Abstract
The diagnosis of chronic traumatic encephalopathy (CTE) upon autopsy in a growing number of athletes and soldiers alike has resulted in increased awareness, by both the scientific/medical and lay communities, of the potential for lasting effects of repetitive traumatic brain injury. While the scientific community has come to better understand the clinical presentation and underlying pathophysiology of CTE, the diagnosis of CTE remains autopsy-based, which prevents adequate monitoring and tracking of the disease. The lack of established biomarkers or imaging modalities for diagnostic and prognostic purposes also prevents the development and implementation of therapeutic protocols. In this work the clinical history and pathologic findings associated with CTE are reviewed, as well as imaging modalities that have demonstrated some promise for future use in the diagnosis and/or tracking of CTE or repetitive brain injury. Biomarkers under investigation are also discussed with particular attention to the timing of release and potential utility in situations of repetitive traumatic brain injury. Further investigation into imaging modalities and biomarker elucidation for the diagnosis of CTE is clearly both needed and warranted.
Highlights
Increasing awareness by both medical professionals and the lay community concerning the potential long-term effects of repetitive traumatic brain injury, such as chronic traumatic encephalopathy (CTE) and cognitive impairment (Guskiewicz et al, 2005; Gavett et al, 2010; Daneshvar et al, 2011), has led to the identification of a need for improved diagnostic and prognostic tests
The frequent lack of gross neuroanatomical changes observed in CTE is in striking contrast to dementia pugilistica, believed to represent a more severe form of CTE observed in boxers (Millspaugh, 1937; Corsellis et al, 1973; Adams and Bruton, 1989; Casson et al, 2006)
While some controversy exists concerning identification of CTE, the work of Corsellis and colleagues is notable in that at no point is encephalopathy defined by the presence of a fenestrated or cavum septum pellucidum and important, the complete tetrad was not observed in a third of the cases characterized as dementia pugilistica (Casson et al, 2006)
Summary
Increasing awareness by both medical professionals and the lay community concerning the potential long-term effects of repetitive traumatic brain injury, such as chronic traumatic encephalopathy (CTE) and cognitive impairment (Guskiewicz et al, 2005; Gavett et al, 2010; Daneshvar et al, 2011), has led to the identification of a need for improved diagnostic and prognostic tests. Despite the lack of specific diagnostic criteria required for pre-mortem clinical diagnosis, patients afflicted with CTE diagnosed post-mortem are often described as suffering behavioral, cognitive, and emotional changes or impairments prior to death (Gavett et al, 2011b; Omalu et al, 2011b; Saulle and Greenwald, 2012). The tendency for a latent period creates a clear distinction between initial symptoms associated with traumatic brain injury (TBI) and the persistent, long-term degeneration, much like other neurodegenerative diseases such as Alzheimer’s disease (AD)
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