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chronic traumatic encephalopathy; repetitive head acceleration events (CTE, RHAE)

Etiology: - repetitive head injury, concussion - regularly heading a soccerball (> 1000 headers/year) [2,6] - unintentional head impact in soccer players [6] - retired professional soccer players [7] - football players with history of grade 3 cerebral concussion [4] - hits to the head more important than concussions as cause of CTE [10] - repetitive head acceleration events Epidemiology: - athletes of contact sports - soccer, football - found in all but 1 of 111 donated brains from retired National Football League players (99%) [8] - military veterans Pathology: - repetitive head acceleration events are associated with neuroinflammation, axonal injury, & long-term neurological impairments, including increased risk for chronic traumatic encephalopathy [12] - tauopathy - tau protein found outside the microtubules of axons [3] - neurofibrillary tangles throughout the brain - relative absence of amyloid deposits - ref [8] mentions amyloid-beta - TDP43 positive inculsions & TDP43 positive neurites - affects frontal cortex, temporal cortex, medial temporal lobe, basal ganglia, diencephalon, brainstem Clinical manifestations: - mood, behavioral, or cognitive symptoms common - headache & loss of attention span in early phases - cognitive slowing, disorganized thoughts [5] - memory impairment & visualspatial disorder less prominent early - dementia & aggression in later phases [3] - parkinsonism, psychomotor slowing - progressive motor neuron disease in severe cases [8] - bradykinesia - profound weakness - atrophy - spacsticity - fasciculations - gait ataxia (shuffling, wide base), balance disorder - dysarthria - slow processing speed - executive function impairment - onset of symptoms several years before death Laboratory: - CCL11 in CSF may be increased [9] Differential diagnosis: - amyotrophic lateral sclerosis - dementia pugilistica (probably the same disorder) Management: - red light therapy may protect college football players from brain injury from frequent head impacts (repetitive head acceleration events) [12] - early psychotherapy & selective serotonin reuptake inhibitor (SSRI)

Related

amyotrophic lateral sclerosis (ALS); Lou Gerig's disease dementia pugilistica

General

traumatic brain injury (TBI) encephalopathy tauopathy chronic neurologic disease

References

  1. McKee AC et al TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Ex Neurol 2010 69(9):918 PMID: 20720505 http://journals.lww.com/jneuropath/Documents/tdp-43%20proteinopathy%20and%20motor%20neuron%20disease%20in%20chronic%20traumatic%20encephalopathy.pdf
  2. Fox Sports, Nov 29, 2011
  3. McKee AC et al The spectrum of disease in chronic traumatic encephalopathy Brain. December 2, 2012 PMID: 23208308 http://brain.oxfordjournals.org/content/early/2012/12/02/brain.aws307.full?sid=1920e46f-1812-4a44-ab87-bb3b93b48ea8
  4. Mathews BR Mild Cognitive Impairment Linked to Concussion in Retired NFL Players. NEJM Journal Watch. June 17, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
  5. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018. - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  6. Stewart WF, Kim N, Ifrah CS et al Symptoms from repeated intentional and unintentional head impact in soccer players. Neurology Feb 1, 2017 PMID: 28148633 http://www.neurology.org/content/early/2017/02/01/WNL.0000000000003657 - Lingsma H, Maas A Heading in soccer. More than a subconcussive event? Neurology Feb 1, 2017 PMID: 28148628 http://www.neurology.org/content/early/2017/02/01/WNL.0000000000003679
  7. Ling H, Morris HR, Neal JW et al Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathologica. Feb 15, 2017 PMID: 28205009 http://link.springer.com/article/10.1007%2Fs00401-017-1680-3
  8. Mez J, Daneshvar DH, Kiernan PT et al Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360-370 PMID: 28742910 http://jamanetwork.com/journals/jama/fullarticle/2645104 - Rabinovici GD Advances and Gaps in Understanding Chronic Traumatic Encephalopathy. From Pugilists to American Football Players. JAMA. 2017;318(4):338-340. PMID: 28742889 http://jamanetwork.com/journals/jama/article-abstract/2645082
  9. Cherry JD, Stein TD, Tripodis Y, et al. CCL11 is increased in the CNS in chronic traumatic encephalopathy but not in Alzheimer's disease. PLoS One. 2017 Sep 26;12(9):e0185541 PMID: 28950005 Free PMC Article
  10. Boren C A new study shows that hits to the head, not concussions, cause CTE. Washington Post. Jan 18, 2018 https://www.washingtonpost.com/news/early-lead/wp/2018/01/18/a-new-study-shows-that-hits-to-the-head-not-concussions-cause-cte/?utm_term=.a820fd964c9b
  11. Pierre K, Dyson K, Dagra A, et al. Chronic traumatic encephalopathy: update on current clinical diagnosis and management. Biomedicines. 2021;9:415. PMID: 33921385
  12. Lindsey HM et al Transcranial Photobiomodulation Promotes Neurological Resilience in Current Collegiate American Football Players Exposed to Repetitive Head Acceleration Events. Journal of Neurotrauma. 2026. Jan 20 Not yet indexed in PubMed https://journals.sagepub.com/doi/10.1177/08977151251403554