2 Neuroscience2.13 Neurodegeneration
2.13.8 Chronic traumatic encephalopathy
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Exposure and pathology
Chronic traumatic encephalopathy (CTE) is a neuropathological condition, meaning it is defined by changes in brain tissue. It is linked to repeated head impacts, including impacts that never led to a diagnosed concussion.
The characteristic lesion is abnormal phosphorylated tau in neurones around small blood vessels at the depths of the cortical sulci (the grooves between the brain's folds).
Exposure does not guarantee disease. The chance of CTE after a given history of head impacts is still uncertain.
A single concussion is not evidence that CTE will develop.
Terms to keep apart
Term | Meaning |
|---|---|
Concussion | An acute brain injury, diagnosed clinically, caused by biomechanical forces |
Persistent post-concussion symptoms | Symptoms that continue after the injury. Assess for causes that may be contributing |
CTE neuropathology | A specific diagnosis made on brain tissue, currently confirmed only after death |
Traumatic encephalopathy syndrome | Clinical criteria for research use, meant to describe a possible linked syndrome |
Clinical assessment
Cognitive, behavioural and mood symptoms after repeated impacts are nonspecific. Several treatable conditions can explain them.
Assess for depression, substance use, sleep disorders and other neurological disease rather than putting the symptoms down to CTE automatically.
No routine scan or blood test can currently confirm CTE in a living person. Research biomarkers are still being evaluated.
Brain-donation studies are open to selection bias. They cannot directly show how common CTE is among everyone who has been exposed.
In clinical care, address the person's symptoms, their function and their exposure history. Do not present an uncertain pathological explanation as if it were established.