![]() ![]() The majority of stage four patients have septal abnormalities. There is also atrophy of the white matter tracts. There is profound atrophy of the frontal, medial temporal lobes, as well as anterior thalami. In stage IV, the reduction in brain weight is dramatic, and brain weights of 1,000 g (compared to 1,300–1,400 g in normal brains) have been reported. P-tau pathology spreads, involving the frontal, temporal, parietal and insular cortices. One half of CTE patients display septal abnormalities, including cavum septum pellucidum. There is global brain weight loss, mild frontal lobe and temporal lobe atrophy, and dilation of the ventricles. ![]() ![]() In stage III, most gross pathological sections show macroscopic abnormalities. There are multiple foci of p-tau within the depth of sulci, and there is an emergent spreading pattern. On gross anatomical sections and neuroimaging, enlargement of lateral ventricles, cavum septum pellucidum with or without fenestration, as well as pallor of the locus coeruleus and substantia nigra are observed. In stage II, localized macroscopic abnormalities might be noted. There might be a scant number of neurofibrillary tangles (NFTs) and neurites in the locus coeruleus. In stage I CTE, the brain grossly appears normal, but p-tau is found in a finite number of loci, often in the lateral and frontal cortices, as well as proximal to small blood vessels in the depth of sulci. Based on the pattern of pathological progression, CTE is divided into four respective stages ( Figure 1). These pathological changes lead to progressive debilitating neurodegeneration. The disease nomenclature evolved into “dementia pugilistica” ( 4), and finally CTE in 1949 ( 5).ĬTE has a unique neuropathological characteristic, comprised of accumulation of phosphorylated tau (p-tau) in sulci and peri-vascular regions, microgliosis, and astrocytosis. The report was focused on a number of boxers who had suffered repetitive head blows throughout their careers, and were presenting with both psychiatric symptoms as well as severe memory and neurocognitive deficits, analogous to typical dementia patients ( 3). Although CTE has been publicly recognized relatively recently, it was first described as “punch drunk” syndrome in a classic article by Martland et al. There has been a rise of CTE diagnosis in athletes, especially American football players, as well as in military veterans in combat settings ( 1, 2). The combination of advanced of research techniques including neuroimaging, as well as increasing public awareness of CTE, offers promising vistas for research advancement.Ĭhronic Traumatic Encephalopathy (CTE) is a distinctive tau-protein associated neurodegenerative disease. Providing education for safe practice techniques, such as safe tackling and hitting, and providing ready access to full neuropsychiatric assessment by team physician could have measurable benefits. Prevention is another key strategy that needs to be implemented in various sports and military settings. As there are no disease modifying regimen for CTE, the newly developed TBI treatments, if administered in a time sensitive manner, can offer a potential viable option. Although ApoE4 carriers have been reported to suffer more severe outcome post TBI. On a genetic basis, there are no clear risk factor genes. Clinically, CTE has a more subtle presentation, as patients often present with two distinct phenotypes, with one subtype initially presenting with affective changes, and the other subtype with more cognitive impairment. As per most recent disease classification, the disease manifests itself in four different stages, characterized by widespread tauopathy. CTE has a unique neuropathological signature comprised of accumulation of phosphorylated tau (p-tau) in sulci and peri-vascular regions, microgliosis, and astrocytosis. Yale Neurology, Yale Medicine, New Haven, CT, United StatesĬhronic Traumatic Encephalopathy (CTE) is a debilitating neurodegenerative disease, which has been increasingly reported in athletes, especially American football players, as well as military veterans in combat settings, commonly as a result of repetitive mild traumatic brain injuries (TBIs). ![]()
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