Arciniega Hector, Jung Leonard B, Tuz-Zahra Fatima, Tripodis Yorghos, John Omar, Kim Nicholas, Carrington Holly W, Knyazhanskaya Evdokiya E, Chamaria Arushi, Breedlove Katherine, Wiegand Tim L T, Daneshvar Daniel, Billah Tashrif, Pasternak Ofer, Coleman Michael J, Adler Charles H, Bernick Charles, Balcer Laura J, Alosco Michael L, Lin Alexander P, Koerte Inga K, Cummings Jeffrey L, Reiman Eric M, Stern Robert A, Bouix Sylvain, Shenton Martha E
Department of Rehabilitation Medicine (HA, OJ), New York University Grossman School of Medicine, New York, NY; NYU Concussion Center (HA), NYU Langone Health, New York, NY; Psychiatry Neuroimaging Laboratory (HA, LBJ, OJ, NK, HWC, EK, AC, TLTW, TB, OP, MJC, IKK, SB, MES), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cBRAIN (LBJ, TLTW, IKK), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universit¨at, Munich, Germany; Department of Biostatistics (FT-Z, YT), Boston University School of Public Health Boston, MA; Center for Clinical Spectroscopy (KB, APL), Department of Radiology, Brigham and Women's Hospital Boston, MA; Department of Physical Medicine and Rehabilitation (DD), Harvard Medical School Boston, MA; Department of Physical Medicine and Rehabilitation (DD), Massachusetts General Hospital Boston, MA; Department of Physical Medicine and Rehabilitation (DD), Spaulding Rehabilitation Hospital, Cambridge, MA; Department of Radiology (OP, APL, MES), Brigham and Women's Hospital, Harvard Medical School Boston, MA; Department of Psychiatry (OP, IKK, MES), Massachusetts General Hospital Boston, MA; Department of Neurology (CHA), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ; Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV (CB); Department of Neurology (CB), University of Washington, Seattle, WA; Department of Neurology (LJB), New York University Grossman School of Medicine, New York, NY; Department of Population Health (LJB), New York University Grossman School of Medicine, New York, NY; Department of Ophthalmology (LJB), New York University Grossman School of Medicine, New York, NY; Department of Neurology (MLA, RAS), Boston University Alzheimer's Disease Research Center and CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA; Graduate School of Systemic Neurosciences (IKK), Ludwig-Maximilians-Universität, Munich, Germany; Chambers-Grundy Center for Transformative Neuroscience (JLC), Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV; Banner Alzheimer's Institute and Arizona Alzheimer's Consortium (EMR), Phoenix, AZ; Department of Psychiatry (EMR), University of Arizona, Tucson, AZ; Department of Psychiatry (EMR), Arizona State University, Phoenix, AZ; Neurogenomics Division (EMR), Translational Genomics Research Institute and Alzheimer's Consortium, Phoenix, AZ; Department of Anatomy and Neurobiology (RAS); Department of Neurosurgery (RAS), Boston University Chobanian & Avedisian School of Medicine, Boston, MA; and Department of Software Engineering and Information Technology (SB), École de technologie supérieure, Université du Québec, Montreal, Canada.
Neurol Clin Pract. 2024 Oct;14(5):e200324. doi: 10.1212/CPJ.0000000000200324. Epub 2024 Aug 15.
Exposure to repetitive head impacts (RHI) is linked to the development of chronic traumatic encephalopathy (CTE), which can only be diagnosed at post-mortem. The presence of a cavum septum pellucidum (CSP) is a common finding in post-mortem studies of confirmed CTE and in neuroimaging studies of individuals exposed to RHI. This study examines CSP in living former American football players, investigating its association with RHI exposure, traumatic encephalopathy syndrome (TES) diagnosis, and provisional levels of certainty for CTE pathology.
Data from the DIAGNOSE CTE Research Project were used to compare the presence and ratio of CSP in former American football players (n = 175), consisting of former college (n = 58) and former professional players (n = 117), and asymptomatic unexposed controls without RHI exposure (n = 55). We further evaluated potential associations between CSP measures and cumulative head impact index (CHII) measures (frequency, linear acceleration, and rotational force), a TES diagnosis (yes/no), and a provisional level of certainty for CTE pathology (suggestive, possible, and probable).
Former American football players exhibited a higher CSP presence and ratio than unexposed asymptomatic controls. Among player subgroups, professional players showed a greater CSP ratio than former college players and unexposed asymptomatic controls. Among all football players, CHII rotational forces correlated with an increased CSP ratio. No significant associations were found between CSP measures and diagnosis of TES or provisional levels of certainty for CTE pathology.
This study confirms previous findings, highlighting a greater prevalence of CSP and a greater CSP ratio in former American football players compared with unexposed asymptomatic controls. In addition, former professional players showed a greater CSP ratio than college players. Moreover, the relationship between estimates of CHII rotational forces and CSP measures suggests that cumulative frequency and strength of rotational forces experienced in football are associated with CSP. However, CSP does not directly correlate with TES diagnosis or provisional levels of certainty for CTE, indicating that it may be a consequence of RHI associated with rotational forces. Further research, especially longitudinal studies, is needed for confirmation and to explore changes over time.
反复头部撞击（RHI）与慢性创伤性脑病（CTE）的发生有关，而CTE只能在尸检时诊断。透明隔腔（CSP）的存在在确诊CTE的尸检研究以及暴露于RHI的个体的神经影像学研究中是常见发现。本研究在现役前美国橄榄球运动员中检查CSP，调查其与RHI暴露、创伤性脑病综合征（TES）诊断以及CTE病理学暂定确定性水平的关联。
来自诊断CTE研究项目的数据用于比较前美国橄榄球运动员（n = 175）中CSP的存在情况和比例，这些运动员包括前大学球员（n = 58）和前职业球员（n = 117），以及未暴露于RHI的无症状对照（n = 55）。我们进一步评估了CSP测量值与累积头部撞击指数（CHII）测量值（频率、线性加速度和旋转力）、TES诊断（是/否）以及CTE病理学暂定确定性水平（提示性、可能性和可能性较大）之间的潜在关联。
前美国橄榄球运动员的CSP存在情况和比例高于未暴露的无症状对照。在运动员亚组中，职业球员的CSP比例高于前大学球员和未暴露的无症状对照。在所有橄榄球运动员中，CHII旋转力与CSP比例增加相关。未发现CSP测量值与TES诊断或CTE病理学暂定确定性水平之间存在显著关联。
本研究证实了先前的发现，突出了与未暴露的无症状对照相比，前美国橄榄球运动员中CSP的患病率更高且CSP比例更大。此外，前职业球员的CSP比例高于大学球员。此外，CHII旋转力估计值与CSP测量值之间的关系表明，橄榄球运动中经历的旋转力的累积频率和强度与CSP有关。然而，CSP与TES诊断或CTE的暂定确定性水平没有直接关联，表明它可能是与旋转力相关的RHI的结果。需要进一步的研究，特别是纵向研究，以进行确认并探索随时间的变化。
