The mystery of captain Bellini

The memory of defender Hideraldo Luís Bellini – who was the first Brazilian to raise the Jules Rimet trophy above his head at the World Cup competition in 1958 – began to falter in 1998. He 68 at that time and was recording a television commercial. Bellini could not manage to learn by heart a text of a mere four lines. “From then on, I began to pay attention and noticed he was forgetting simple daily things,” said his wife Giselda. “If I asked him to buy a few things in the market, five items, for example, he would return without at least two of them.” The medical diagnosis carried out by an exclusion method was that he had Alzheimer´s disease.

Over the following 16 years, the illness removed dates, names, faces and
memories. The elegant Bellini died at the age of 83 on March 20 this year as a result of respiratory failure, completely alienated from the world and himself. However, researcher Ricardo Nitrini, who had been Bellini´s neurologist since 2008, suspected that his patient had been a victim of a disturbance with symptoms that are similar to Alzheimer´s disease called chronic traumatic encephalopathy. This illness is more common amongst American football and hockey players, boxers and practitioners of mixed martial arts (MMA) and is associated with frequent blows to the head that cause concussion.

As the difference between encephalopathy and the Alzheimer´s disease can only be established through anatomopathological examination, the family donated Bellini´s brain to the bank of human brains held at the University of São Paulo. It is one of the largest in the world and Nitrini is a director. Now, slices and fragments of the player´s encephalic mass are kept in microscope slides and freezers at a temperature of 80 degrees below zero, among 3,000 other brains. The real cause of the 1958 Brazilian team captain´s death should be known by June.

The suspicion that Bellini, who also played for Vasco and São Paulo during his career, had been struck by chronic traumatic encephalopathy is based on his style of play. He was a defender, 1.82 meters tall and used and abused aerial battles for the ball. “He was a very impulsive sportsman and one of the best headers Brazil ever had,” said José Macia, known as Pepe, a former Santos and national team player. When Bellini entered the field, a clash of heads was a frequent occurrence. He headed the ball about 30% times more often than the average five headers made by a player without his profile in a single game. Moreover, the balls were made from leather until the 1980s and ended up weighting more than half a kilo on rainy days. Balls nowadays are less susceptible to water absorption and therefore lighter, thanks to technological advances. However, neurologist Nitrini believes the greatest danger is not in the impact of the ball on the head but when heads clash as the adversaries challenge for the ball.

This chronic traumatic encephalopathy was initially known as dementia pugilistica and was described for the first time by the American pathologist Harrison Martland in 1928 in an article in the magazine The Journal of American Medical Association (Jama). His study was based on boxers who were victims of the tremors typical of Parkinson´s disease, dizziness and cognitive changes characteristic of Alzheimer´s disease. It was established in 1957 that the first symptoms of the disease usually appear on average 16 years after the end of the boxer´s career in the ring. It is suspected that the Parkinson´s disease Muhammad Ali has is in fact encephalopathy. Nine out of ten professional boxers show permanent brain lesions arising from punches.

There are other sports that are even more liable to brain damage. Questions started being raised about the violence of American football in 2002. After carrying out an anatomopathological examination of the brain of Pittsburgh Steelers player Mike Webster, the Nigerian pathologist, Bennet Omalu of the University of California, warned of the dangers of the sport in developing neurodegenerative problems. Webster had been known as Iron Mike and many regarded him as the best player in the American national league. When he died in 2002, aged only 50, he showed symptoms of dementia, depression and amnesia. At the time, the National Football League (NFL) claimed that the sport was safe and accused Omalu of practicing “voodoo medicine”. In 2008, neuropathologist Ann McKee of Boston University began to study chronic traumatic encephalopathy. She now has a bank with more than 200 brains of ex-footballers and has become an acknowledged expert on the subject. “If the brain is submitted to repetitive concussions, in a vicious cycle and without any time to recover, a protein called tau accumulates,” she told VEJA. “It is an extremely toxic process that leads to the death of the brain cells.” An American footballer experiences between 900 and 1,500 concussions per season – equivalent to up to 93 clashes per game.

Concussion is defined as a sudden blow to the head, leading to a temporary interruption of cerebral activity. One of the most common mechanisms is when the brain shakes. “The shock against the walls of the brain leads to lesions,” said doctor Renato Anghinah, head of the post traumatism brain encephalic cognitive rehabilitation service of the
Hospital das Clínicas in São Paulo. “Every time there is a contusion, neuron cells may die or suffer ruptures that prevent their proper functioning.” As a result, the protein tau that is found in the interior of the neurons is released. Two hours after the blow, the protein is deposited in the brain and remains there for around three months. If the concussions are frequent, the tau deposit is always renewed. In chronic traumatic encephalopathy, the protein tends to deposit in the thalamus, amygdala and frontal cortex, brain structures responsible for maintaining the basic functions of the organism, by the most primary emotions and executive functions.
Science is still trying to uncover the mechanisms behind the repetitive concussions. “We are investigating the genetic differences between the sportsmen who develop the illness and those who remain healthy,” said McKee. She was the first to describe a case of chronic traumatic encephalopathy in an American football player, Patrick Grunge, in February of this year. She is now anxiously awaiting the results of the anatomopathologist examinations of Bellini´s brain.

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