Traumatic Encephalopathy Syndrome and Tauopathy in a 19-Year-Old With Child Abuse.

The majority of traumatic encephalopathy syndrome (TES) cases have been reported in former contact sport athletes. This is the first case with TES in a 19-year-old male patient with progressive cognitive decline after daily domestic physical violence through repeated hits to the head for 15 years. The patient presented with a moderate depressive episode and progressive cognitive decline. Tau positron emission tomography (PET) with 220 MBq of [18F]PI-2620 revealed increased focal signal at the frontal and parietal white/gray matter border. Brain magnetic resonance imaging (MRI) showed a cavum septum pellucidum, reduced left-sided hippocampal volume, and a left midbrain lesion. Cerebrospinal fluid results showed elevated total and p-tau. Neurocognitive testing at admission showed memory deficits clearly below average, and hampered dysfunctions according to the slow processing speed with a low mistake rate, indicating the acquired, thus secondary, attentional deficits. We diagnosed the patient with a TES suggestive of chronic traumatic encephalopathy and classified him as having subtle/mild functional limitation with a most likely transition to mild dementia within the TES criteria. This report underlines child abuse as a relevant criterion in diagnosing TES in cases with repetitive hits to the head. In addition to clinical markers, we show the relevance of fluid tau biomarkers and tau-PET to support the diagnosis of TES according to the recently published diagnosis criteria for TES.

Changes in circulating microRNAs following head impacts in soccer.

AIM: To explore the short-term effects of accidental head impacts and repetitive headers on circulating microRNAs, accounting for the effects of high-intensity exercise alone. METHODS: Blood samples were collected from professional soccer players at rest. Repeat samples were drawn 1 h and 12 h after three conditions: (1) accidental head impacts in a match, (2) repetitive headers during training, and (3) high-intensity exercise. 89 samples were screened to detect microRNAs expressed after each exposure. Identified microRNAs were then validated in 98 samples to determine consistently deregulated microRNAs. Deregulated microRNAs were further explored using bioinformatics to identify target genes and characterize their involvement in biological pathways. RESULTS: Accidental head impacts led to deregulation of eight microRNAs that were unaffected by high-intensity exercise; target genes were linked to 12 specific signaling pathways, primarily regulating chromatin organization, Hedgehog and Wnt signaling. Repetitive headers led to deregulation of six microRNAs that were unaffected by high-intensity exercise; target genes were linked to one specific signaling pathway (TGF-ß). High-intensity exercise led to deregulation of seven microRNAs; target genes were linked to 31 specific signaling pathways. CONCLUSION: We identified microRNAs specific to accidental head impacts and repetitive headers in soccer, potentially being useful as brain injury biomarkers.

Head impact exposure in youth football-Are current interventions hitting the target?

Restrictions on heading in youth football have been implemented in some countries to limit head impact exposure. However, current interventions remain poorly guided by evidence. Our objective was to quantify heading exposure in youth football, assessing the effects of sex and age. Football matches played during an international youth football tournament with no heading restrictions were directly observed, including players from both sexes (11-19 years). The elite senior level was included for comparison, using video analysis. All heading events were registered, classified, and assigned to individual players. Heading rates were calculated for each sex and age group. We observed a total of 267 matches, corresponding to 4011 player hours (1927 player hours for females, 2083 player hours for males). Males headed more frequently than females (2.7 vs 1.8 headers/player hour; P < .001). Heading rates increased with age (ANOVA, P < .001), approaching the elite senior level for players 16 years and older. There was substantial variation within teams for all age and sex groups, with the widest range (1-18 headers) observed for girls aged 19. Girls younger than 12 years had the lowest exposure, with an average of <2 players per team heading the ball, each with 1-2 headers. In conclusion, age and sex influence head impact exposure in youth football, and warrants careful consideration when introducing injury prevention measures. Males are more frequently exposed than females, heading rates increase with age, and there is substantial variation between players. Heading is a rare event in the youngest age groups, especially among females.

Evaluation of an In-Ear Sensor for Quantifying Head Impacts in Youth Soccer.

BACKGROUND: Wearable sensor systems have the potential to quantify head kinematic responses of head impacts in soccer. However, on-field use of sensors (eg, accelerometers) remains challenging, owing to poor coupling to the head and difficulties discriminating low-severity direct head impacts from inertial loading of the head from human movements, such as jumping and landing. PURPOSE: To test the validity of an in-ear sensor for quantifying head impacts in youth soccer. STUDY DESIGN: Descriptive laboratory study. METHODS: First, the sensor was mounted to a Hybrid III headform and impacted with a linear impactor or a soccer ball. Peak linear acceleration (PLA), peak rotational acceleration (PRA), and peak rotational velocity (PRV) were obtained from both systems; random and systematic errors were calculated with Hybrid III as reference. Then, 6 youth soccer players wore sensors and performed a structured training protocol, including heading and nonheading exercises; they also completed 2 regular soccer sessions. For each accelerative event recorded, PLA, PRA, and PRV outputs were compared with video recordings. Receiver operating characteristic curves were used to determine the sensor's discriminatory capacity in both on-field settings, establishing cutoff values for predicting outcomes. RESULTS: For the laboratory tests, the random error was 11% for PLA, 20% for PRA, and 5% for PRV; the systematic error was 11%, 19%, and 5%, respectively. For the structured training protocol, heading events resulted in higher absolute values (PLA = 15.6 g± 11.8 g) than nonheading events (PLA = 4.6 g± 1.2 g); the area under the curve was 0.98 for PLA. In regular training sessions, the area under the curve was >0.99 for PLA. A 9 g cutoff value yielded a positive predictive value of 100% in the structured training protocol versus 65% in the regular soccer sessions. CONCLUSION: The in-ear sensor displayed considerable random error and substantially overestimated head impact exposure. Despite the sensor's excellent on-field accuracy for discriminating headings from other accelerative events in youth soccer, absolute values must be interpreted with caution, and there is a need for secondary means of verification (eg, video analysis) in real-life settings. CLINICAL RELEVANCE: Wearable sensor systems can potentially provide valuable insights into head impact exposures in contact sports, but their limitations require careful consideration.

Chronic traumatic encephalopathy: neuroimaging biomarkers.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impact exposure, such as that resulting from sports-related concussive and subconcussive brain trauma. Currently, the only way to diagnose CTE is by using neuropathologic markers obtained postmortem. To diagnose CTE earlier, so that possible treatment interventions may be employed, there is a need to develop noninvasive in vivo biomarkers of CTE. Neuroimaging provides promising biomarkers for the diagnosis of CTE and may also help elucidate pathophysiologic changes that occur with chronic sports-related brain injury. To describe the use of neuroimaging as presumed biomarkers of CTE, this chapter focuses on only those studies that report the chronic stages of sports-related brain injury, as opposed to previous chapters that described neuroimaging in the context of acute and subacute injury. Studies using positron emission tomography and magnetic resonance imaging and spectroscopy will be discussed for contact/collision sports such as American football, boxing, mixed martial arts, rugby, and soccer, in which repetitive head impacts are common.

White matter alterations in college football players: a longitudinal diffusion tensor imaging study.

The aim of this study was to evaluate longitudinal changes in the diffusion characteristics of brain white matter (WM) in collegiate athletes at three time points: prior to the start of the football season (T1), after one season of football (T2), followed by six months of no-contact rest (T3). Fifteen male collegiate football players and 5 male non-athlete student controls underwent diffusion MR imaging and computerized cognitive testing at all three timepoints. Whole-brain tract-based spatial statistics (TBSS) were used to compare fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD), and trace between all timepoints. Average diffusion values were obtained from statistically significant clusters for each individual. No athlete suffered a concussion during the study period. After one season of play (T1 to T2), we observed a significant increase in trace in a cluster located in the brainstem and left temporal lobe, and a significant increase in FA in the left parietal lobe. After six months of no-contact rest (T2 to T3), there was a significant decrease in trace and FA in clusters that were partially overlapping or in close proximity with the initial clusters (T1 to T2), with no significant changes from T1 to T3. Repetitive head impacts (RHI) sustained during a single football season may result in alterations of the brain's WM in collegiate football players. These changes appear to return to baseline after 6 months of no-contact rest, suggesting remission of WM alterations. Our preliminary results suggest that collegiate football players might benefit from periods without exposure to RHI.

Hyperdense basilar artery sign-a reliable sign of basilar artery occlusion.

INTRODUCTION: We aimed to investigate the value of the hyperdense basilar artery (HBA) sign and of basilar artery (BA) attenuation measurements as predictors of basilar artery occlusion (BAO) on nonenhanced cranial CT (NECT). METHODS: Forty-one consecutive patients with proven BAO in CT angiography, who had undergone NECT for initial evaluation (30 males, 11 females) were retrospectively included. Another 41 age-matched patients without BAO were included as a control group. The NECT scans of both groups were assessed by three independent blinded readers (staff, fellow, and resident) in a randomized reading order using a standardized semiquantitative questionnaire. Visual BA hyperdensity, including the presence of HBA sign (hyperdensity scores of 4 and 5/5), was assessed, quantitative BA attenuation was measured in a region of interest (ROI), and diagnosis of BAO was made before and after ROI measurements. For statistical analysis, multivariate mixed effects models, likelihood ratio tests, and receiver operating characteristics techniques were applied. RESULTS: HBA sign had a relatively low sensitivity (60.98-65.85%), specificity (70.73-90.24%), and accuracy (65.85-75.61%) for the presence/absence of BAO on NECT. Optimal cut-off points were 40-42 HU (sensitivity, 68.29-78.05%; specificity, 75.61-82.93%; accuracy, 74.39-80.49%). CONCLUSION: In basilar artery occlusion, quantitative measurement of BA attenuation can slightly improve the diagnostic predictiveness of NECT. However, even with optimal cut-off values, the sensitivity is too low to serve as the sole diagnostic decision-making tool.