SPORTS MEDICINE
January 8, 2016

Sixteen Years of Football; Dead at 25

The case of a football player with CTE offers a sobering portrait of what repeated head injury does to a life and a mind.

The degenerative brain disease, chronic traumatic encephalopathy (CTE), was first found in a former professional football player ten years ago. CTE appears to arise from repeated impacts to the head.

At the moment, CTE can only be diagnosed after death, from microscopic inspection of the brain. Finding it while a person is still alive would be the first step in possibly treating it.

The man had played football for over 16 years. He had more than 10 documented concussions while playing, the first occurring at the age of eight.

Researchers at a Boston University School of Medicine lab who have been studying CTE for several years now have a case study of a CTE patient, a 25-year old former college football player. In addition to the autopsy performed after his death from a bacterial heart infection, the case includes a neuropsychological profile taken a few months before he died. The researchers are hopeful that the information it contains holds the key to diagnosing CTE in the living.

They point to a trio of test findings — the combination of impaired learning and executive function coupled with normal verbal episodic memory retrieval — as a possible set of symptoms that may be characteristic of the disease.

Since this is a case that comes from a single person and one who had also developed several medical issues, there is no confirmation yet that these are actually CTE symptoms, but the findings point the way toward developing diagnostic criteria for CTE.

The man had played football for over 16 years. He had more than 10 documented concussions while playing, the first occurring at the age of eight. During his freshman year of college, he experienced a concussion severe enough to cause momentary loss of consciousness.

Soon after, he developed headaches, neck pain, blurry vision, tinnitus (ringing in the ears), insomnia, anxiety and difficulty with memory and concentration. He stopped playing football at the start of his junior year because of these symptoms and began failing classes and left college without obtaining a degree.

His symptoms persisted and new ones appeared, including apathy, feelings of worthlessness and suicidal thoughts. He had difficulty maintaining a job and eventually stopped seeking employment.

A few years later, he died of cardiac arrest, secondary to bacterial endocarditis.

It is not known whether his symptoms were caused by CTE, major depression, post-concussive syndrome or some combination of the three. He also had other medical problems, including a family history of addiction and a defective aortic valve in his heart.

CTE appears to occur considerably more often in football players than in the general public, but estimates of just how common it is in football players range from 3.7% to over 90%, according to an editorial accompanying the case. This wide range is a good indication of just how little is currently known about CTE.

Medical scientists do know that repeated impacts to the head can cause brain trauma, and studies suggest that when they occur before the age of 12, the risk of damage to the brain is even higher.

The case is part of the Understanding Neurological Injury and Traumatic Encephalopathy (UNITE) study, an ongoing research effort that is investigating ways to diagnose CTE during life. Both the case study and the accompanying editorial are published in JAMA Neurology.

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