Chronic Traumatic Encephalopathy
(CTE): Clinical, Pathophysiologic and
Therapeutic Aspects
Patricio F. Reyes, MD, FAAN
Program Director
HealthPartners Medical Group
St. Paul, MN
Affiliations
Yuma Pharmaceuticals
Chief Medical Officer
Chair, Scientific Advisory Board
Retired Players Association (NFL)
Chief Medical Officer
Board Member
Association of Ringside Physicians
Board Member
Junior Seau
Junior Seau in 2008 with the New England Patriots
No. 55
Linebacker
Personal information
Date of birth: (1969-01-19)January 19, 1969
Place of birth: San Diego, California
Date of death: May 2, 2012(2012-05-02) (aged 43)
Place of death: Oceanside, California
6 ft 3 in (1.91 m)
Weight: 248 lb (112 kg)
Tiaina Baul "Junior" Seau Jr. ( ; January 19, 1969 – May 2, 2012)Height:
was
a linebacker
in the National Football League (NFL) who became a San Diego sports ic
Career information
Of Samoan descent, Seau played college football at the University of Southern
California. He was taken by the San Diego Chargers as the fifth overall p
High school: Oceanside (CA)
Seau retired from pro football in 2010. A standout
College: Southern California
NFL Draft: 1990 / Round: 1 / Pick: 5
Debuted in 1990 for the San Diego Chargers
Last played in 2009 for the New England Patriots
Career history
•San Diego Chargers (1990–2002)
•Miami Dolphins (2003–2005)
•New England Patriots (2006–2009)
Career highlights and awards
•12× Pro Bowl (1991, 1992, 1993, 1994, 1995, 1996, 1997,
1998, 1999, 2000, 2001, 2002)
•8× First-team All-Pro (1991, 1992, 1993, 1994, 1995,
1996,1998, 2000)
•2× Second-team All-Pro (1997, 1999)
•2× AFC Champion (1994, 2007)
•NFL Alumni Linebacker of the Year (2003)
•AFC Player of the Year (1994)
•Walter Payton Man of the Year (1994)
•UPI AFC Defensive Player of the Year (1992)
•NEA NFL Defensive Player of the Year (1992)
•NFL 1990s All-Decade Team
•San Diego Chargers #55 retired
•San Diego Chargers Hall of Fame
•San Diego Chargers 50th Anniversary Team
Career NFL statistics as of 2009
Tackles 1,849
Sacks 56.5
Interceptions 18
Forced fumbles 3
Pass deflections 21
Stats at NFL.com
What is Dementia Pugilistica (DP)?
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•
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“boxer’s syndrome,”
“punch-drunk syndrome,”
“chronic boxer encephalopathy,”
“traumatic boxers encephalopathy.”
Can mimic Alzheimer’s disease
Can mimic Parkinson’s disease
Chronic Traumatic Encephalopathy
•Encephalopathy
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Email
Print
•Dementia with Lewy bodies
•Brain damage
•Amnesia
Share
MLA
In
addition,given
the CSTE
has discovered
early evidenceBrain
of CTE in the
youngest case toTom
date, a recently
deceased
boy who suffered From
multiple concussions
in highTraumatic
school football.
Football
And
Progressive
Damage:
McHale
Of18-year-old
NFL Suffered
Chronic
Encep
McHale,
a Cornell
graduate,
former
restaurateur,
and father
three of
boys,
is the sixth
former NFL player
to be at
diagnosed
post-mortem
with CTE
since 2002.
CTE, a progressive
ne
ScienceDaily
(Jan.University
27, 2009) —
Leading
medical
experts athusband
the Center
for theofStudy
Traumatic
Encephalopathy
(CSTE)
Boston University
School
of Medicine
(BUSM)
reported tod
Boston
University
(2009,
January
27).Steelers
Football
And
Progressive
Brain
Damage:
Tom
McHale
OfLong
NFL
The other former
NFL players diagnosed
with CTE are
former Pittsburgh
Mike Webster,
Terry Long
and Justin Strzelczyk,
along with
Andre Waters and
John Grimsley.
Waters and
commS
Note:
If noto
author
is, the source
is cited
instead. and a leading neuropathologist who specializes in degenerative brain diseases, "CTE has been described for approximately 80 years. Initially referred t
According
Ann McKee,
MD, CSTE
co-director
Story
Source:
Disclaimer:
This
article
is
not
intended
to
provide
medical
advice,
diagnosis
doformer
not necessarily
reflect
those
of ScienceDaily
or its
staff.
Due
to
the
growing
strength
of
these
findings
linking
brain
trauma
on the football
field toViews
CTE, aexpressed
number ofhere
living
NFL players
have
recently
agreed to join
three-time
Super Bowl champion Te
The above story is reprinted from materials
provided
by Boston
University
.or treatment.
Theenlarge
88Materials
Plan was may
named
after former
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Note:
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andJohn
length.
For further
please acontact
source
above.
Following death, CSTE doctors will be able verify with certainty whether or not 88 Plan members' dementia was caused by trauma sustained in sports like football (i.e., CTE) or by other causes of dem
CSTE is a collaboration between SLI and BUSM. SLI was founded by former Harvard football player and WWE pro wrestler Chris Nowinski, and neurosurgeon and concussion expert Robert Cantu, MD
Co-Director of the CSTE, Stern, said, "CTE is the only fully preventable cause of dementia. By studying large numbers of athletes throughout their lives, as well as examining brain tissue through our e
The discovery of the initial stages of CTE in an 18-year-old should move the discussion of football's concussion crisis toward youth football. The identity of the 18-year-old will not be revealed at the f
Lisa McHale, widow of Tom McHale, said, "What's even more disturbing to me, and the reason I am here, is that Tom is not alone. His is now the sixth confirmed case of CTE among former profession
NFL players who have recently chosen to join the CSTE brain donation registry include Hall of Famers Joe DeLamielleure and Willie Wood, an 88 Plan member. They are joined by Ken Gray, Brent Boy
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How dangerous is football? Lisa McHale, widow of Tom McHale, said, "What's even more disturbing to me, and the reason I am here, is that Tom is not alone. His is now the sixth confirmed case of CTE among former profess
Signs and Symptoms of Dementia
Pugilistica
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Declining mental ability
Tremors
Rigidity
Bradykinesia
Lack of coordination
Evolution is insidious
Language difficulties
Contusion
Reyes ‘07
Diffuse Axonal Injury
Dementia Pugilistica and
Parkinson’s Disease
• Pallor of substantia nigra (SN)
• neuronal loss in SN
• Lewy bodies
– Tremors
– Rigidity
Pale SN
– Bradykinesia
– Postural instability Lewy Bodies
Pale
Normal
Similarities Between Dementia
Pugilistica and Alzheimer’s Disease
•
•
•
•
Progressive dementia
Large numbers of NFTs and NPs
Acetylcholine deficiency
Lesions are usually concentrated in the
hippocampus and other parts of the limbic
system which are important in memoryrelated processes, emotional expression
and behavior
Chronic Traumatic Encephalopathy
(CTE)
• Latent complication of traumatic brain
injury
• Neurodegenerative Disorder
• Affects young adults and middle aged
• Contact sports
• Subconcussive and concussive injury
• Cognitive and behavioral symptoms
• ? Pathophysiology
• No treatment
Neuropathology of CTE
• Lagre numbers of NFT
• NFT distribution distinct from AD
• May have neuritic plaques
Neuronal Morphology and
Physiology
• Influenced by cytoskeletal proteins
• Skeletal scaffolding
• Microtubules main cytoskeletal component
• Normal neuronal morphology and
physiology
require stable microtubules
Military Servicemen/Women
•Non penetrating injuries
• Symptoms similar to CTE
• High incidence of ALS
• High incidence of PTSD
• Several thousands affected
• Young members of the military
Hypotheses
• Single/Repeated axonal damage
• Biochemical, structural, membrane, and
metabolic perturbations
• Hyperphosphorylation of tau
• Increase NFTs
Traumatic Brain Injury (TBI)
• Shearing, deformation, elongation and stretching
of axons
• Alters membrane permeability
• Ionic shifts
• Caspase and caspain release
– Tau phosphorylation, protein misfolding,
– truncation, aggregation, cytoskeletal
dissolution
– * CCI Txg -↑ tau after 24 hrs – 7 days
–