To the Editor The study of former professional football players diagnosed posthumously as having chronic traumatic encephalopathy (CTE) is the largest such study to date. 1 The criterion used to diagnose CTE is a crucial limitation that necessitates further discussion.According to 2016 guidelines, the only criterion necessary to diagnose CTE is identification of "at least one perivascular ptau [phosphorylated tau] lesion consisting of ptau aggregates … around a small blood vessel." 1,2 Would a neuropathologist diagnose Alzheimer disease with a solitary area of amyloid-β, or conclude that a patient had Lewy body disease when detecting a single Lewy body? These neurodegenerative diagnoses require specific pathologic criteria tied to well-defined clinical presentations. 3 The diagnosis of CTE requires neither. The proposed CTE diagnostic criterion maximizes sensitivity, identifying cases in which the condition may be present, at the cost of specificity.In the study, 55% of participants with severe CTE had only CTE, whereas 45% harbored copathologies that met neuropathologic criteria for other neurodegenerative diseases-30% of the sample carried concomitant neurologic diagnoses. Is it possible that other, better-described pathologic entities were the primary symptom-evoking entity rather than a single perivascular ptau aggregate? Moreover, the phenotype of mild CTE overlaps significantly with unipolar and bipolar and mood disorders, raising the question of perivascular ptau being more incidental than causal.High rates of neuropathologic findings in asymptomatic individuals have been observed. Jansen et al 4 demonstrated that cerebral amyloid-β was present in 10% to 44% of individuals aged 50 to 90 years with normal cognition. Furthermore, a direct causal relationship between football and neurodegenerative disorders has been called into question by large studies of high school football players. 5 Study of the correlation of neuropathologic findings and symptom profiles is in its infancy, especially when considering a disease without a concrete clinical symptom profile. Given these confounders, perhaps the 55% of athletes with severe CTE and no other neuropathologic findings would serve as the most appropriate group to study in a meaningful way.Repetitive traumatic brain injury (TBI) accrued through professional football may cause neurologic symptoms. However, we believe the low-specificity criterion on which the diagnosis of CTE was based in the study led to an overestimation of the prevalence of CTE. Further evidence is required before premature action is taken that jeopardizes a pastime central to US culture, youth development, and character building.
Background Herpes simplex encephalitis (HSE) occurring within 30 days after neurosurgery for solid CNS tumors is underrecognized and underreported but remains important because of high morbidity and mortality. We present the case of a 41-year-old woman who had HSE after craniopharyngioma surgery, and delayed recognition and treatment led to a poor outcome. Subsequently, we review reported HSE cases after neurosurgery for solid CNS tumors and describe outcomes after treatment with and without acyclovir. Methods A literature search was performed for cases meeting the above criteria. Information was gathered regarding patient demographics, tumor types, symptoms, diagnostic workup, therapy, and outcomes. Results Eighteen cases were studied. Encephalopathy, fever, and seizures were the most common symptoms. A majority of patients (78%) received IV acyclovir, with a 79% survival rate with treatment. Mortality rate was 100% in untreated cases. The median time to starting acyclovir was 17 postoperative days (range, 8-53 days). Most patients received steroids, but its use was not associated with a specific outcome. Conclusions HSE may develop following neurosurgical resection, and the threshold for suspicion of this condition should be extremely low in a patient who shows compatible symptoms (encephalopathy, fever, or seizures) or does not recover as planned. Moreover, in case of suspicion of HSE, acyclovir should be promptly started until infection can be definitely ruled out. A delay in diagnosis of HSE and failure to treat may result in severe morbidity as well as mortality. This observation may warrant further study.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.