Abstract
Brain injuries are becoming increasingly common in athletes and represent an important diagnostic challenge. Early detection and management of brain injuries in sports are of utmost importance in preventing chronic neurological and psychiatric decline. These types of injuries incurred during sports are referred to as mild traumatic brain injuries, which represent a heterogeneous spectrum of disease. The most dramatic manifestation of chronic mild traumatic brain injuries is termed chronic traumatic encephalopathy, which is associated with profound neuropsychiatric deficits. Because chronic traumatic encephalopathy can only be diagnosed by postmortem examination, new diagnostic methodologies are needed for early detection and amelioration of disease burden. This review examines the pathology driving changes in athletes participating in high-impact sports and how this understanding can lead to innovations in neuroimaging and biomarker discovery.
Highlights
Chronic traumatic encephalopathy has evolved from the so-called punch-drunk syndrome, which was used to describe a distinct neuropsychiatric condition that seemed to affect boxers, eventually becoming known as dementia pugilistica during the 1920s and 1930s
Investigators began to realize that the neurocognitive deficits seen in dementia pugilistica affected men and women subjected to a broad range of brain trauma including physical abuse, head banging, poorly controlled epilepsy, and rugby
The results of this study revealed that prior concussion resulting in loss of consciousness is a risk factor for development of mild cognitive impairment due to hippocampal atrophy, changes in cerebral blood flow, and white matter abnormalities.[133]
Summary
From the first description of CTE in an American football player[108] to all of the subsequent research on this matter, both the public and regulatory bodies have realized that sports-related brain injuries is a topic that deserves more attention from clinicians, scientists, and policy makers. One needs to realize that mTBI and CTE are complex diseases, and no single neuroimaging technique or biomarker can adequately describe the disease. Developments in neuroimaging and diagnostic biomarkers are advancing at a brisk pace These innovations will continue to be facilitated by programs of various sports organizations (such as the NFL) that aim to place neurosurgeons and neurologists on the sidelines of competitions to make return-to-play decisions.[3] Only as data collection efforts start to accelerate will we be able to complete the story of the risk factors, epidemiology, pathogenesis, diagnosis, and management of these sports-related brain injuries
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