Chief Concern: “I'm Worried I Have Chronic Traumatic Encephalopathy”

Ideas and Opinions20 February 2018Chief Concern: “I'm Worried I Have Chronic Traumatic Encephalopathy”David L. Brody, MD, PhDDavid L. Brody, MD, PhDNational Institute of Neurological Disorders and Stroke and Uniformed Services University, Bethesda, Maryland (D.L.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2707 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Chronic traumatic encephalopathy (CTE) has been the focus of extensive attention in recent years. In fact, there have been more than 10 times as many news articles as confirmed cases (1, 2) (a search for “chronic traumatic encephalopathy” in LexisNexis on 11 October 2017 revealed 2810 articles from 2014 to the present [Otterson B. Personal communication.]). The condition is pathologic and involves abnormal deposits of a protein called tau in the brain at specific locations in the depths of cortical sulci and near medium-sized blood vessels. Our understanding of the brain pathology that defines CTE is progressing rapidly, with a ...References1. Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318:360-70. [PMID: 28742910] doi:10.1001/jama.2017.8334 CrossrefMedlineGoogle Scholar2. McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68:709-35. [PMID: 19535999] doi:10.1097/NEN.0b013e3181a9d503 CrossrefMedlineGoogle Scholar3. McKee AC, Cairns NJ, Dickson DW, Folkerth RD, Keene CD, Litvan I, et al; TBI/CTE group. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathol. 2016;131:75-86. [PMID: 26667418] doi:10.1007/s00401-015-1515-z CrossrefMedlineGoogle Scholar4. Bieniek KF, Ross OA, Cormier KA, Walton RL, Soto-Ortolaza A, Johnston AE, et al. Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank. Acta Neuropathol. 2015;130:877-89. [PMID: 26518018] doi:10.1007/s00401-015-1502-4 CrossrefMedlineGoogle Scholar5. Blennow K, Brody DL, Kochanek PM, Levin H, McKee A, Ribbers GM, et al. Traumatic brain injuries. Nat Rev Dis Primers. 2016;2:16084. [PMID: 27853132] doi:10.1038/nrdp.2016.84 CrossrefMedlineGoogle Scholar6. Stern RA, Daneshvar DH, Baugh CM, Seichepine DR, Montenigro PH, Riley DO, et al. Clinical presentation of chronic traumatic encephalopathy. Neurology. 2013;81:1122-9. [PMID: 23966253] doi:10.1212/WNL.0b013e3182a55f7f CrossrefMedlineGoogle Scholar7. Montenigro PH, Alosco ML, Martin BM, Daneshvar DH, Mez J, Chaisson CE, et al. Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. J Neurotrauma. 2017;34:328-40. [PMID: 27029716] doi:10.1089/neu.2016.4413 CrossrefMedlineGoogle Scholar8. Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013;132:8-17. [PMID: 23753087] doi:10.1542/peds.2013-0432 CrossrefMedlineGoogle Scholar9. Brody DL. Concussion Care Manual: A Practical Guide. 1st ed. New York: Oxford Univ Pr; 2014. Google Scholar10. Judgment of Kevin Turner and Shawn Wooden v. National Football League and NFL Properties, LLC. No. 2:12-md-02323-AB. MDL no. 2323. Civ. Action No.: 14-cv-00029-AB. 22 April 2015. Accessed at www.paed.uscourts.gov/documents/opinions/15D0344P.pdf on 19 December 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: National Institute of Neurological Disorders and Stroke and Uniformed Services University, Bethesda, Maryland (D.L.B.)Note: The author is not related to Judge Anita B. Brody of the U.S. District Court, who was involved in the National Football League settlement.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2707.Corresponding Author: David L. Brody, MD, PhD, NINDS Molecular Contrast MR Imaging Unit, Building 10, 5n240, 10 Center Drive, Bethesda, MD 20892; e-mail, David.[email protected]gov.Author Contributions: Conception and design: D.L. Brody.Drafting of the article: D.L. Brody.Final approval of the article: D.L. Brody.This article was published at Annals.org on 9 January 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byChallenges in the pharmacological treatment of patients under suspicion of chronic traumatic encephalopathy: A reviewAnti-Phospho-Tau Gene Therapy for Chronic Traumatic EncephalopathyChronic Traumatic Encephalopathy in Professional American Football Players: Where Are We Now? 20 February 2018Volume 168, Issue 4Page: 285-286KeywordsAlzheimer diseaseBrainBrain diseasesCognitive impairmentExercise therapyHead injuryMemorySafetyToxinsTraumatic brain injury ePublished: 9 January 2018 Issue Published: 20 February 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...