his sophomore season, Richy was a significant contributor on a team with state championship aspirations.
Thus his third concussion came at an especially inopportune time, during a mid-November practice after Plant's first playoff game. Richy doesn't remember much about the injury: how, where or when exactly it happened.
After a visit to Florida Orthopaedic on Dec. 9, 2010, Hilgers wrote Richy was "still recovering" and ruled him out for another week. Richy missed a third playoff game and didn't return until the Class 5A state title game, where the Panthers lost 29-7 to Fort Lauderdale St. Thomas Aquinas.
Richy went on to play another season of basketball, but it was apparent his future was in football. All of his gifts on the court — agility, power, explosiveness and coordination — made him an especially tantalizing prospect on the gridiron.
And he was still growing, getting stronger and picking up the intricacies of the game.
"Richy was kind of a perfect storm," Plant football coach Robert Weiner said. "He took those skills that he got from basketball and put it together with the strength he got from football, and now we had a prospect."
Richy's future in the game seemed bright, if not assured. But there were those three concussions — two that were known of at the time.
No. 3 is a tipping point, when patients become more likely to start that long, silent march toward a lifetime of confusion, darkness and distress.
"Lots of red flags go up," said Hilgers, Richy's former doctor who is now director of sports medicine fellowship at Level One Orthopedics and runs a Level I concussion center at Orlando Health.
Regardless, doctors take patients on a case-by-case basis. They use test results as their guide, allowing for the possibility that some patients are better able to bounce back from multiple concussions than others.
Doctors such as Hilgers fill a need but know there's much more work to be done. An estimated 3.8 million Americans sustain sports-related traumatic brain injuries each year, according to the U.S. Centers for Disease Control and Prevention. And many doctors understand that is probably a low estimate.
"Many athletes do not know that they have a concussion and therefore they never report them and never seek help," Hilgers said.
Here again, Richy is a perfect storm.
He had reported his concussions to the appropriate authorities, but several memories don't quite match with doctor's reports, and some head blows didn't merit visits to the doctor.
"Immediately I knew something was wrong. I felt buzzing in my ear and I got real, real dizzy. I remember being pissed off." — Richy Klepal
It was late in Plant's 2011 playoff opener against Orlando Boone, an eventual 33-point win, and Richy never saw the hit coming.
He was running downfield one moment and sprawled on the turf the next, victim of a helmet-to-helmet blow that almost certainly would have drawn a penalty flag had officials seen it.
"I was blindsided," he said.
Richy watched from the sideline the rest of the night and missed a few practices, but he returned for the next week's playoff game. He had no lingering symptoms of a concussion, passed all of his tests and was ready to rejoin his teammates.
By this time, Richy had become an integral part of the Panthers' vaunted offensive attack.
In the Class 8A state championship game, they ran a number of plays behind Klepal en route to 310 rushing yards. Plant's success running the ball played a key role in the title-clinching 31-20 win over Miramar.
"He was instrumental in that victory," Rick Klepal said. "Go back and watch that opening drive … they were running plays where Richy was out leading the way. They shoved it down their throats and that set the tone."
Richy presented his father with a gift when it was all over. "I will never cherish anything quite like I do that banged-up helmet," Rick Klepal said.
With basketball finally out of the picture and now living up to his considerable football promise, Richy went into the spring as one of the nation's most sought-after offensive line prospects.
His father took him on a cross-country summer road trip, visiting many of the schools that had expressed an interest in him: Oregon, Southern Cal, Indiana, Georgia and all of the major programs in Florida, among others.
When it was over, Richy committed to the only school that felt like home: Florida State.
"I fell in love with the school," he said. "That's where I saw myself."
He announced his commitment to the Seminoles in July 2012, hoping to end the recruiting process early so he could focus on his final high school season.
At 6 feet 5 and 285 pounds, Richy was bigger, stronger, meaner and smarter than ever. He was a helmeted Incredible Hulk bent on making Friday nights miserable for opposing defensive linemen.
"He had a lot of potential," said Tom Lemming, a longtime recruiting expert for MaxPreps/CBS Sports who ranked Klepal among Florida's top 60 senior prospects. "He was a good-sized kid with some ability."
This was surely just the start.
"The moment that it happened I was furious. I was really, really mad at myself. The feeling was very familiar." — Richy Klepal
The days of getting manhandled during board drills were over for Richy. Now it was his turn to inflict cruel lessons about size and skill advantages.
He had won eight straight matchups — "a rapid fire session," he called it — during a Sept. 5 practice when senior defensive tackle Quinn Metoyer lined up across from him.
They got into their three-point stances, waited for the whistle, then charged into each other. In only a few seconds, everything changed for Richy.
"It was one of those freak things," Metoyer said. "I knew immediately."
So did Richy, who fell to all fours and needed help getting to his feet.
Even then, a feeling of finality settled over his mother, who showed up near the end of practice and saw him sitting in the bleachers.
"In the back of my mind I was thinking, 'Not again,' " she said. "This has got to be it."
That night, Richy experienced a checklist's worth of postconcussion symptoms: headaches, nausea, dizziness, balance problems and sensitivity to light.
His girlfriend, Olivia Portugues, arrived later that evening. She found an incoherent and agitated Richy sprawled on his bed, wearing a hooded sweatshirt and sunglasses in his pitch-black bedroom.
"I brought him a milk shake and he didn't even touch it," said Portugues, also a senior at Plant. "He wasn't like himself at all. I was so scared."
It was obvious Richy would be held out of the next game, a highly anticipated matchup against nationally ranked John Curtis Christian in New Orleans. Richy and his family secured permission to accompany the team to Louisiana.
The trip only made things worse. Between persistent postconcussion symptoms — he kept his sunglasses on most of the time — and the Panthers' 30-point loss, Richy only wanted relief from the pain.
Within a couple of days, Richy was back at Hilgers' office for more tests, and the results created more doubt about his future. He bombed most of the exams, which evaluated his reaction time, memory and balance. "Richy scored below the 10th percentile in most of the tests," Hilgers said, meaning at least 90 percent of patients outscored him on most tests.
Hilgers ordered Richy to skip classes and practice until the symptoms receded. Doctors often recommend avoiding anything that might stress the brain.
Richy was still complaining of headaches, dizziness and nausea during his next visit to Florida Orthopaedic on Sept. 19. Then there was the MRI exam, which showed bleeding on his brain, including the usually fatal Duret hemorrhage.
"He could have died from this concussion," Hilgers said. "There are not many cases like Richy's. He's a very lucky case."
Even pickup basketball was a potentially fatal risk. The decision was difficult but obvious: Richy's athletic career was over.
"It was probably one of the worst feelings I've had in my life," he said.
All that remained was telling his teammates at practice the next day. Richy started crying before he could open his mouth.
"It was a very emotional moment," said Weiner, lowering his voice at the memory. "That's real life stuff. That's real-man stuff."
A new course
"Look for the exits; they may save your life." — Rick Klepal in a letter to Richy on his 16th birthday
Richy felt adrift without football, which had given him daily structure, most of his friends and social standing.
"I thought of myself differently," he said. "I lost a sense of who I was. I was so used to being an athlete."
An affable and outgoing sort, Richy stopped hanging out with the football team — "It hurt too much," he said — and settled into a depression that worried his parents and girlfriend.
Still on doctor's orders to give his brain rest, Richy rarely left his room, let alone the house, over the next few weeks.
He became so despondent, his mother said, he asked her to leave work in the middle of the day. She rushed home.
"I was worried because that had never happened," she said. "He was just feeling really bad and depressed."
Gradually, the fog of depression started to lift and some of his symptoms went away.
Richy started thinking about this new, football-free future. He looked into community colleges in California and thought about studying along the beaches of the Pacific Coast. Santa Monica College sounded far and sunny and different, alluring for a teenager seeking a new identity.
He worked at a couple of local pizzerias, creating his own special pies.
"He was a nice and quiet kid, kind of a gentle giant," said Ryan Kelly, executive chef at Fire Bar & Grill. "And he worked hard."
Things were looking up even before he got a phone call from Florida State, which still honored the scholarship offer.
Richy and his parents drove up to Tallahassee, where the Seminoles coaching staff essentially recruited him all over again and arranged several meetings with academic staff. They had discussions about Richy eventually getting into coaching.
"You would have thought they were trying to sign the most valuable recruit in the country," Rick Klepal said. "They kind of gave him some of his value back. You could see it had the desired effect on him."
Richy got the boost he needed, finishing up the necessary high school assignments to graduate a semester early.
He was going to wear the FSU garnet and gold after all.
"I don't ever want to put a young man at risk. But if it heals, I've had crazier things happen." — FSU coach Jimbo Fisher
Today, Richy is trying to schedule another MRI exam.
"It's really to give me a ballpark of where I am," he said. "I want to know where my head is as far as healing and get some perspective on the next four years."
Richy has been a college student almost two months now, taking classes, making friends and enjoying his newfound freedom. His girlfriend plans to attend Florida State in the fall.
Richy has expressed an interest in film school and the university's entrepreneurship program. He said he won't be a guy who works in a cubicle.
"I'm a different type," he said. "That's not really for me."
And, yes, Richy has also expressed an interest in football. Not just coaching but possibly playing again.
Hilgers wouldn't recommend it. His mother and girlfriend would prefer he didn't. His father wouldn't agree without a guarantee of no further risk to his son but embraces Richy finding a routine that gives him purpose.
FSU coach Jimbo Fisher said he wouldn't allow it without the approval of two doctors and Richy's parents.
"I want to make sure, from a medical standpoint, that there's no chance for him to have further effects," Fisher said. "But he's probably never going to play again. Maybe he'll be a student-coach and interact with us every day. He can still be around here with the team and stay around athletics."
Richy understands this is all a long shot.
His body and mind are willing and able.
His brain probably isn't.
Times news researcher Caryn Baird contributed to this report. Joel Anderson can be reached at firstname.lastname@example.org or on Twitter @jdhometeam.