Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide

Abstract

<jats:p>Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.</jats:p>

Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

“…71 Since the identification of CTE in a former professional American football player in 2005, 72 and additional intensive pathological studies, this condition has gained widespread public attention, and has now been identified in brains of former ice hockey, baseball, rugby and soccer players, 73 wrestlers, 74 and military veterans. 75,76 The prevalence and incidence of CTE in amateur and professional athletes is still unknown, adding to difficulties in discussing its epidemiology and population risks for athletes. Although CTE is primarily considered to be a neurodegenerative disease that sometimes results from a career of either collegiate or professional contact sports, cases of CTE have been reported in high school athletes.…”

Cavum Septi Pellucidi in Symptomatic Former Professional Football Players

“…3,7 Moreover, CTE has been found in nonathletes who have experienced repetitive head impacts, including military service members, 2,8,9 persons with medical conditions such as epilepsy and autism, and victims of physical abuse. 2,10 All patients with neuropathologically confirmed CTE reported to date have had a history of brain trauma, typically from repetitive mild or subconcussive head impacts.…”

Evaluating the Risks and Benefits of Participation in High-School Football

“…Currently, we are unable to predict the probability of long-term problems for a given number of sport-related concussions. Some athletes who have sustained multiple traumatic injuries to the brain over long careers in boxing, American football, and other sports have pathologic changes in the brain such as the deposition of beta-amyloid and phosphorylated tau [15][16][17][18][19][20][21][22][23][24]. This condition has become known as chronic traumatic encephalopathy.…”