Of UFOs and other thoughts

McCrory, Paul

doi:10.1136/bjsm.36.3.157

Cited by 19 publications

(6 citation statements)

References 51 publications

(32 reference statements)

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“…There was no histological evidence of the previous diffuse axonal injury typically observed in acute traumatic brain injury, whereas all six of our post-mortem cases had septal fenestration and one also had cavum septi pellucidi. The finding of septal fenestration is supportive of their past histories of chronic repetitive head impacts from playing football [ 29 ]. The rate of septal abnormalities in our footballers is greater than the non-boxer general population, in whom septal fenestration and fenestration with cavum septi pellucidi were 6 and 3%, respectively, in autopsy [ 9 ]; while these macroscopic features were found in all 11 professional boxers in the Corsellis series, except in one case in whom cavum septi pellucidi was not observed, but ‘the septum was nevertheless fenestrated to destruction’ [ 9 ].…”

Section: Discussionmentioning

confidence: 85%

Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players

Morris²,

et al. 2017

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In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer’s disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer’s disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case–control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.

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Section: Discussionmentioning

confidence: 85%

Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players

Morris²,

et al. 2017

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“…However, review of the literature reveals that small CSPs have been seen in up to 76% of healthy subjects on 1.5-T MRIs, as were used in this study. 20,48 The radiologists interpreting the MRIs in the present study paid special attention to the septum region because of the known association between septal abnormalities and CTE of boxers. 11,14,54,71 It is possible that paying special attention to the septal region on all MRIs (not only those of football players) may result in a higher incidence of small CSPs being reported in MRIs of the general population in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Is There Chronic Brain Damage in Retired NFL Players? Neuroradiology, Neuropsychology, and Neurology Examinations of 45 Retired Players

Casson

Viano

Haacke

et al. 2014

Sports Health: A Multidisciplinary Approach

117

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Background:Neuropathology and surveys of retired National Football League (NFL) players suggest that chronic brain damage is a frequent result of a career in football. There is limited information on the neurological statuses of living retired players. This study aimed to fill the gap in knowledge by conducting in-depth neurological examinations of 30- to 60-year-old retired NFL players.Hypothesis:In-depth neurological examinations of 30- to 60-year-old retired players are unlikely to detect objective clinical abnormalities in the majority of subjects.Study Design:A day-long medical examination was conducted on 45 retired NFL players, including state-of-the-art magnetic resonance imaging (MRI; susceptibility weighted imaging [SWI], diffusion tensor imaging [DTI]), comprehensive neuropsychological and neurological examinations, interviews, blood tests, and APOE (apolipoprotein E) genotyping.Level of Evidence:Level 3.Methods:Participants’ histories focused on neurological and depression symptoms, exposure to football, and other factors that could affect brain function. The neurological examination included Mini-Mental State Examination (MMSE) evaluation of cognitive function and a comprehensive search for signs of dysarthria, pyramidal system dysfunction, extrapyramidal system dysfunction, and cerebellar dysfunction. The Beck Depression Inventory (BDI) and Patient Health Questionnaire (PHQ) measured depression. Neuropsychological tests included pen-and-paper and ImPACT evaluation of cognitive function. Anatomical examination SWI and DTI MRI searched for brain injuries. The results were statistically analyzed for associations with markers of exposure to football and related factors, such as body mass index (BMI), ethanol use, and APOE4 status.Results:The retired players’ ages averaged 45.6 ± 8.9 years (range, 30-60 years), and they had 6.8 ± 3.2 years (maximum, 14 years) of NFL play. They reported 6.9 ± 6.2 concussions (maximum, 25) in the NFL. The majority of retired players had normal clinical mental status and central nervous system (CNS) neurological examinations. Four players (9%) had microbleeds in brain parenchyma identified in SWI, and 3 (7%) had a large cavum septum pellucidum with brain atrophy. The number of concussions/dings was associated with abnormal results in SWI and DTI. Neuropsychological testing revealed isolated impairments in 11 players (24%), but none had dementia. Nine players (20%) endorsed symptoms of moderate or severe depression on the BDI and/or met criteria for depression on PHQ; however, none had dementia, dysarthria, parkinsonism, or cerebellar dysfunction. The number of football-related concussions was associated with isolated abnormalities on the clinical neurological examination, suggesting CNS dysfunction. The APOE4 allele was present in 38% of the players, a larger number than would be expected in the general male population (23%-26%).Conclusion:MRI lesions and neuropsychological impairments were found in some players; however, the majority of retired NFL players had no clinical ...

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“…It had been proposed that identification of CSP on CT scans could be of a diagnostic value for DP/CTE [ 43 ]. However this pathological feature is not consistently present [ 44 ], possibly because of the high prevalence of CSP in both boxers and non-boxers [ 45 ]. Because of the rigid enclosure of the brain inside the calvarium, acceleration-deceleration injuries associated with boxing often involve cerebral and meningeal vascular damage, the most common of which is subdural hematoma and to a lesser extent epidural, subarachnoid, and/or intraparenchymal hemorrhages [ 46 ].…”

Section: Overviewmentioning

confidence: 99%

“…Common structural abnormalities often reported in the brain of professional boxers include cavum septum pellucidum (often with fenestrations), ventricular and sulcal enlargement, and cortical and cerebellar atrophy. Although CSP is often reported in studies of boxers and is postulated to be a sign of DP/CTE [ 43 ], and a marker of brain atrophy [ 44 , 103 , 104 ], its relatively high incidence in the normal adult population precludes its presence as a diagnostic specific to boxing [ 105 ]. Despite the lack of specific in vivo findings in CTE, studies using both traditional and newer imaging methods have advanced our understanding of the consequences of repetitive head trauma.…”

Section: Overviewmentioning

confidence: 99%

Chronic traumatic encephalopathy: clinical‐biomarker correlations and current concepts in pathogenesis

Gandy

Ikonomović

Mitsis

et al. 2014

Mol Neurodegeneration

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BackgroundChronic traumatic encephalopathy (CTE) is a recently revived term used to describe a neurodegenerative process that occurs as a long term complication of repetitive mild traumatic brain injury (TBI). Corsellis provided one of the classic descriptions of CTE in boxers under the name “dementia pugilistica” (DP). Much recent attention has been drawn to the apparent association of CTE with contact sports (football, soccer, hockey) and with frequent battlefield exposure to blast waves generated by improvised explosive devices (IEDs). Recently, a promising serum biomarker has been identified by measurement of serum levels of the neuronal microtubule associated protein tau. New positron emission tomography (PET) ligands (e.g., [18 F] T807) that identify brain tauopathy have been successfully deployed for the in vitro and in vivo detection of presumptive tauopathy in the brains of subjects with clinically probable CTE.MethodsMajor academic and lay publications on DP/CTE were reviewed beginning with the 1928 paper describing the initial use of the term CTE by Martland.ResultsThe major current concepts in the neurological, psychiatric, neuropsychological, neuroimaging, and body fluid biomarker science of DP/CTE have been summarized. Newer achievements, such as serum tau and [18 F] T807 tauopathy imaging, are also introduced and their significance has been explained.ConclusionRecent advances in the science of DP/CTE hold promise for elucidating a long sought accurate determination of the true prevalence of CTE. This information holds potentially important public health implications for estimating the risk of contact sports in inflicting permanent and/or progressive brain damage on children, adolescents, and adults.

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Of UFOs and other thoughts

Cited by 19 publications

References 51 publications

Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players

Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players

Is There Chronic Brain Damage in Retired NFL Players? Neuroradiology, Neuropsychology, and Neurology Examinations of 45 Retired Players

Chronic traumatic encephalopathy: clinical‐biomarker correlations and current concepts in pathogenesis

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