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The clinical spectrum of sport-related traumatic brain injury

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Abstract

Acute and chronic sports-related traumatic brain injuries (TBIs) are a substantial public health concern. Various types of acute TBI can occur in sport, but detection and management of cerebral concussion is of greatest importance as mismanagement of this syndrome can lead to persistent or chronic postconcussion syndrome (CPCS) or diffuse cerebral swelling. Chronic TBI encompasses a spectrum of disorders that are associated with long-term consequences of brain injury, including chronic traumatic encephalopathy (CTE), dementia pugilistica, post-traumatic parkinsonism, post-traumatic dementia and CPCS. CTE is the prototype of chronic TBI, but can only be definitively diagnosed at autopsy as no reliable biomarkers of this disorder are available. Whether CTE shares neuropathological features with CPCS is unknown. Evidence suggests that participation in contact–collision sports may increase the risk of neurodegenerative disorders such as Alzheimer disease, but the data are conflicting. In this Review, the spectrum of acute and chronic sport-related TBI is discussed, highlighting how examination of athletes involved in high-impact sports has advanced our understanding of pathology of brain injury and enabled improvements in detection and diagnosis of sport-related TBI.

Key Points

  • In high-impact sports, cerebral concussion is the most common form of acute traumatic brain injury (TBI), but other moderate and severe TBIs can occur

  • Cerebral concussion is a clinical diagnosis that can present with cognitive, physical and/or behavioural signs and symptoms, and does not require loss of consciousness

  • Second-impact syndrome is a rare and controversial syndrome that must be considered in the management of a young athlete with concussion

  • Increased exposure to sport and advancing age are putative risk factors for the development of chronic traumatic encephalopathy (CTE)

  • Antemortem diagnosis of CTE is difficult, and further research is needed to establish effective biomarkers that reflect disease activity

  • Chronic postconcussion syndrome is a form of chronic TBI that is clinically distinct from CTE; neuropathological overlap between these two conditions is unknown

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Figure 1: Mechanisms of brain acceleration–deceleration secondary to biomechanical forces transmitted to the brain.
Figure 2: Brain imaging in a retired professional boxer with probable chronic traumatic encephalopathy.

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Jordan, B. The clinical spectrum of sport-related traumatic brain injury. Nat Rev Neurol 9, 222–230 (2013). https://doi.org/10.1038/nrneurol.2013.33

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