First known case of CTE in American pro soccer diagnosed in brain of former MLS player Scott Vermillion

The first known public diagnosis of chronic traumatic encephalopathy (CTE) in American professional soccer has been found, according to the New York Times.

The family of Scott Vermillion, a former MLS soccer player who died December 25, 2020 of acute alcohol and prescription drug poisoning, per the Times, heard from doctors at Boston University that Vermillion had stage 2 CTE after they had examined his brain.

CTE is a degenerative brain disease that can be diagnosed only posthumously and is caused by repetitive hits to the head. Symptoms don't occur until years after the blows and often worsen over time.

"Soccer is clearly a risk for CTE," Dr. Ann McKee, the director of the CTE Center at Boston University, told the Times. "Not as much as football, but clearly a risk."

According to his obituary, Vermillion played as a defender for three seasons at the University of Virginia, from 1995-97, where he played in two NCAA final four championships. He played four seasons in the MLS from 1998-2001 with the Kansas City Wizards, Colorado Rapids and D.C. United and was also a starting defender on the 1998 U.S. Men's National Team. Vermillion suffered an ankle injury that eventually prompted the end of his career.

"When I met Scott, he was a vibrant, outgoing pro athlete, super fun, a jokester," Cami Jones, who was married to Vermillion from 1999-2004, told the Times. “I watched him change really rapidly, and it was scary."

According to the Times, Vermillion withdrew from his family in his later years and drank excessively, leading to bouts of erratic behavior. He was arrested in 2018 for an alleged incident of aggravated domestic battery, the Times repor.

CTE is caused by tau, a protein in the brain released as a result of head trauma. When tau clumps together, it damages brain cells and can change the brain’s function. Though tau causes Alzheimer’s, the tau that causes CTE looks distinctly different. Under a microscope, it can be seen in telltale brown spots.

As CTE progresses, those clusters or clumps of tau will spread, and the disease will become more severe. That’s why, in the early stages of disease, stages 1 and 2, the symptoms usually relate to behavioral changes or mood swings. In stages 3 and 4, the disease is exhibited in memory loss.

Though high-contact sports like football, hockey and boxing are most commonly associated with CTE, there's a growing concern about it also impacting soccer players at all levels.

Last April, U.S. Soccer, Major League Soccer and the National Women's Soccer League joined a trial program that allows teams two additional substitutes for suspected concussions in each match. The program is expected to run through August 2022.

In a statement in response to the New York Times report, the MLS Players Association issued a statement that called on the league to "unilaterally adopt a full concussion substitution rule immediately."

In 2015, the U.S. Soccer Federation recommended bans on heading the ball for players under the age of 11, limits for practicing them for players 11 to 13 and having medical professionals rather than coaches make decisions on whether players suspected of concussions can remain in games.

"Major League Soccer’s highest priority is protecting the health and safety of our players," MLS chief medical officer Margot Putukian said in a statement. "Although head injuries, including concussions, are a risk in all sports, including soccer, MLS has comprehensive policies to educate players, coaches, officials and medical staffs about the importance of head injury identification, early reporting, and treatment. MLS is a leader in the sport, advocating for and piloting the FIFA concussion substitute program, implementing a medical spotter program to identify potential head injuries, and removing from play any player with a suspected head injury for assessment and, as necessary, treatment.

"MLS and its medical advisors continually align our protocols with the most up-to-date science as our medical staffs provide players with exceptional care on and off the field. There is always more progress to be made, and MLS is staunchly committed to this important work."

Contributing: Nancy Armour, Associated Press

This article originally appeared on USA TODAY: First known case of CTE in US pro soccer found in Scott Vermillion