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  • Risk Factors for Chronic Traumatic Encephalopathy

    Final Number:

    Joseph C. Maroon MD; Jeffrey Bost; Robert Winkelman; Austin Amos; Christina Mathyssek MS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: We will present the most comprehensive literature review to date of case studies describing chronic traumatic encephalopathy (CTE) and its multiple risk factors in order to identify significant risk factors for developing CTE related to mild traumatic brain injury (mTBI).

    Methods: Pubmed literature review as of March 12, 2013 revealed 27 articles describing one or more unique CTE cases between 1954 and 2012.

    Results: We identified 151 cases with diagnosis of CTE, involving both single and multiple mTBI; 143 athletes (mostly prize fighters 68 and football players 63) and 5 military veterans. Known causes of death; natural (n=74, 70.3%), accidental (n=18, 17.1%), or suicide (n=14, 12.6%). Age at death ranged from 17 to 91, most dying between 60-69 years (25.9%). 25 cases (16.7%) had a co-morbid neurodegenerative disease. A genetic profile was available for 79 cases. Neuropathological changes shown include atrophy, ventricular dilation, cavum septum pellucidum, tau pathology (neurofibrillary tangle(NFTs) and others. Clinical presentations included difficulties with attention, memory and language, depression, paranoia, suicide ideations, substance abuse (n=28, 18.5%) executive function and visuospatial impairments; however, 5 cases (3.3%) were asymptomatic. There is also a reported higher incidence of obesity and premorbid violence.

    Conclusions: mTBI has been considered the main cause for CTE; yet, little is known about factors that increase or decrease risk for the development of CTE after mTBI, mostly because of ascertainment bias. The lack of prospective studies in well-described samples renders it impossible to even estimate CTE incidence rates. Here we will describe CTE and its relation to mTBI, and address possible precipitating risk factors for its development. Furthermore, we will discuss the hypothesis that microglial activation is a primary etiology of CTE and environmental factors,age and sub-concussive head trauma all may contribute to CTE.

    Patient Care: Chronic Traumatic Encephalopathy (CTE) has become a major concern of both the public and medical community. The fear surrounding this condition is mostly related to the lack of compared trials and the fact that only mTBI has been determined to be the major risk factor to its discovery. It is important to identify other confounding factors in addition to mTBI that may predispose individuals to this condition in order to better understand those at greater risk.

    Learning Objectives: Review how the histological diagnosis chronic of traumatic enchephalopathy relates to mTBI. Understand how various risk factors including underlying subject’s genetics, substance abuse, age and other factors may influence the development of this condition. Discuss the importance for randomized blinded trials to better determine the incidence of CTE in various comparative populations.

    References: Russell L Blaylock, Joseph Maroon, Immunoexcitotoxicity as a central mechanism in chronic traumatic encephalopathy-A unifying hypothesis, Surg Neurol Int 2011, 2:107 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(7):709–35. Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulative effects of concussion in high school athletes. Neurosurgery. 2002;51(5):1175–9; discussion 1180–1. Amen DG, Newberg A, Thatcher R, Jin Y, Wu J, Keator D, et al. Impact of playing American professional football on longterm brain function. J Neuropsychiatry Clin Neurosci. 2011;23(1):98–106. Omalu BI, Bailes J, Hammers JL, Fitzsimmons RP. Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: the role of the forensic pathologist.Am J Forensic Med Pathol. 2010;31(2):130–2. Omalu BI, Hamilton RL, Kamboh MI, DeKosky ST, Bailes J. Chronic traumatic encephalopathy (CTE) in a national football league player: case report and emerging medicolegal practice questions. J Forensic Nurs. 2010;6(1):40–6. McKee AC, Gavett BE, Stern RA, Nowinski CJ, Cantu RC, Kowall NW, et al. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol. 2010;69(9):918–29. See more in attachments

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