Chronic Traumatic Encephalopathy

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Original Editor - Gareth Geoffreys

Top Contributors - Gareth Geoffreys, Lucinda hampton, Kim Jackson, Rucha Gadgil, Aminat Abolade and Carina Therese Magtibay  

Introduction

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder caused by repetitive blunt force and the transfer of acceleration-deceleration forces to the brain. CTE was originally classified as "punch drunk" syndrome due to its prevalence in boxers. Although Brain trauma like CTE has been a recognized neurological condition in boxing for almost a century now, its prevalence in other contact sports, such as rugby, hockey and American football has only recently been brought to light. CTE is a neurological disorder that can only be confirmed in a post-mortem Autopsy

Epidimiology

Every year an estimated 42 million people suffer a mild traumatic brain injury (MTBI) or concussion.

Neuropathology

CTE is a tauopathy that results from the culmination of repetitive MTBI .

Symptoms

Symptoms of CTE can manifest in any of the four main clinical domains:

• Behavioural:
  • Verbal or physical violence
  • Explosivity
  • Loss of control/short fuse
• Cognitive:
  • Impairment of memory
  • Executive dysfunction
  • Reduced attention span
• Mood:
  • Depression
  • Helplessness
• Motor:

Motor dysfunction only occurs at later stages of Neurodegeneration and is strongly correlated with age. With Age CTE is often found to develope into more serious forms of neuromuscular diseases, such as Motor Neurone Disease, Alzheimer's Disease and Lewy Body Disease.

Clinical subtypes of chronic traumatic encephalopathy Behavioral features Mood features Cognitive features Motor features Explosivity Depression Dementia Ataxia Loss of control Hopelessness Memory impairment Dysarthria Short fuse Suicidality Executive dysfunction Parkinsonism Impulsivity Anxiety Lack of insight Gait Disturbance Aggression Fearfulness Perseveration Tremor Rage Irritability Impaired attention and Masked facies Physical violence Labile emotions concentration Rigidity Verbal violence Apathy Language difficulties Muscle weakness Inappropriate speech Loss of interest Dysgraphia Spasticity Boastfulness Fatigue Alogia Clonus

Clinical assessment

Single incidences of head trauma such as concussion will very rarely result in the development of CTE. However, repeated brain trauma sustained at the subconcussive and concussive level has been found to be a strong predictor of CTE Development.

CTE is a neurological disorder that can only be confirmed in a post-mortem Autopsy. Therefore, a general consensus on the best way to clinically assess CTE is lacking. however, some have tried to create frameworks from which you can more accurately judge the likelihood of CTE being present. When assessing the clinical presentation of CTE, Montenigro et al. (2014) suggest five criteria:

1. History of multiple impacts, 2 moderate or severe TBI’s, 4 concussions, or 6 years of sub-concussive trauma (e.g. contact sports, military service, domestic abuse

when assessing the gravity of an MTBI, the Centers for Disease control and prevention (CDC) suggests the following procedure:

1. Assess for on or more of the following:
   • Confusion or disorientation
   • loss of consciousness for 30 min or less
   • post traumatic amnesia for less that 24h
   • and/or other transient 93 neurological abnormalities such as focal signs, seizure, and intracranial lesion not requiring surgery
2. Glasgow Coma Scale score of 13–15 after 30 min post-injury or later upon presentation for healthcare
3. These manifestations of MTBI must not be due to drugs, alcohol, medications, caused by other injuries or treatment for other injuries (e.g., psychological trauma, language barrier or coexisting medical conditions) or caused by penetrating craniocerebral injury.

Glasgow Coma Scale assessment

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