Subconcussive impact in sports: a new era of awareness.

ional athletes vanced degenaradigm shift tion experts. only an all-orso result from al detrimental nto the media veteran footer of the ball were heavier, after a 5-year tensive degenCTE were disted as cause of y” was docuA concussive episode refers to inertially induced duced traumatic alteration of function of the cere associated imaging abnormalities. Appreciation f of gravity linear acceleration, angular velocity, and eration during dynamic motion of the head a emerged recently in the neurosurgical community literature details potential detrimental effects of r cussive episodes in contact sports such as boxin American football (4, 8, 13-15, 25, 32, 35-37), rug 42), hockey (9, 49, 50), and soccer (18, 23, 24, repeat concussive episode before resolution of init symptoms has been associated with fatal cerebral hypothesized “second impact syndrome” (5, 6, 27 prevention efforts in sports have focused on minim lete’s concussive episode risk, and although the e tive subconcussive trauma in contact sports ha creased attention recently, it has yet to be fully add The term dementia pugilistica (22) describes a syndro sive neurodegeneration, first described in retired box repetitive subconcussive head impacts, that shares logic features with Alzheimer disease (1, 2, 11, 31, 3 term replacing dementia pugilistica, chronic traumati pact-inwithout ad center lar accelrain has luminous itive con, 17, 26), 9, 20, 29, 46-48). A ncussion a via the ain injury g an athof repetieived ined. f progresxposed to icopatho. The new phalopathy which is recognized to result from a variety of minor CTE is associated with personality changes, memor parkinsonism, and speech and gait abnormalities. P marks include gross cerebral andmedial temporal lo extensive tau-immunoreactive neurofibrillary tangle 30, 45). Spurred by highly publicized cases of profess who died at a young age and were found to have ad erative brain changes at autopsy, there has been a p among sports medicine and head injury preven An increasing realization is that brain injury is not nothing phenomenon (eg, concussion) but may al accumulated subconcussive impacts. The potenti effect of repetitive heading in soccer was thrust i limelight in 2002 following the death of English baller Jeffrey Astle. Astle had been a prolific head during an era in which the leather balls employed especially in wet conditions. Astle died at age 59 history of rapidly deterioratingmental capacity. Ex erative brain disease and taupathy consistent with covered at autopsy;minor repetitive traumawas sta death, and a verdict of “death by industrial injur ic entity, mented (28). This ruling of cause of death was especially striking