Chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy that is thought to result from mild repetitive head trauma. 

The exact incidence and prevalence is unknown. It is most commonly seen in amateur and professional sports players where head contact is common (e.g. boxing, American football, rugby, ice hockey), as well as in military personnel exposed to explosive blasts 1,3

Symptoms have an insidious onset, most often years after the initial injuries, with loss of normal attention, concentration and memory. This can progress, in some cases in 2-3 years, to include motor symptoms such impaired gait, impaired, executive function, lack of insight and poor judgement 1,2,4

Macroscopic appearance

There is generalised cerebral atrophy with more pronounced atrophy of the frontal and temporal lobes (including mesial temporal lobe) as well as the thalamus, hypothalamus and mammillary bodies. A cavum septum pellucidum may be present 2.  

Histology

CTE is characterised by the presence of neurofibrillary tangles and TDP-43 binding protein in subcortical and perivascular regions, often with reactive astrocytes and microglia 7

Pathophysiology

Although the details remain to be elucidated, there is mounting evidence that reactive gliosis and redistribution of aquaporin 4 molecules, leading to disruption of transparachymal CSF clearance of interstitial beta-amyloid via the glymphatic system may be a key component 8

MRI

Imaging features of CTE are nonspecific but the following may be seen 4,7

There is clinical and imaging overlap of CTE with other neurodegenerative diseases, and traumatic brain injury is a risk factor for their development (i.e. not just CTE) and should be considered in the differential diagnosis 5,6:

This syndrome was first recognised in boxers in 1928, and has been known as "punch drunk" and "dementia pugilistica". 

Neurodegenerative diseases

Neurodegenerative diseases are legion and their classification just as protean. A useful approach is to divide them according to underlying pathological process, although even using this schema, there is much overlap and thus resulting confusion.

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Article Information

rID: 40778
Section: Pathology
Synonyms or Alternate Spellings:
  • Chronic traumatic encephalopathy (CTE)
  • Chronic post-traumatic encephalopathy

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