Repetitive head injury syndrome

traumatic brain injury

What Is Repetitive head injury syndrome?

Repetitive Head Injury Syndrome (RHS or RHI) is a neurodegenerative condition that affects the brain and spinal cord, which leads to impairment in decision making and nerve control.

The condition leads to memory loss, depression, and behavioral changes. It is also known as Chronic Traumatic Encephalopathy (CTE).

RHI is an extremely rare neurological disease that affects a small percentage of the general population. What researchers today understand about this condition may not be the same as what was understood in the 20th century.

The first symptoms of RHI include cognitive impairment and dementia, which can manifest as early as 60 years old. In 95% of cases, symptoms appear after age 65.

It is estimated that there are between 200,000 and 800,000 people in the world with RHI.

What is chronic traumatic encephalopathy?

What is CTE?

CTE is a degenerative brain disease that has been found in former military personnel, football players, and boxing champions. All of these people have been exposed to repeated trauma on the head.

But there are not the only people that will likely have CTE. For example, young and elderly adults soccer players, hockey players with mild or moderate TBI from multiple minor head injuries or multiple concussions.

Even if they have multiple minor concussions, they have an increased risk of neurodegenerative disease.

A sport-related concussion, for example, a National Football League player or any other affected athletes reported playing, has the exposure to repetitive head injuries could end up with chronic and catastrophic effects.

Even if it is just a second head injury, repeated brain injury exposure ultimately may have an increased risk of neurodegenerative.

Chronic traumatic encephalopathy is a disease of brain damage that persists over a period of years or decades and is due to traumatic effects on the skull. The brain of a person who suffers from chronic traumatic encephalopathy gradually worsens and loses mass over time.

The symptoms of CTE that occur in four stages generally occur eight to ten years after repeated mild traumatic brain injuries.

Boston University’s CTE Center says chronic traumatic encephalopathy (CTE) is a degenerative brain disease that occurs in athletes, military veterans, and others with a history of repeated brain trauma.

Catastrophic sports injury research

Repeated head injuries or a previous head injury like a history of multiple concussions demonstrated a high incidence of CTE symptoms.

The research has the goal of more than disease control, the goal is prevention in the sports injury populations. College soccer related concussions outpaced the number of cervical spine injuries occurring in college football plus the number of concussions in football combined.

A previous head injury and previous mental health disorders were hard to account for in terms of how they played a role in the studies.

CTE Risk Factors

Repeated exposure to traumatic brain injury is thought to increase the risk of CTE, but experts are still learning about the risk factors. It is a progressive degenerative disease that affects the brains of people who have repeatedly suffered concussions and traumatic brain injuries, such as athletes who practice contact sports, members of the military, and others.

It does not take a catastrophic head injury to bring on the symptoms of chronic or prolonged symptoms of chronic traumatic encephalopathy.

Chronic traumatic encephalomyopathy

A small group of people with CTE have chronic traumatic encephalomyopathy (CTEM), which is characterized by symptoms of motor neuron disease and mimics amyotrophic lateral sclerosis (ALS).

Previously, the condition known as chronic traumatic encephalopathy (CTE) was thought to occur primarily in boxers and was called dementia pugilistica.

We have already shared that chronic traumatic encephalopathy (CTE) is a progressive degenerative disease of the brain that occurs in people with a history of repeated brain trauma (often in athletes), including symptomatic concussions and asymptomatic sub-consecutive blows to the head that does not cause symptoms.

This is why documented head injury documentation, including mild TBI, in the National Football League, demonstrated little concern and may not have been taken as seriously. The accumulative effect of football brain injuries is what leads to catastrophic head injuries.

Even players with a history of multiple concussions demonstrated they were not having symptoms. So much so that they were still playing at a very high level.

And that is the danger because the traumatic brain injury and repetitive head injury, even if they sustained repeated minor head injuries

Chronic traumatic encephalopathy typically occurs with several of the same symptoms experienced by people who suffer from other types of dementia such as:

  • memory loss

  • aggression

  • confusion

  • depression

  • judgment disorders

  • difficulty controlling impulses

  • irregular behavior

  • suicidal tendencies

  • anxiety

  • problems sleeping

  • dizziness

  • balance problems.

traumatic brain injuries

Balance impairments (as measured by computerized posturography (CPT) administered by sports medicine specialists, are more common in dementias of all types compared with controls and have been demonstrated acutely after mild TBI or repetitive mild head injuries that were the nonpenetrating traumatic brain injury.

CPT score is predictive of recurrent falls in persons with balance and vestibular disorders. Tau proteins (collectively termed “total-tau”) are a logical indicator of CTE and, more broadly, TBI-onset neurodegeneration.

Total-tau in cerebrospinal fluid (CSF) is one of the most predictive biomarkers for clinical use in neurodegenerative disorders associated with cognitive impairment)

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome caused by single, episodic, or repeated blunt force effects on the head and the transmission of acceleration and deceleration forces to the brain.

Missed or delayed diagnosis of mTBI is attributed to the subtlety of symptoms, the overlap of clinical signs and the common effects of heightened arousal and activity in times of combat, a lack of knowledge as to the specifics of diagnosis and detection, greater attention paid to more visible concomitant injuries, and a reduced subjective awareness related to cognitive deficits in the acute period on behalf of the injured service member.

At present, a definitive diagnosis of CTE is made on postmortem examination, using a battery of immunohistochemical markers to define pathognomonic histopathologic

Chronic traumatic encephalopathy (CTE) is a progressive and fatal brain disease that is associated with repeated traumatic brain injury (TBIs) including concussions and repeated blows to the head.

Brain Injuries Need Specialists

CTE can be said to resemble Alzheimer’s disease (AD)

Cognitively, CTE can be said to resemble Alzheimer’s disease (AD). However, CTE is not a degenerative disease like AD, but instead, it causes the brain to deteriorate over time. It is not yet known exactly what causes CTE. It is hypothesized that it could be due to repeated blows to the head.

What are the four stages of CTE?

CTE happens when the brain is not able to complete certain tasks that it should be able to do. It can happen if there is a stroke, a tumor, or a traumatic brain injury.

The four stages of CTE:

1. Mild (mild dementia), like Alzheimer’s disease
2. Moderate (moderate dementia), like Parkinson’s Disease
3. Severe (severe dementia), like Huntington’s disease
4. Chronic (chronic dementia), like ALS and frontotemporal dementia (FTD).

What are the early signs of CTE?

CTE (Chronic Traumatic Encephalopathy, or CTE) is a degenerative brain disease that can arise from multiple concussions. CTE is the leading cause of dementia and the most common cause of death in American football players who play at a professional level.

It usually affects their frontal lobes, causing memory problems and impaired reasoning, judgment, and personality. It can also affect other areas of the brain such as the hippocampus, which controls short-term memory.

It’s possible that mild TBI may cause people with CTE brain damage may show signs of another neurodegenerative disease, including Alzheimer’s disease, amyotrophic lateral sclerosis (ALS) — also known as Lou Gehrig’s disease — Parkinson’s disease or frontotemporal lobar degeneration (frontotemporal dementia). Repeated exposure to traumatic brain injury is thought to increase the risk of CTE

The symptoms of CTE are similar to those seen in Alzheimer’s disease (AD) but different enough for it to be considered its own condition. The long-term prognosis for players with CTE is unknown, but research has shown that no brain damage occurs after six months’ recovery from an injury to the brain.

example of brain with CTE

After two years of recovery, it doesn’t take long-term damage and no further cognitive impairment is seen unless there are repeated concussions in adulthood.

Neuropsychologic testing is the standard for monitoring cognitive recovery after a concussion.

However, two studies suggest that abnormalities in visual-motor and motor cortex function persist after neuropsychologic testing has normalized. These tests did not involve the medial temporal lobe.

Slower recovery in patients with a second concussion was also seen and additional history of multiple concussions demonstrated accelerated declines. Further head injury studies, not including head injury fatalities like that often occur in combat associated concussions led researchers to believe that even more studies are required.

Basic science research is also ongoing. Brain injury medicine experiments in concussed rats demonstrated prolonged abnormalities in metabolic markers of brain activity.

Is CTE a progressive degenerative condition?

CTE is a progressive degenerative condition resulting from repetitive brain trauma/chronic brain injury events. CTE can be diagnosed at any age. Diagnosis can be done via brain MRI.

Does CTE affect the brain in an even more severe way than Alzheimer’s?

There is little debate about whether or not CTE affects the brain in a severe way. Anecdotal evidence suggests that cognitive decline does not occur until the later stages of CTE, with some individuals showing signs of cognitive impairment early on. Is this true for all people?

The answer to this question depends on what type of dementia you’re interested in. Neurodegenerative disorders like Alzheimer’s disease is a progressive neurological disorder that impacts memory, thinking, and judgment.

CTE RHI Brain Trauma

In contrast, CTE does not affect thought or judgment; it can cause paralysis and other symptoms similar to those of Alzheimer’s disease but without the cognitive decline that occurs with Alzheimer’s disease.

So, if you want to know whether an individual has CTE or not (and what stage they are at), you need to look at different types of dementia such as frontotemporal dementia (FTD) (a progressive condition affecting memory and thinking), vascular dementia (which affects the brain’s blood supply), and non-focal non-progressive dementias (NFCDs) (a type of “mini-Alzheimer’s).

These conditions are often associated with neurodegenerative diseases such as Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis/Parkinsonism, Lou Gehrig’s disease/ALS/ALS, and multiple sclerosis/MS.)

When do CTE symptoms start?

There are four stages to the repetitive head injury syndrome. It is important to watch for early signs of CTE. The repetitive head injury syndrome symptoms show up at different times for the injured person. CTE currently has no cure.

It is unclear whether the risk of suicide is being changed.

There are several risk factors that make some people more vulnerable to developing CTE than others, including the age at which they were first exposed to the head, the number of years of exposure, and genetics.

Boxing and CTE

Other terms for the condition included chronic boxer encephalopathy, boxer traumatic encephalopathy, boxer dementia, pugilistic dementia, boxing-related chronic traumatic brain injury (CTBI-B), and blow-drunk syndrome.

A concussion occurs when a blow to the head or a sudden jerk shakes your head, causing brain movement in the bony and rigid skull. This doesn’t mean a handful of concussions. Most people diagnosed with CTE suffered hundreds or thousands of head bumps from contact sports or military service over many years.

The disease often worsens over time and can lead to dementia. For most patients, mild brain injuries do not require comprehensive rehabilitation, but they do require focal medical and rehabilitative treatment based on the individual’s clinical evaluation and diagnostic test results.

Symptoms of encephalopathy

Symptoms of encephalopathy may include behavior problems, mood disorders, and thinking problems. CTE is a diagnosis that is only made at autopsy by examining sections of the brain.

Fostering a safe gaming environment and strictly adhering to early detection and protecting high-risk subgroups from the additional impact on the head play an important role in minimizing CTE incidence.

The current recommendation for preventing CTE

The current recommendation for preventing CTE is to reduce mild traumatic brain injury and prevent additional injuries following a concussion. In the event of a severe head injury, many of the above treatments can be continued on an outpatient basis.

But most of the rehabilitation process is focused on reintegrating brain injury patients back into their home environment and community. I never thought that all these blows to the head might have something to do with my current situation.

Originally known as punch drunk syndrome and first documented in boxers in the 1920s, chronic traumatic encephalopathy (CTE) has become a well-known topic in the sports medicine community.

Chronic traumatic encephalopathy (CTE) was originally known as punch-drunk syndrome and was first documented in boxers in the 1920s

It has developed into a well-known topic in the sports medicine community. Neuron loss, brain tissue scarring, accumulation of protein-like senile plaques, hydrocephalus, weakening of the corpus callosum, diffuse axonal injury, neurofibrillar tangles, and cerebellum damage are associated with the syndrome.

A primary head injury can be catastrophic, but the effects of repetitive head injuries also need to be considered.

Repeated headbutts include not only headbutts that result in mild TBI or concussion, but also headbutts where the person does not feel any symptoms after a blow to the head.

Other factors include military, previous domestic violence, and repeated hitting of the head.

CTE has been found in individuals whose primary exposure to headbutts from soccer (over 500 cases confirmed at VA-BU-CLF Brain Bank), military (over 50 cases), hockey (over 30 cases), boxing (more than 20 cases, 50 worldwide), rugby (more than 10 cases), soccer (5+ cases, 20+ worldwide), pro wrestling (5+ cases) and, in fewer each than three cases of baseball, basketball, intimate partner violence and people with developmental disabilities who engaged in head-banging behavior.

mTBI mild traumatic brain injury

Make sure you give them a list of your symptoms, the severity and frequency of their occurrence, and the number and type of injuries. Symptoms often include:

  • fatigue

  • headaches

  • nausea

  • balance problems

  • dizziness

  • insomnia

  • vision problems

The dramatic difference in soccer has sparked a debate about equipment and rule changes in soccer, as it is known that a significant number of concussions occur when players hit the ball with their heads.

Most documented cases occurred in athletes with slightly repeated head butts (RHI) over a longer period of time.

The lack of or delayed diagnosis of MTBI will focus on the subtlety of symptoms, the overlap of clinical symptoms and the frequent effects of increased arousal and activity during combat periods, lack of knowledge of the specifics of diagnosis and detection, and increased attention to more visible accompanying injuries and decreased subjective awareness of cognitive deficits in the acute phase on behalf of the injured service member.

CTE symptoms don’t develop right after a head injury, but experts estimate they can develop over years or decades after repeated head trauma.


Some signs and symptoms of CTE are thought to include difficulty thinking (cognition) and emotions, physical problems, and other behaviors. CTE was found in the brains of people who played soccer and other contact sports such as boxing.

Reports have been published in recent years of neuropathologically confirmed CTE found in other athletes, including soccer and hockey players (playing and retired), and military veterans with repeated brain trauma in the past.

emotional pain causes physical pains

The symptoms alone don’t diagnose CTE and can be linked to many other disorders and health concerns.

These persistent symptoms negatively impact the patient’s daily activities such as postconcussion syndrome (PCS). Both post-concussion syndrome (PCS) and chronic traumatic encephalopathy (CTE) are considered neurological disorders that are long-term effects of a concussion (s).

Post-concussion syndrome can also affect the ability to live and enjoy life because the brain simply isn’t working properly. The

CTE usually starts gradually, several years after repeated blows to the head or repeated concussions.

The structure of tau in CTE is different from the accumulation of dew that occurs in Alzheimer’s disease and other forms of dementia.

However, in 10-15% of patients, symptoms persist for one year after concussion and mainly include headaches, fatigue, irritability, and cognitive problems (e.g. It is currently being investigated whether other brain imaging techniques can help diagnose CTE in the future.)

The brain degeneration is associated with common symptoms of CTE, including memory loss, confusion, poor judgment, impulse control problems, aggression, depression, suicidality, Parkinson’s, and possibly progressive dementia.

In the early years of life between the late 20s and early 30s, the first form of CTE can lead to mental health and behavioral problems such as depression, anxiety, impulsivity, and aggression.

Recent research by Christine Mac Donald, Ph.D. and associate professor at the Department of Neurological Surgery at the University of Washington, found that “80% of patients with concussion sought help with mental health problems within 5 years, BUT only 18% had a sustainable solution to their symptoms. Previously, it was thought that more than 80% of people would recover from a concussion within a year.



About The Author

Tiffany Dyar

Tiffany Dyar is the former Executive Director for The Center for Health Innovation & Implementation Science, and the former Program Manager at Regenstrief Institute.Tiffany has co-authored several medical publications including The American Journal of Critical Care  Journal of General Internal Medicine Trials Journal  Best Practices in Mental Health  & The New England Journal of Medicine

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