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Abstract
Introduction: It remains unclear if tau imaging may assist diagnosis of chronic traumatic encephalopathy (CTE). Flortaucipir PET has shown superior frontal with medial temporal tau binding consistent with the provisional neuropathological criteria for mid-stage CTE in group-level analyses of retired symptomatic NFL players and in one individual with pathologically confirmed CTE. 18F-MK6240 is a new PET ligand that has high affinity for tau. We present the case of a 63-year-old cognitively impaired, former Australian rules football player with distinct superior frontal and medial temporal 18F-MK6240 binding and show it to be significantly different to the pattern seen in prodromal Alzheimer's disease (AD).Findings: The participant was recruited for a study of amyloid-β and tau several decades after traumatic brain injury. He had multiple concussions during his football career but no cognitive complaints at retirement. A thalamic stroke in his mid 50s left stable mild cognitive deficits but family members reported further short-term memory, behavioral, and personality decline preceding the study. Imaging showed extensive small vessel disease on MRI, a moderate burden of amyloid-β plaques, and 18F-MK6240 binding in bilateral superior frontal and medial temporal cortices. Voxel-wise analysis demonstrated that the frontally predominant pattern of the participant was significantly different to the posterior temporo-parietal predominant pattern of prodromal AD.Conclusion: Although lacking neuropathological examination to distinguish CTE from a variant of AD, the clear demonstration of a CTE-like tau pattern in a single at-risk individual suggests further research on the potential of 18F-MK6240 PET for identifying CTE is warranted.
Highlights
It remains unclear if tau imaging may assist diagnosis of chronic traumatic encephalopathy (CTE)
We present a case of a retired professional Australian rules football player with a clear fronto-temporal predominant pattern of tau deposition using a recently developed tau tracer 18FMK6240
There were no abnormalities of the septum pellucidum. We present this case of a retired professional Australian rules football player with documented multiple concussions and cognitive and behavioral changes several decades later to highlight an unusual fronto-temporal predominant pattern of tau deposition on positron emission tomography (PET) imaging that may suggest Chronic traumatic encephalopathy (CTE)
Summary
It remains unclear if tau imaging may assist diagnosis of chronic traumatic encephalopathy (CTE). Flortaucipir PET has shown superior frontal with medial temporal tau binding consistent with the provisional neuropathological criteria for mid-stage CTE in group-level analyses of retired symptomatic NFL players and in one individual with pathologically confirmed CTE. The fourth, an Australian rules football player, was found to have features of stage III CTE with concurrent Alzheimer’s disease (AD) neuropathologic change and severe small vessel disease [5]. The authors highlighted the complexities of distinguishing tau pathology in cases of CTE concurrent with AD [5] In both CTE and AD, tau deposits in the form of neurofibrillary tangles (NFT) have been shown to comprise mixed 3-repeat/4-repeat isoforms [6], suggesting that the pattern of tau distribution rather than the presence of tau may be more useful in discriminating these two conditions. There remains debate as to whether the preliminary CTE neuropathological criteria are specific for prior head impacts or whether these findings can occur in individuals without a history of head impacts [10]
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