Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts.
Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts.
复制标题
DOI：
10.1001/jamaneurol.2023.2907
复制
发表时间：
2023-10-01
期刊：
影响因子：
29
通讯作者：
Alosco, Michael L.
中科院分区：
文献类型：
--
作者：
Mckee, Ann C.;Mez, Jesse;Abdolmohammadi, Bobak;Butler, Morgane;Huber, Bertrand Russell;Uretsky, Madeline;Babcock, Katharine;Cherry, Jonathan D.;Alvarez, Victor E.;Martin, Brett;Tripodis, Yorghos;Palmisano, Joseph N.;Cormier, Kerry A.;Kubilus, Caroline A.;Nicks, Raymond;Kirsch, Daniel;Mahar, Ian;Mchale, Lisa;Nowinski, Christopher;Cantu, Robert C.;Stern, Robert A.;Daneshvar, Daniel;Goldstein, Lee E.;Katz, Douglas I.;Kowall, Neil W.;Dwyer, Brigid;Stein, Thor D.;Alosco, Michael L.
在年轻、已故、有症状的接触运动运动员的方便样本中，有哪些神经病理学和临床发现？在该病例系列中，有 152 名死亡时年龄小于 30 岁的接触性运动运动员，其中 63 名（41.4%）发现慢性创伤性脑病 (CTE)，几乎所有人都有轻度 CTE（I 期和 II 期）。与 CTE 相关的神经病理学异常包括心室扩大、透明隔腔、丘脑切迹以及额叶白质中血管周围富含色素的巨噬细胞沉积。这些发现证实，CTE 和其他脑部病变可以在有症状的年轻接触运动运动员中发现，但这些病理状况的临床相关性尚不确定。本病例系列描述了死亡时年龄小于 30 岁的年轻接触运动运动员的神经病理学和临床特征。年轻的接触运动运动员可能面临长期神经病理性疾病的风险，包括慢性创伤性脑病（CTE）。旨在描述作为接触性运动运动员的年轻大脑捐献者的神经病理学和临床症状。本病例系列分析了通过了解神经损伤和创伤性脑病 (UNITE) 脑库确定的 156 名 30 岁以下大脑捐献者中的 152 名的研究结果，这些捐献者于 2008 年 2 月 1 日至 2022 年 9 月 31 日期间捐献了大脑。神经病理学评估、回顾性电话临床评估和对知情者的在线问卷调查均以盲法进行。数据分析于 2021 年 8 月至 2023 年 6 月期间进行。接触运动造成的重复性头部撞击。根据明确的诊断标准进行大体和微观神经病理学评估，包括 CTE 诊断；知情者报告的运动史和知情者完成的量表，用于评估认知症状、情绪障碍和神经行为失调。在该研究纳入的 152 名已故接触性运动参与者中（平均 [SD] 年龄，22.97 [4.31] 岁；141 [92.8%] 男性），63 名（41.4%；中位 [IQR] 年龄，26 [24-27] 岁）被诊断出 CTE。在 63 名被诊断患有 CTE 的大脑捐献者中，60 名 (95.2%) 被诊断为轻度 CTE（I 期或 II 期）。患有 CTE 的大脑捐献者年龄更大（平均差异为 3.92 岁；95% CI，2.74-5.10 岁）。在 63 名患有 CTE 的运动员中，45 名（71.4%）是参加业余运动的男性，包括美式橄榄球、冰球、足球、橄榄球和摔跤； 1 名患有 CTE 的女性参加过大学足球比赛。对于那些踢足球的人来说，有 CTE 的人比没有 CTE 的人的职业生涯持续时间明显更长（平均差异，2.81 年；95% CI，1.15-4.48 年）。与没有 CTE 的运动员相比，患有 CTE 的运动员有更多的心室扩张、透明隔腔、丘脑切迹和额叶白质中血管周围富含色素的巨噬细胞。所有大脑捐赠者都经常出现认知和神经行为症状。自杀是最常见的死亡原因，其次是意外服药过量；根据 CTE 状态，死亡原因或临床症状没有差异。该病例系列发现，无论 CTE 状态如何，暴露于重复头部撞击的年轻大脑捐赠者都会出现严重症状，并且该样本中症状的原因可能是多因素的。未来的研究需要包括未暴露于重复性头部撞击的年轻大脑捐赠者，以阐明暴露、白质和微血管病理结果、CTE 和临床症状之间的关联。
What are the neuropathologic and clinical findings in a convenience sample of young, deceased, symptomatic contact sport athletes? In this case series of 152 contact sport athletes younger than 30 years at the time of death, chronic traumatic encephalopathy (CTE) was found in 63 (41.4%), with nearly all having mild CTE (stages I and II). Neuropathologic abnormalities associated with CTE included ventricular enlargement, cavum septum pellucidum, thalamic notching, and perivascular pigment–laden macrophage deposition in the frontal white matter. These findings confirm that CTE and other brain pathologies can be found in young, symptomatic contact sport athletes, but the clinical correlates of these pathologic conditions are uncertain. This cases series describes the neuropathologic and clinical features of young contact sport athletes who were younger than 30 years at the time of death. Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). To characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes. This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022. Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023. Repetitive head impacts from contact sports. Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation. Among the 152 deceased contact sports participants (mean [SD] age, 22.97 [4.31] years; 141 [92.8%] male) included in the study, CTE was diagnosed in 63 (41.4%; median [IQR] age, 26 [24-27] years). Of the 63 brain donors diagnosed with CTE, 60 (95.2%) were diagnosed with mild CTE (stages I or II). Brain donors who had CTE were more likely to be older (mean difference, 3.92 years; 95% CI, 2.74-5.10 years) Of the 63 athletes with CTE, 45 (71.4%) were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer. For those who played football, duration of playing career was significantly longer in those with vs without CTE (mean difference, 2.81 years; 95% CI, 1.15-4.48 years). Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. Cognitive and neurobehavioral symptoms were frequent among all brain donors. Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status. This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. Future studies that include young brain donors unexposed to repetitive head impacts are needed to clarify the association among exposure, white matter and microvascular pathologic findings, CTE, and clinical symptoms.
登录
查看更多内容
影响因子：
12.7
作者：
通讯作者：
--
影响因子：
12.7
作者：
Chancellor KB;Chancellor SE;Duke-Cohan JE;Huber BR;Stein TD;Alvarez VE;Okaty BW;Dymecki SM;McKee AC
通讯作者：
McKee AC
影响因子：
3.2
作者：
Bieniek KF;Cairns NJ;Crary JF;Dickson DW;Folkerth RD;Keene CD;Litvan I;Perl DP;Stein TD;Vonsattel JP;Stewart W;Dams-O'Connor K;Gordon WA;Tripodis Y;Alvarez VE;Mez J;Alosco ML;McKee AC;TBI/CTE Research Group
通讯作者：
TBI/CTE Research Group
影响因子：
3.2
作者：
Doherty, Colin P.;O'Keefe, Eoin;Campbell, Matthew
通讯作者：
Campbell, Matthew
影响因子：
12.7
作者：
Holleran, Laurena;Kim, Joong Hee;Brody, David L.
通讯作者：
Brody, David L.