Football Concussions and Return to Play Assessment  

Cognitive Impairments from Sports Injury with normal MRI.
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Age: 18


This patient is an 18 year old high-school football standout with the promise of an exciting college football career. He was accepted to start his freshman year to play football for a well-known and highly competitive NCAA team. He has a history of multiple concussions with lingering cognitive impairments, although headache is not a particular problem in this case.

The important thing to note is that this patient was given the “green-light” to play based on standard neurological, neuropsychological and conventional radiological scanning criteria. All these traditional tests had produced negative findings, or in other words produced no evidence of damage.

Even though the patient was cleared to play, he still felt something wasn’t right “in his head” and wanted more information. He then underwent an fMRI through Notus.


Notus NeuroCogs™ detected several notable evidences of functional injury. The patient shows activation deficiencies largely limited to subcortical and medial frontal cortex. These are two areas most commonly seen deficient in mild TBI. These areas seem particularly vulnerable to brain trauma and can show functional disruption when most other brain areas show normal functional activation. This most likely has to do with the physical location of these areas within the brain which makes them most susceptible to the mechanical forces that cause distortions of brain tissue (compression, stretching, twisting) during impact-based head injuries.

Also, as seen in some of the other case studies presented here, this type of mild to moderate brain trauma can often greatly compromise the internal functioning of brain cells (due to twisting and stretching of axons), without actually destroying the external structure of the cells.

Thus, brain tissue might appear normal on conventional CT and MRI scanning methods in such cases. This is clearly the case for the current patient, as the images below indicate no obvious brain tissue damage. Examples from a few of the Notus exams presented here show lack of activation specifically in subcortical and medial frontal areas. This is shown both in the fMRI statistical reports as well as the fMRI brain images.

Summary: Based on fMRI findings alone that correlated strongly with the patient’s symptoms and soundly verified his suspicions, the patient decided to not continue to play college football. The decision was made despite indications from all other clinical exams that the patient was okay to return to play.

Data from the fMRI exams is presented below. In the graphs below, all “fragile” regions (medial prefrontal areas and subcortical areas) are indicated with arrows above each column.





In the images below, all “fragile” areas where activation should be present, but is not, are indicated by red arrows.




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