Former football player Michael Keck knew something was going wrong with his brain. He was only in his 20s and his memory was failing. He was having trouble concentrating and he'd become uncharacteristically emotional and short-fused. Keck suspected he might have the same problem as NFL star Junior Seau, the former linebacker for the San Diego Chargers, who fatally shot himself in the chest at age 43 because he had a degenerative brain disease called chronic traumatic encephalopathy, or CTE.
Keck died from a congenital heart defect at the age of 25 in 2013. Near the end of his life he told his wife, Cassandra, he wanted to donate his brain to Boston University so pathologists could look for CTE. In the researchers' report, published Monday in JAMA Neurology, doctors found clumps of abnormal tau protein scattered throughout his brain in a pattern researchers say is one of the hallmarks of CTE.
"It was the worst CTE I've seen in an individual this young" said study coauthor Dr. Ann McKee. "It was quite widespread," said McKee, chief of neuropathology at the Bedford Veterans Administration and a professor of neurology and pathology at the Boston University School of Medicine.
Keck had played tackle football since he was age 6 and had sustained more than 10 concussions by the time he was a junior in college. The jolt to the brain had left him with excruciating headaches and unable to play. He became so sensitive to light that he placed heavy blankets over the windows.
By the time Keck was 25, he had lost the ability to work and had become completely dependent on his wife.
Following Michael's wishes, his wife, Cassandra, asked doctors to send his brain off to BU. Researchers there discovered that Keck not only had CTE, but also that it was as severe as what had been found in the brain of 43-year-old Seau.
Tackle at a young age
McKee suspects that part of the reason for the severity of Keck's disease was the age he took up tackle football. "He started playing when he was quite young," McKee said. "So he had 16 years of football behind him. That's a lengthy exposure. Brain injury is cumulative."
Such severe disease in someone so young is troubling, McKee said. She suspects that Michael may have had something in his genetics that predisposed him to a worse outcome from concussions.
While she doesn't suggest a specific age for kids to start playing tackle football, McKee believes kids should avoid head contact in any sport, including football.
"If you're going to play [tackle] football, put it off until the body matures completely, until the body size has caught up with head size, until the muscles are coordinated," McKee said.
Cassandra Keck took some comfort in hearing the diagnosis. The man she met and married had been smart, kind and industrious. But then he started to change; his memory deteriorated and he became violent and abusive.
Keck had maintained a 3.8 GPA at Harrisonville High in Missouri and was able to keep his grades high in his freshman year at the University of Missouri. That all changed after he transferred to Missouri State University and sustained his second college concussion playing linebacker.
Michael took a year off football to recover. When he tried to start working out with the team again, his headaches would flare and his vision would fade to black. Though his vision would return eventually, it was frightening and Keck told his coaches he couldn't come back.
"He couldn't read his books," Cassandra said. "The words would get all scrambled. He'd get angry and punch the book and throw it across the room. He couldn't read, so he couldn't study. He felt like he was failing. He just wanted to graduate from college."
About a year before he died, he had to stop working. "Having to be somewhere on time was very stressful," Cassandra said. "I'd have to put his shoes and socks and hat by the door so he knew where everything was. I'd have to get his shirt and pants ready."
Head hits and later symptoms
There still isn't enough evidence to suggest that youngsters need to give up tackle football, experts told NBC News. It's unknown how many people end up with permanent debilitating symptoms as a result of hits on the field, said David Hovda, a professor of neurosurgery and director of the Brain Injury Research Center at the University of California, Los Angeles, who is unaffiliated with the new study.
Even if it's a small percentage, "we still need to do something about it," Hovda said. "Every person is important. But we have to be cautious about changes that affect everybody."
If the percentage is much larger, say one-third of players, then "we have a real problem that needs to be fixed," Hovda said.
Another question is whether head hits among some youngsters can be linked to CTE symptoms later in life.
"Certainly we have known that CTE changes in the brain can be found in younger players," said Dr. Julian Bailes, medical director of Pop Warner football, who is unaffiliated with the new study. "But I don't think that any research, and not the [new] case report, necessarily correlates with football participation at a young age. In my opinion, it is more likely that the exposure that he got in high school or college, or even doing other activities, led to the accrual of CTE changes."
Bailes, clinical professor of neurosurgery at the University of Chicago Pritzker School of Medicine and the chairman of the department of neurosurgery at the NorthShore University HealthSystem reported on the 2009 death of Chris Henry, the only active NFL player to die and have CTE at age 26, with forensic pathologist Dr. Bennet Omalu.
The hits little kids sustain playing tackle football rarely lead to concussions, Bailes said.
"For instance, in Pop Warner football, we think that currently the concussion rate is only 1 percent annually for players, while they are receiving about 100 cranial impacts per season, almost all of low velocity," he added. "However, high school players hit at high velocity (high g-forces) and at about 600-800/year, and college approximately 1000/year. "
Taught to play through pain
For her part, Cassandra hopes that in telling Michael's story, people will better understand the dangers of concussions.
Even as a youngster, Michael had been taught to play through pain, even if it was associated with a brain injury, she said.
"He told me that when he was 8 he would be sitting on the bench holding his head and the coach would be rubbing it because it hurt so bad," Cassandra said.
Whether Keck was playing youth, or high school or college football, the message was "if you're hurt, you just get out there and play — don't be a wuss," Cassandra said.