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4 Stages of Chronic Traumatic Encephalopathy

September 16, 2020
Arman Fesharaki-Zadeh, MD, PhD

A 59-year-old man with a history of multiple concussions has been having a series of neurocognitive symptoms for the past several years. Discover more in this case.

Based on the nature and popularity of contact sports and the intrinsic component of head collisions, prevention of head trauma poses a paramount challenge and requires a paradigm shift. Education of athletes on safe techniques, such as safe tackling, could offer significant potential benefits. Read the case to learn more.

A 59-year-old man with a history of multiple concussions has been having a series of neurocognitive symptoms for the past several years.

• ex-football player

• played in high school and college

• suffered more than 20 concussions

• lost consciousness a few times for unknown durations

Brain imaging indicates cavum septum pellucidum (CSP) involving the lateral ventricles

Significant memory and cognitive issues developed about 4 years ago. Symptoms:

• depression

• excessive drinking

• work-related frustrations

Behavioral changes:

• unusual emotional reactivity in certain everyday situations

• difficulties following instructions

• problems retaining details from conversations

Imaging reveals significant asymmetrical left hippocampal atrophy, 11th percentile compared with his age-matched controls,

There is no consensus on the clinical characteristics of CTE; however, clinical symptoms that correspond to 4 neuropathological stages have been proposed by McKee and colleagues.

See: McKee AC, Stern RA, Nowinski CJ, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136:43-64.

Stage 1. Patient is clinically asymptomatic or may complain of mild short-term memory deficits, or depressive symptoms; mild aggressive symptoms have also been reported.

Stage 2. Mood and behavioral symptoms are more severe and may include explosive behavioral outbursts and more severe depressive symptoms.

Stage 3. Patients display more cognitive deficits: memory loss, executive and visuospatial functioning deficits as well as symptoms of apathy.

Stage 4. Patients have profound language deficits, psychotic symptoms such as paranoia as well as motor deficits and parkinsonism.

For more on this topic, see Clinical Characteristics of Chronic Traumatic Encephalopathy, on which this slideshow is based.

This article was originally posted on June 23, 2020, and has since been updated. -Ed

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