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June 2016

A Clinical Approach to the Diagnosis of Traumatic Encephalopathy Syndrome: A Review

Author Affiliations
  • 1Department of Neurology, NorthShore University Health System, Glenview, Illinois
  • 2Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor
  • 3Department of Psychiatry, University of Michigan Health System, Ann Arbor
  • 4Department of Neurology, University of Michigan Health System, Ann Arbor
JAMA Neurol. 2016;73(6):743-749. doi:10.1001/jamaneurol.2015.5015

Importance  Chronic traumatic encephalopathy (CTE) refers to pathologic changes that have been found in some individuals with a history of repetitive traumatic impact to the head (hereinafter referred to as head trauma). These changes cannot be assessed during the clinical evaluation of a living patient.

Observations  The neuropathologic features, taxonomy, history, role of biomarkers in diagnosis, and existing criteria of CTE are reviewed. Previous criteria have been proposed to approach the living patient; however, a unified, specific approach is needed for the practicing clinician. We propose a new diagnostic construct for the clinical syndrome associated with repetitive exposure to head trauma: traumatic encephalopathy syndrome. This clinical paradigm will provide the framework for a diagnosis of probable, possible, and unlikely traumatic encephalopathy syndrome, with included discussion regarding the minimum exposure, nature of the clinical course, and additional clinical features needed for diagnosis.

Conclusions and Relevance  While prospective longitudinal studies are ongoing to further elucidate the association of exposure to head trauma, clinical features, and the development of pathologic changes, a corresponding clinical construct for diagnosis is necessary.