Abstract
Chronic traumatic encephalopathy (CTE) results from repetitive brain injuries and is a common neurotraumatic sequela in contact sports. CTE is often accompanied by neuropsychiatric symptoms, which could escalate to suicidal ideation (SI) and suicidal behaviour (SB). Nevertheless, fairly limited emphasis about the association between suicidality and CTE exists in medical literature. Here, we report two cases of retired professional athletes in high contact sports (boxing and ice hockey) who have developed similar clinical trajectories characterized by progressive neuropsychiatric symptoms compatible with a CTE diagnosis and subsequent SB in its severe forms (medical serious suicide attempt (SA) and completed suicide). In addition to the description of outlining clinical, neuropsychological, neuroimaging, and differential diagnosis elements related to these cases, we also hypothesized some mechanisms that might augment the suicide risk in CTE. They include those related to neurobiological (neuroanatomic/neuroinflammatory) dysfunctions as well as those pertaining to psychiatry and psychosocial maladaptation to neurotraumas and retirement from professional competitive activity. Findings described here can provide clinical pictures to improve the identification of patients with CTE and also potential mechanistic insights to refine the knowledge of eventual severe SB development, which might enable its earlier prevention.
Highlights
Contact sports athletes are commonly exposed to concussions [1]
Along with chronic traumatic brain injury, Chronic traumatic encephalopathy (CTE) has been an evolving clinical concept [15,16,17] that highlights the crucial involvement of repetitive head traumas in the development of neuropsychiatric symptoms in contact sports professionals [18]
Within the last 10 years has the potential for suicidality that is associated with earlier head trauma and CTE been gaining prominence in the literature
Summary
Contact sports athletes are commonly exposed to concussions [1]. After the first occurrence, susceptibility to subsequent concussions is progressively augmented in both frequency and severity, compounding brain injuries [2]. Along with chronic traumatic brain injury, CTE has been an evolving clinical concept [15,16,17] that highlights the crucial involvement of repetitive head traumas in the development of neuropsychiatric symptoms in contact sports professionals [18]. In this regard, the characteristic triad of cognitive decline, failing in anger management, and depression has been the defining neuropsychiatric manifestations of CTE [19]. Both presented patients had given and signed their consent to describe and publish, in anonymized form, their medical story
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