The Long Drive Ahead to Better Understanding Chronic Traumatic Encephalopathy: First (Case) and 10 (Years Later).

Abstract

In this issue of JAMA Neurology, Mez and colleagues 1 present a case of a young former amateur football player diagnosed with chronic traumatic encephalopathy (CTE), identified pathologically at autopsy at age 25 years, following death due to complications of endocarditis. This athlete is just one in a series of former contact sports athletes, including those having played American football, with evidence of CTE at autopsy. Several of these former players were even younger—just teenagers at the time pathological findings were identified. 2 What distinguishes this case from other similar cases was his inclusion in the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) study, with an evaluation that uniquely included neuropsychological testing within months of his young death. As noted by the authors, arguably a group in the best position to recognize CTE clinically, his history and profile did not clearly distinguish CTE from postconcussion syndrome or depression, particularly given the young age of presentation. The case, in its findings, uncertainties, and timing, offers an opportunity to highlight a number of important, ongoing developments in the field of concussion and CTE, but also underscores the many substantial, unresolved, and essential questions left unanswered in the field. The case of this former collegiate football player appears 10 years after the first reported case of football-associated CTE, identified in a former professional athlete. 3 That publication put the sport of American football under increasing scrutiny about the prevalence and long-term sequelae of head injury in the sport. Omalu and colleagues 3 faced a now storied criti