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      Chronic Traumatic Encephalopathy in a National Football League Player

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          Abstract

          We present the results of the autopsy of a retired professional football player that revealed neuropathological changes consistent with long-term repetitive concussive brain injury. This case draws attention to the need for further studies in the cohort of retired National Football League players to elucidate the neuropathological sequelae of repeated mild traumatic brain injury in professional football. The patient's premortem medical history included symptoms of cognitive impairment, a mood disorder, and parkinsonian symptoms. There was no family history of Alzheimer's disease or any other head trauma outside football. A complete autopsy with a comprehensive neuropathological examination was performed on the retired National Football League player approximately 12 years after retirement. He died suddenly as a result of coronary atherosclerotic disease. Studies included determination of apolipoprotein E genotype. Autopsy confirmed the presence of coronary atherosclerotic disease with dilated cardiomyopathy. The brain demonstrated no cortical atrophy, cortical contusion, hemorrhage, or infarcts. The substantia nigra revealed mild pallor with mild dropout of pigmented neurons. There was mild neuronal dropout in the frontal, parietal, and temporal neocortex. Chronic traumatic encephalopathy was evident with many diffuse amyloid plaques as well as sparse neurofibrillary tangles and tau-positive neuritic threads in neocortical areas. There were no neurofibrillary tangles or neuropil threads in the hippocampus or entorhinal cortex. Lewy bodies were absent. The apolipoprotein E genotype was E3/E3. This case highlights potential long-term neurodegenerative outcomes in retired professional National Football League players subjected to repeated mild traumatic brain injury. The prevalence and pathoetiological mechanisms of these possible adverse long-term outcomes and their relation to duration of years of playing football have not been sufficiently studied. We recommend comprehensive clinical and forensic approaches to understand and further elucidate this emergent professional sport hazard.

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          Most cited references 30

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          Relationship between concussion and neuropsychological performance in college football players.

          Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes. To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players. A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions (n = 16) underwent neuropsychological comparison with matched control athletes from within the sample (n = 10). Clinical interview, 8 neuropsychological measures, and concussion symptom scale ratings at baseline and after concussion. Of the 393 players, 129 (34%) had experienced 1 previous concussion and 79 (20%) had experienced 2 or more concussions. Multivariate analysis of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009), resulting in lowered baseline neuropsychological performance. A significant interaction was found between LD and history of multiple concussions and LD on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]), indicating poorer performance for the group with LD and multiple concussions compared with other groups. A discriminant function analysis using neuropsychological testing of athletes 24 hours after acute in-season concussion compared with controls resulted in an overall 89.5% correct classification rate. Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.
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            Post concussion syndrome.

             Peter Ryan,  G Warden (2003)
            Individuals sustaining mild traumatic brain injuries often report a constellation of physical, cognitive, and emotional/behavioral symptoms referred to as post concussion symptoms (PCS). The most commonly reported post concussion symptoms are headache, dizziness, decreased concentration, memory problems, irritability, fatigue, visual disturbances, sensitivity to noise, judgment problems, depression, and anxiety. Although these PCS often resolve within one month, in some individuals PCS can persist from months to years following injury and may even be permanent and cause disability. When this cluster of PCS is persistent in nature, it is often called the post concussion syndrome or persistent PCS. Both physiological and psychological etiologies have been suggested as causes for persistent post concussion symptoms and this has led to much controversy and debate in the literature. Most investigators now believe that a variety of pre-morbid, injury-related, and post-morbid neuropathological and psychological factors contribute to the development and continuation of these symptoms in those sustaining mild traumatic brain injury (MTBI).
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              Concussion in professional football: reconstruction of game impacts and injuries.

              Concussion in professional football was studied with respect to impact types and injury biomechanics. A combination of video surveillance and laboratory reconstruction of game impacts was used to evaluate concussion biomechanics. Between 1996 and 2001, videotapes of concussions and significant head impacts were collected from National Football League games. There were clear views of the direction and location of the helmet impact for 182 cases. In 31 cases, the speed of impact could be determined with analysis of multiple videos. Those cases were reconstructed in laboratory tests using helmeted Hybrid III dummies and the same impact velocity, direction, and head kinematics as in the game. Translational and rotational accelerations were measured, to define concussion biomechanics. Several studies were performed to ensure the accuracy and reproducibility of the video analysis and laboratory methods used. Concussed players experienced head impacts of 9.3 +/- 1.9 m/s (20.8 +/- 4.2 miles/h). There was a rapid change in head velocity of 7.2 +/- 1.8 m/s (16.1 +/- 4.0 miles/h), which was significantly greater than that for uninjured struck players (5.0 +/- 1.1 m/s, 11.2 +/- 2.5 miles/h; t = 2.9, P < 0.005) or striking players (4.0 +/- 1.2 m/s, 8.9 +/- 2.7 miles/h; t = 7.6, P < 0.001). The peak head acceleration in concussion was 98 +/- 28 g with a 15-millisecond half-sine duration, which was statistically greater than the 60 +/- 24 g for uninjured struck players (t = 3.1, P < 0.005). Concussion was primarily related to translational acceleration resulting from impacts on the facemask or side, or falls on the back of the helmet. Concussion could be assessed with the severity index or head injury criterion (the conventional measures of head injury risk). Nominal tolerance levels for concussion were a severity index of 300 and a head injury criterion of 250. Concussion occurs with considerable head impact velocity and velocity changes in professional football. Current National Operating Committee on Standards for Athletic Equipment standards primarily address impacts to the periphery and crown of the helmet, whereas players are experiencing injuries in impacts to the facemask, side, and back of the helmet. New tests are needed to assess the performance of helmets in reducing concussion risks involving high-velocity and long-duration injury biomechanics.
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                Author and article information

                Journal
                Neurosurgery
                Ovid Technologies (Wolters Kluwer Health)
                0148-396X
                1524-4040
                July 2005
                July 01 2005
                July 2005
                July 01 2005
                : 57
                : 1
                : 128-134
                Affiliations
                [1 ] Departments of Pathology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
                [2 ] Departments of Human Genetics and Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
                [3 ] Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
                [4 ] Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
                Article
                10.1227/01.NEU.0000163407.92769.ED
                15987548
                © 2005

                Molecular medicine, Neurosciences

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