Abstract
During the past decade, there has been an increasing interest in early diagnosis and treatment of traumatic brain injuries (TBI) that lead to chronic traumatic encephalopathy (CTE). The subjects involved range from soldiers exposed to concussive injuries from improvised explosive devices (IEDs) to a significant number of athletes involved in repetitive high force impacts. Although the forces from IEDs are much greater by a magnitude than those from contact sports, the higher frequency associated with contact sports allows for more controlled assessment of the mechanism of action. In our study, we report findings in university-level women soccer athletes followed over a period of four and a half years from accession to graduation. Parameters investigated included T1-, T2-, and susceptibility-weighted magnetic resonance images (SWI), IMPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and C3 Logix behavioral and physiological assessment measures. The MRI Studies show several significant findings: first, a marked increase in the width of sulci in the frontal to occipital cortices; second, an appearance of subtle hemorrhagic changes at the base of the sulci; third was a sustained reduction in total brain volume in several soccer players at a developmental time when brain growth is generally seen. Although all of the athletes successfully completed their college degree and none exhibited long term clinical deficits at the time of graduation, the changes documented by MRI represent a clue to the pathological mechanism following an injury paradigm. The authors propose that our findings and those of prior publications support a mechanism of injury in CTE caused by an autoimmune process associated with the release of neural proteins from nerve cells at the base of the sulcus from a water hammer injury effect. As evidence accumulates to support this hypothesis, there are pharmacological treatment strategies that may be able to mitigate the development of long-term disability from TBI.
Highlights
The study reported here was designed to prospectively assess the mechanisms by which emerging traumatic brain injury (TBI) and subsequent development of clinical chronic traumatic encephalopathy (CTE) in athletes participating in contact sports are affected by the repeated rapid acceleration andBrain Sci. 2017, 7, 164; doi:10.3390/brainsci7120164 www.mdpi.com/journal/brainsciBrain Sci. 2017, 7, 164 deceleration of the brain [1,2,3,4,5,6,7,8,9,10,11]
As evidence accumulates to support this hypothesis, there are pharmacological treatment strategies that may be able to mitigate the development of long-term disability from TBI
The most prominent observation in this study was the marked increase in the width of the sulci of soccer players and the determination that the increased width was most evident in the athletes who experienced concussions
Summary
The study reported here was designed to prospectively assess the mechanisms by which emerging traumatic brain injury (TBI) and subsequent development of clinical chronic traumatic encephalopathy (CTE) in athletes participating in contact sports are affected by the repeated rapid acceleration andBrain Sci. 2017, 7, 164; doi:10.3390/brainsci7120164 www.mdpi.com/journal/brainsciBrain Sci. 2017, 7, 164 deceleration of the brain [1,2,3,4,5,6,7,8,9,10,11]. The study reported here was designed to prospectively assess the mechanisms by which emerging traumatic brain injury (TBI) and subsequent development of clinical chronic traumatic encephalopathy (CTE) in athletes participating in contact sports are affected by the repeated rapid acceleration and. Clinical manifestations of TBI occur in approximately one third of collegiate and professional football and soccer players during their lifetime, a much larger percentage of players experience major body impacts [12]. A 2002 report [2] from the Institute of Medicine (IOM) identified soccer as a sport in which young athletes experience significant brain injury, and a 2011 report [1] from the IOM discussed cognitive rehabilitation therapy for TBI in athletes. It is apparent that women soccer players experience mild to moderate brain injury to an equal or greater extent than other women athletes [4]
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