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The clinical spectrum of sport-related traumatic brain injury
Traumatic brain injuries (TBIs) sustained by athletes in contact–collision sports can cause long-term neurological complications. In recent years, cases of chronic traumatic encephalopathy—a neurodegenerative sequela of repetitive TBI—in retired boxers and American football players have been highly publicized. Here, Barry Jordan reviews the spectrum of sport-related brain injuries, and outlines the need for appropriate detection and management of both acute and chronic TBIs in athletes.
Acute and chronic sports-related traumatic brain injuries (TBIs) are a substantial public health concern. Various types of acute TBI can occur in sport, but detection and management of cerebral concussion is of greatest importance as mismanagement of this syndrome can lead to persistent or chronic postconcussion syndrome (CPCS) or diffuse cerebral swelling. Chronic TBI encompasses a spectrum of disorders that are associated with long-term consequences of brain injury, including chronic traumatic encephalopathy (CTE), dementia pugilistica, post-traumatic parkinsonism, post-traumatic dementia and CPCS. CTE is the prototype of chronic TBI, but can only be definitively diagnosed at autopsy as no reliable biomarkers of this disorder are available. Whether CTE shares neuropathological features with CPCS is unknown. Evidence suggests that participation in contact–collision sports may increase the risk of neurodegenerative disorders such as Alzheimer disease, but the data are conflicting. In this Review, the spectrum of acute and chronic sport-related TBI is discussed, highlighting how examination of athletes involved in high-impact sports has advanced our understanding of pathology of brain injury and enabled improvements in detection and diagnosis of sport-related TBI.
Key Points
In high-impact sports, cerebral concussion is the most common form of acute traumatic brain injury (TBI), but other moderate and severe TBIs can occur
Cerebral concussion is a clinical diagnosis that can present with cognitive, physical and/or behavioural signs and symptoms, and does not require loss of consciousness
Second-impact syndrome is a rare and controversial syndrome that must be considered in the management of a young athlete with concussion
Increased exposure to sport and advancing age are putative risk factors for the development of chronic traumatic encephalopathy (CTE)
Antemortem diagnosis of CTE is difficult, and further research is needed to establish effective biomarkers that reflect disease activity
Chronic postconcussion syndrome is a form of chronic TBI that is clinically distinct from CTE; neuropathological overlap between these two conditions is unknown
Journal Article
Dream big : Michael Jordan and the pursuit of Olympic gold
From the age of nine years Michael dreams of playing basketball for the United States in the Olympics, and with hard work and his mother's encouragement, he realizes his dream.
Book
Consensus Statement on Concussion in Sport: The 4th International Conference on Concussion in Sport, Zurich, November 2012
This paper is a revision and update of the recommendations developed following the 1st (Vienna 2001), 2nd (Prague 2004), and 3rd (Zurich 2008) International Consensus Conference on Concussion in Sport and is based on the deliberations at the 4th International Conference on Concussion in Sport held in Zurich, November 2012. The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. While agreement exists pertaining to principle messages conveyed within this document, the authors acknowledge that the science of concussion is evolving, and therefore, management and RTP decisions remain in the realm of clinical judgment on an individualized basis. There was acknowledgement by the Concussion in Sport Group that, although the terms mild traumatic brain injury and concussion are often used interchangeably in the sporting context and particularly in the US literature, others use the term to refer to different injury constructs.
Journal Article
The best American sports writing 2017
An anthology of top-selected sports writing from the past year is culled from hundreds of national, regional, and specialty publications as well as a variety of leading sports blogs.
BOOK
Brain and blood biomarkers of tauopathy and neuronal injury in humans and rats with neurobehavioral syndromes following blast exposure
Traumatic brain injury (TBI) is a risk factor for the later development of neurodegenerative diseases that may have various underlying pathologies. Chronic traumatic encephalopathy (CTE) in particular is associated with repetitive mild TBI (mTBI) and is characterized pathologically by aggregation of hyperphosphorylated tau into neurofibrillary tangles (NFTs). CTE may be suspected when behavior, cognition, and/or memory deteriorate following repetitive mTBI. Exposure to blast overpressure from improvised explosive devices (IEDs) has been implicated as a potential antecedent for CTE amongst Iraq and Afghanistan Warfighters. In this study, we identified biomarker signatures in rats exposed to repetitive low-level blast that develop chronic anxiety-related traits and in human veterans exposed to IED blasts in theater with behavioral, cognitive, and/or memory complaints. Rats exposed to repetitive low-level blasts accumulated abnormal hyperphosphorylated tau in neuronal perikarya and perivascular astroglial processes. Using positron emission tomography (PET) and the [18F]AV1451 (flortaucipir) tau ligand, we found that five of 10 veterans exhibited excessive retention of [18F]AV1451 at the white/gray matter junction in frontal, parietal, and temporal brain regions, a typical localization of CTE tauopathy. We also observed elevated levels of neurofilament light (NfL) chain protein in the plasma of veterans displaying excess [18F]AV1451 retention. These findings suggest an association linking blast injury, tauopathy, and neuronal injury. Further study is required to determine whether clinical, neuroimaging, and/or fluid biomarker signatures can improve the diagnosis of long-term neuropsychiatric sequelae of mTBI.
Journal Article
Et Tu, Agent? Commission-Based Steering in Residential Real Estate
Real estate agents are required to serve their clients' best interests. However, policymakers have long suspected that buyer agents steer their clients away from properties that offer low buyer agent commissions. They consider steering a key reason why agent commissions have remained high in the internet era, even as commissions in other industries have plummeted. Analyzing a new dataset, we provide the first systematic, nationwide evidence that buyer agents do in fact steer clients away from properties that offer low buyer agent commissions.
Journal Article
Genetic Influences on Outcome Following Traumatic Brain Injury
Several genes have been implicated as influencing the outcome following traumatic brain injury (TBI). Currently the most extensively studied gene has been APOE. APOE can influence overall and rehabilitation outcome, coma recovery, risk of posttraumatic seizures, as well as cognitive and behavioral functions following TBI. Pathologically, APOE is associated with increased amyloid deposition, amyloid angiopathy, larger intracranial hematomas and more severe contusional injury. The proposed mechanism by which APOE affects the clinicopathological consequences of TBI is multifactorial and includes amyloid deposition, disruption of cytoskeletal stability, cholinergic dysfunction, oxidative stress, neuroprotection and central nervous system plasticity in response to injury. Other putative genes have been less extensively studied and require replication of the clinical findings. The COMT and DRD2 genes may influence dopamine dependent cognitive processes such as executive/frontal lobe functions. Inflammation which is a prominent component in the pathophysiological cascade initiated by TBI, is in part is mediated by the interleukin genes, while apoptosis that occurs as a consequence of TBI may be modulated by polymorphisms of the p53 gene. The ACE gene may affect TBI outcome via mechanisms of cerebral blood flow and/or autoregulation and the CACNA1A gene may exert an influence via the calcium channel and its effect on delayed cerebral edema. Although several potential genes that may influence outcome following TBI have been identified, future investigations are needed to validate these genetic studies and identify new genes that might influence outcome following TBI.
Journal Article