The DOI matches its Crossref record; 21 of the 22 references it cites were found in a registry or an index.
Emerging Histomorphologic Phenotypes of Chronic Traumatic Encephalopathy in American Athletes
Abstract
BACKGROUND: We define chronic traumatic encephalopathy (CTE) as a progressive neurodegenerative syndrome caused by single, episodic, or repetitive blunt force impacts to the head and transfer of acceleration-deceleration forces to the brain. OBJECTIVE: We present emerging histomorphologic phenotypes of CTE that we identified in our cohort of CTE cases with apolipoprotein E genotyping and causes and manners of death. METHODS: Autopsy brain tissue of 14 professional athletes and 3 high school football players was examined after unexpected deaths. Histochemical and immunohistochemical tissue staining was performed with apolipoprotein E genotyping. RESULTS: Ten of 14 professional athletes (71%) were positive for CTE: 7 of 8 football players, 2 of 4 wrestlers, and 1 boxer. One of 3 high school players manifested incipient CTE. The age range of those with CTE was 18 to 52 years; they were all male athletes. In all cases of CTE, Alzheimer-type cerebral cortical atrophy was absent; negligible to mild neocortical neuronal dropout was present. The fundamental neuropathologic feature of CTE was the topographic distribution of sparse, moderate, and frequent band-shaped, flame-shaped, small and large globose neurofibrillary tangles and neuritic threads in the cerebral cortex, subcortical nuclei/basal ganglia, hippocampus, and brainstem nuclei. Sparse to frequent diffuse amyloid plaques may accompany tauopathy and was seen in only 2 CTE cases. No α-synucleinopathy was present. All 7 CTE-positive professional athletes with known apolipoprotein E genotypes had at least 1 E3 allele comprising 5 E3/E3 (71%) and 2 E3/E4 (29%). Alcohol- and drug-related deaths, suicides, and accidental deaths were overrepresented in our CTE cohort. CONCLUSION: The emerging histomorphologic features of our CTE cohort may specify histologic criteria for CTE diagnosis, may identify emerging histologic variants of CTE and may facilitate more objective surveillance and accurate identification of sentinel CTE cases.
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“Prior to 2015, there were no agreed upon neuropathological criteria for CTE, and the criteria put forward by the two research groups in the US differed [15, 16].”
From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [15]
In the citing paper
“The consensus panel did not adopt the four neuropathological phenotypes [15] or stages of CTE [16], and indicated that the preliminary criteria were a “first step along the path to standardizing the neuropathology of CTE” [30].”
From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [15]
In the citing paper
“Over the past decade, the clinical features attributed to CTE have been expanded greatly and include virtually any mental health or neurological symptom or problem present prior to death”
From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [15]
In the citing paper
“Prior to 2016, there were no agreed upon neuropathological criteria for CTE, and the criteria published by the 2 leading research groups in the United States differed substantially (7,14).”
From Mild Chronic Traumatic Encephalopathy Neuropathology in People With No Known Participation in Contact Sports or History of Repetitive Neurotrauma (2019) · cites this paper as [7]
In the citing paper
“In different autopsy series, the percentage of former professional American football players who have died and donated their brains to research varies from 50 % [88], 80 % [146], to 97 %) [128].”
From The neuropathology of sport (2014) · cites this paper as [146]
In the citing paper
“Although CTE was first identified in association with boxing, CTE has been diagnosed neuropathologically in American football players, professional and amateur boxers, ice hockey players, professional wrestlers, soccer players, rugby players, and a professional baseball player (Figs. 3, 4, 5, 6) [38, 65, 66, 88, 91, 127, 128, 146–148].”
From The neuropathology of sport (2014) · cites this paper as [146]
Citations
Cites
Chronic traumatic encephalopathy in athletes: Progressive tauopathy after repetitive head injury
McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., Santini, V. E., Lee, H.-S., Kubilus, C. A., & Stern, R. A. (2009) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3181a9d503 · Cited by 2,295
MARTLAND, H. S. (1928) · Journal of the American Medical Association · doi:10.1001/jama.1928.02700150029009 · Cited by 774
Chronic Traumatic Encephalopathy in a National Football League Player
Kelly, D. F. (2006) · Neurosurgery · doi:10.1097/00006123-200605000-00037 · Cited by 694
Association of apolipoprotein E polymorphism with outcome after head injury
Teasdale, G. M., Nicoll, J. A. R., Murray, G. D., & Fiddes, M. (1997) · The Lancet · doi:10.1016/s0140-6736(97)04318-3 · Cited by 683
Apolipoprotein E epsilon4 associated with chronic traumatic brain injury in boxing
Jordan, B. D. (1997) · JAMA · doi:10.1001/jama.278.2.136 · Cited by 665
Mayeux, R., Ottman, R., Maestre, G., Ngai, C., Tang, M.-X., Ginsberg, H., Chun, M., Tycko, B., & Shelanski, M. (1995) · Neurology · doi:10.1212/wnl.45.3.555 · Cited by 590
Love, S., Louis, D. N., & Ellison, D. W. (2008) · CRC Press eBooks · doi:10.1201/b22602 · Cited by 445
Apolipoprotein E-ε4 genotype predicts a poor outcome in survivors of traumatic brain injury
Friedman, G., Froom, P., Sazbon, L., Grinblatt, I., Shochina, M., Tsenter, J., Babaey, S., Yehuda, A. B., & Groswasser, Z. (1999) · Neurology · doi:10.1212/wnl.52.2.244 · Cited by 437
Traumatic Brain Injury — Football, Warfare, and Long-Term Effects
DeKosky, S. T., Ikonomović, M. D., & Gandy, S. (2010) · New England Journal of Medicine · doi:10.1056/nejmp1007051 · Cited by 322
Chronic traumatic encephalopathy (CTE) in a National Football League Player
Omalu, B. I., Hamilton, R. L., Kamboh, M. I., DeKosky, S. T., & Bailes, J. E. (2010) · Journal of Forensic Nursing · doi:10.1111/j.1939-3938.2009.01064.x · Cited by 260
Self-citationNeuropathologic Alterations in Mild Cognitive Impairment: A Review
Markesbery, W. R. (2010) · Journal of Alzheimer's Disease · doi:10.3233/jad-2010-1220 · Cited by 236
Chronic Traumatic Encephalopathy, Suicides and Parasuicides in Professional American Athletes
Omalu, B. I., Bailes, J. E., Hammers, J., & Fitzsimmons, R. P. (2010) · American Journal of Forensic Medicine & Pathology · doi:10.1097/paf.0b013e3181ca7f35 · Cited by 217
Self-citationIncidence of Mild Cognitive Impairment: A Systematic Review
Luck, T., Luppa, M., Briel, S., & Riedel-Heller, S. G. (2010) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000272424 · Cited by 213
Lower Cognitive Performance of Older Football Players Possessing Apolipoprotein E ε4
Kutner, K. C., Erlanger, D. M., Tsai, J., Jordan, B. D., & Relkin, N. R. (2000) · Neurosurgery · doi:10.1097/00006123-200009000-00026 · Cited by 170
Chronic traumatic encephalopathy in a professional American wrestler
Omalu, B. I., Fitzsimmons, R. P., Hammers, J., & Bailes, J. (2010) · Journal of Forensic Nursing · doi:10.1111/j.1939-3938.2010.01078.x · Cited by 155
Self-citationLong term neuropsychological outcome after head injury: relation to APOE genotype
Millar, K. (2003) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.74.8.1047 · Cited by 146
Neuropathology: A Reference Text of CNS Pathology
Ellison, D. (1998) · Cited by 140
Apolipoprotein E, Amyloid, and Alzheimer Disease
Bales, K. R. (2002) · Molecular Interventions · doi:10.1124/mi.2.6.363 · Cited by 114
Kamboh, M. I. (1995) · Atherosclerosis · doi:10.1016/0021-9150(94)05409-c · Cited by 104
Self-citationBancher, C., Egensperger, R., Kösel, S., Jellinger, K. A., & Graeber, M. B. (1997) · Acta Neuropathologica · doi:10.1007/s004010050726 · Cited by 71
Senile Dementia of the Neurofibrillary Tangle Type: A Comparison with Alzheimer’s Disease
Yamada, M., Itoh, Y., Sodeyama, N., Suematsu, N., Otomo, E., Matsushita, M., & Mizusawa, H. (2001) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000051245 · Cited by 36
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Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research
Maas, A. I. R., Menon, D. K., Adelson, P. D., Andelic, N., Bell, M. J., Belli, A., Bragge, P., Brazinova, A., Büki, A., Chesnut, R. M., et al. (2017) · The Lancet Neurology · doi:10.1016/s1474-4422(17)30371-x · Cited by 2,609
Impairment of Glymphatic Pathway Function Promotes Tau Pathology after Traumatic Brain Injury
Iliff, J. J., Chen, M. J., Plog, B. A., Zeppenfeld, D. M., Soltero, M., Yang, L., Singh, I., Deane, R., & Nedergaard, M. (2014) · The Journal of Neuroscience · doi:10.1523/jneurosci.3020-14.2014 · Cited by 1,159
Morris, M., Maeda, S., Vossel, K., & Mucke, L. (2011) · Neuron · doi:10.1016/j.neuron.2011.04.009 · Cited by 899
Chronic neuropathologies of single and repetitive TBI: substrates of dementia?
Smith, D. H., Johnson, V. E., & Stewart, W. (2013) · Nature Reviews Neurology · doi:10.1038/nrneurol.2013.29 · Cited by 699
The Neuropathology and Neurobiology of Traumatic Brain Injury
Blennow, K., Hardy, J., & Zetterberg, H. (2012) · Neuron · doi:10.1016/j.neuron.2012.11.021 · Cited by 669
Metadata
- Authors
- Omalu, B., Bailes, J., Hamilton, R. L., Kamboh, M. I., Hammers, J., Case, M., & Fitzsimmons, R.
- Affiliations
- West Virginia University (US)
- Corresponding author
- Omalu, Bennet
- Fitzsimmons, Robert
- Venue
- Neurosurgery
- Published
- 2011-07
- Volume
- 69
- Issue
- 1
- Pages
- 173-183
- ISSN
- 0148-396X (ISSN-L)
- OpenAlex
- W1985345440
- Cited by
- 381
- References
- 22
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 9 · 2023: 21 · 2022: 17 · 2021: 18 · 2020: 20 · 2019: 31 · 2018: 30 · 2017: 41 · 2016: 39 · 2015: 44 · 2014: 35 · 2013: 36 · 2012: 16
- FWCI
- 22.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurosurgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- chronic traumatic encephalopathy, histopathology, neurofibrillary tangles, tauopathy, APOE genotype, professional athletes, football players, boxing, wrestling, causes of death, autopsy brain tissue, neurodegeneration
- MeSH terms
- Adolescent, Adult, Americas, Athletic Injuries, Autopsy, Brain, Cause of Death, Humans, Male, Middle Aged, Phenotype, Cohort Studies, Cerebral Amyloid Angiopathy, Neurofibrillary Tangles, Brain Injury, Chronic, Young Adult, Plaque, Amyloid
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