Ask a Doctor: Does SI's Big Ben Frontal Lobe Argument Hold Water?

Yesterday Ben posted a story from Sports Illustrated on the blog about how Big Ben's "deviant" behavior may have been caused by frontal lobe injury. I decided to ask our resident blog expert, neurologist Cynthia Brown, MD, who we had consulted previously on Ben Roethlisberger when his concussion issues popped up during the season and the question is whether he should play or not. So we borrowed Cynthia from her DynaMed obligations for a few minutes as she tells us her feelings about whether Roethlisberger's head injuries could have caused his behavioral issues:
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There is not an easy answer to this complex situation. The circumstances of Ben Roethlisberger's 2006 motorcycle accident indicate that he was riding without a helmet and that he suffered enough of an impact to cause multiple facial fractures and loss of teeth (riding without a helmet on that day would indicate bad judgment even before the documented head trauma). There is also documentation of other sports-related concussions.

The article by David Epstein does address the issues well. At first blush, it is difficult to differentiate what may be adolescent-type behavior in a young man with fame and fortune and irresponsible behavior, from that of someone with frontal lobe damage. The acceleration/deceleration head injuries that Ben has experienced can cause brain damage on a cellular level which can result in frontal lobe damage manifested by poor judgment (loss of executive function) and the loss of ability to filter speech and behavior in order to behave in a socially appropriate fashion (disinhibition). Damage to the temporal lobes (which can also occur from acceleration/deceleration head trauma) can also result in certain deviant sexual behaviors, but this would be highly unusual. I agree with the comments of the neurologists and neuropsychologists that determination of his behavior patterns earlier in life as well as extensive neuropsychological testing will be able to determine whether this is the behavior of an egotistical man or inappropriate behavior of a brain-damaged individual.

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Thank you to Cynthia for once again providing us with some expert opinion here at NYaT!