In the 71 years since Yankees slugger Lou Gehrig declared himself "the luckiest man on the face of the earth," despite dying from a disease that would soon bear his name, he has stood as America's leading icon of athletic valor struck down by random, inexplicable fate.
A peer-reviewed paper to be published today in the Journal of Neuropathology and Experimental Neurology, however, suggests that the demise of athletes like Gehrig and soldiers given a diagnosis of amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease, might have been catalyzed by injuries only now becoming understood: concussions and other brain trauma.
"Here he is, the face of his disease, and he may have had a different disease as a result of his athletic experience," said Dr. Ann McKee, the director of the neuropathology laboratory for the New England Veterans Administration Medical Centers and the lead neuropathologist on the study.
Gehrig's name does not appear in the paper; his case was discussed in interviews merely as an illustration of the new uncertainty surrounding cases resembling his, said Dr. Robert Stern, who serves with McKee as co-director of Boston University's Center for the Study of Traumatic Encephalopathy. The cause of his disease will most likely never be determined because his remains were cremated, and now lie in Kensico Cemetery in Valhalla, N.Y.
Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said markings in the spinal cords of two players and one boxer who also received a diagnosis of ALS indicated that those men did not have ALS at all. They had a different fatal disease, doctors said, caused by concussionlike trauma, that erodes the central nervous system in similar ways.
The finding could prompt a redirection in the study of motor degeneration in athletes and military veterans being given diagnoses of ALS at rates considerably higher than normal, said several experts in ALS who had seen early versions of the paper. Patients with significant histories of brain trauma could be considered for different types of treatment in the future, perhaps leading toward new pathways for a cure.
"Most ALS patients don't go to autopsy — there's no need to look at your brain and spinal cord," said Dr. Brian Crum, an assistant professor of neurology at the Mayo Clinic in Rochester, Minn. "But a disease can look like ALS, it can look like Alzheimer's, and it's not when you look at the actual tissue. This is something that needs to be paid attention to."
Gehrig had a history of significant concussions on the baseball field, and perhaps others sustained as a battering-ram football halfback in high school and at Columbia University. Given that, it's possible that Gehrig's renowned commitment to playing through injuries like concussions, which resulted in his legendary streak of playing in 2,130 consecutive games over 14 years, could have led to his condition.