CC BY-NC-ND 4.0 · Indian Journal of Neurotrauma 2022; 19(01): 057-058
DOI: 10.1055/s-0041-1732794
Letter to the Editor

Uneasy Lies the Head that Wears the Crown: Historical Vignette on Chronic Traumatic Encephalopathy

1   Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
Chandramouli Bhattacharya
2   Department of Internal Medicine, Peerless Hospital, Kolkata, West Bengal, India
Nabanita Ghosh
3   Department of Neuroaneshesiology, National Neurosciences Centre, Kolkata, West Bengal, India
› Author Affiliations

Progressive neurological deterioration in boxers who suffer repeated traumatic brain injury (TBI) was termed chronic traumatic encephalopathy (CTE) by Macdonald Critchley.[1] Behavioral changes including emotional lability, slowness of speech and thought, memory deterioration, mood swings, irritability, depression, paranoia, and uninhibited violent behavior are the features of CTE.[1] The victims also have a combination of pyramidal, extrapyramidal, and cerebellar signs.[1] CTE is now increasingly documented in athletes involved in contact sports.[2] It is a neurodegenerative disorder akin to Alzheimer’s disease, with perivascular accumulation of phosphorylated tau proteins in neurons and astrocytes at the depths of the cortical sulci.[2]

Clinically, CTE is divided into four stages, based on the increasing disability of the patients ([Table 1]). CTE has gained recognition only recently, as, historically, there is sparse documentation of repetitive head injury, leading to behavioral alterations. We present two documented cases of startling personality changes and psychological decline in kings who suffered from repeated TBI.

Table 1

Stages of chronic traumatic encephalopathy (adapted from Turk and Budson[2])

Stage 1

Headaches with loss of attention and concentration

Stage 2

Stage 1 features with explosiveness, short-term memory loss, mood swings and depression

Stage 3

Worsening of stage 2 features with cognitive impairment, executive dysfunction and visuospatial abnormalities

Stage 4

Worsening of stage 3 symptoms with dementia, paranoia, aggression, impulsivity and motor problems (Parkinsonism, gait and speech abnormalities)

Publication History

Article published online:
29 July 2021

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