Sports-injury Encephalopathy

Angeline Prabhu, MD; Bilal Abaid, MD; Samreen Fathima, MD; Shivani Naik, MD; Steven Lippmann, MD


South Med J. 2019;112(10):547-550. 

In This Article

Abstract and Introduction


Sports-related encephalopathies are a growing concern among athletes who have experienced head trauma. Anxiety is heightened for the public and especially among parents of children playing contact sports. The most common neuropsychological conditions are concussions and traumatic encephalopathies. Concussions result from brain traumas that can be asymptomatic, but more serious concussions can include loss of consciousness, neurological abnormalities, and/or posttraumatic amnesias. Repetitive concussions lead to persistent brain pathology, known as chronic traumatic encephalopathies. This gradually progressive neurodegenerative disease frequently presents with cognitive and neurological deficits, which can result in significant parkinsonian features and dementia. Imaging studies may be noncontributory; however, diffusion tensor imaging, magnetic resonance spectroscopy, and functional magnetic resonance imaging can detect changes indicative of these encephalopathies. Progressive neuronal degeneration with tau proteins are documented on pathological examination. Prevention, early diagnosis, and proper treatment are the recommended approach to these conditions.


Brain damage caused by sports-related injuries is a public health concern of epidemic proportions.[1] Boxing legend Muhammad Ali was undefeated in his prime in the ring, only to develop parkinsonism and dementia secondary to his years of recurrent head trauma.[2]

Sports-related concussions, traumatic brain injuries, and chronic traumatic encephalopathies are the most common types of central nervous system (CNS) damage.[3] Previously, chronic traumatic encephalopathy (CTE) was known as punch drunk syndrome, dementia pugillistica, and/or psychopathic deterioration of pugilists.[4] These brain traumas characterize 10% of all head and neck pathologies.[5] More than 1 million Americans have traumatic brain damage.[4] Approximately 3 million sports-related concussions are documented annually,[6–8] with 17% of athletes developing a CTE.[5] Football players are the individuals who are most likely to suffer a concussion,[8] and encephalopathies also are noted among athletes who engage in boxing, rugby, wrestling, hockey, soccer, karate, basketball, parachuting, or volleyball.[9]

Brain injuries often are classified as acute or chronic. An acute injury occurs during an impact; the most common are concussions and concussions with diffuse cerebral swellings. Persistent CNS damage can be the long-term consequence of a single injury and/or multiple brain injuries.[1] The contributory effect of multiple brain traumas in the development of CTE is widely recognized. Coaches, athletic trainers, and physicians play a vital role in the recognition of the concussed athlete. Early recognition, treatment, and protocoled return to play may mitigate the progression from acute head trauma to CTE.