Davis Gavin A, Castellani Rudolph J, McCrory Paul
*Department of Neurosurgery, Cabrini Medical Centre, Malvern, Victoria, Australia; ‡Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; §Department of Pathology, University of Maryland, Baltimore, Maryland.
Neurosurgery. 2015 Jun;76(6):643-55; discussion 655-6. doi: 10.1227/NEU.0000000000000722.
The recent interest in concussion in sport has resulted in significant media focus about chronic traumatic encephalopathy (CTE), although a direct causative link(s) between concussion and CTE is not established. Typically, sport-related CTE occurs in a retired athlete with or without a history of concussion(s) who presents with a constellation of cognitive, mood, and/or behavioral symptoms and who has postmortem findings of tau deposition within the brain. There are many confounding variables, however, that can account for brain tau deposition, including genetic mutations, drugs, normal aging, environmental factors, postmortem brain processing, and toxins. To understand the roles of such factors in neurodegenerative diseases that may occur in athletes, this article reviews some neurodegenerative diseases that may present with similar findings in nonathletes. The article also reviews pathological changes identified with normal aging, and reviews the pathological findings of CTE in light of all these factors. While many of these athletes have a history of exposure to head impacts as a part of contact sport, there is insufficient evidence to establish causation between sports concussion and CTE. It is likely that many of the cases with neuropathological findings represent the normal aging process, the effects of opiate abuse, or a variant of frontotemporal lobar degeneration. Whether particular genetic causes may place athletes at greater risk of neurodegenerative disease is yet to be determined.
近期对运动性脑震荡的关注使得媒体大量聚焦于慢性创伤性脑病（CTE），尽管脑震荡与CTE之间的直接因果关系尚未确立。典型的与运动相关的CTE发生在一名退休运动员身上，该运动员有或没有脑震荡病史，表现出一系列认知、情绪和/或行为症状，且尸检发现大脑内有tau蛋白沉积。然而，有许多混杂变量可解释大脑tau蛋白沉积，包括基因突变、药物、正常衰老、环境因素、尸检时的大脑处理过程以及毒素。为了解这些因素在运动员可能发生的神经退行性疾病中的作用，本文综述了一些在非运动员中可能出现类似表现的神经退行性疾病。文章还综述了正常衰老所确定的病理变化，并根据所有这些因素对CTE的病理发现进行了综述。虽然这些运动员中的许多人有过作为接触性运动一部分而遭受头部撞击的经历，但尚无足够证据证实运动性脑震荡与CTE之间存在因果关系。很可能许多有神经病理学发现的病例代表正常衰老过程、阿片类药物滥用的影响或额颞叶痴呆的一种变体。特定的遗传原因是否会使运动员患神经退行性疾病的风险更高，还有待确定。
