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In this issue of JAMA Neurology, Mez and colleagues1 present a case of a young former amateur football player diagnosed with chronic traumatic encephalopathy (CTE), identified pathologically at autopsy at age 25 years, following death due to complications of endocarditis. This athlete is just one in a series of former contact sports athletes, including those having played American football, with evidence of CTE at autopsy. Several of these former players were even younger—just teenagers at the time pathological findings were identified.2 What distinguishes this case from other similar cases was his inclusion in the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) study, with an evaluation that uniquely included neuropsychological testing within months of his young death. As noted by the authors, arguably a group in the best position to recognize CTE clinically, his history and profile did not clearly distinguish CTE from postconcussion syndrome or depression, particularly given the young age of presentation. The case, in its findings, uncertainties, and timing, offers an opportunity to highlight a number of important, ongoing developments in the field of concussion and CTE, but also underscores the many substantial, unresolved, and essential questions left unanswered in the field.
Noble JM. The Long Drive Ahead to Better Understanding Chronic Traumatic EncephalopathyFirst (Case) and 10 (Years Later). JAMA Neurol. 2016;73(3):263-265. doi:10.1001/jamaneurol.2015.4297