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Concussion and CTE by Dr. Zach

BT Montreal | posted Wednesday, Sep 27th, 2017

By Dr Zach Levine, ER physician MUHC


Background – Aaron Hernandez found to have grade 3 (of 4) CTE at the age of 27

Numerous other players have had CTE (bob probert hockey, junior seau football)


Sports with head contact — hockey, soccer, football, basketball (can have collisions), cycling (falls)

Sports are good for fun, relaxation, health, fitness, sense of achievement


ER visits for concussions have increased 60% over the past 10 years



What is CTE?

(used to be called demetia pugilistica or punch drunk syndrome, discovered in boxers)

Chornic traumatic encephalopathy.

Symptoms — memory loss, confusion, aggression, suicidality.

  • Difficulty thinking (cognitive impairment)
  • Impulsive behavior.
  • Depression or apathy.
  • Short-term memory loss.
  • Difficulty planning and carrying out tasks (executive function)
  • Emotional instability.
  • Substance abuse.
  • Suicidal thoughts or behavior.

So mood changes, thinking problems, memory loss


Diagnosed only on autopsy.  Buildup of tau protein in brain.

Caused by recurrent hits to head, symptomatic and not

Onset in the 40’s (much earlier than dementia, which has similar symptoms)


What is concussion?

Blow to the head that causes symptoms.  Not need to have LOC.

Concussion symptoms:

blurred/double vision



Sleep probs


Memory problems

Difficulty concentrating

Somatic (h/a), cognitive, and emotional symptoms


Get off the field.  Evaluation with SCAT5.

Rest 24-48 hours.  Then gradual activity, mental then physical, below symptom threshold


What is the relationship between CTE and Concussion?  Recurrent hits to the head cause CTE.  Not necessarily concusions.  Also not all people with multiple head hits or concussions will get CTE


The earlier one starts to get head injuries, the worse the outcome


Kids concussions and QC contact sport:


Kids concussions — big head thin skull, weak neck muscles, poor technique (use forehead where skull is thickest) all contribute.  Also less myelinated (and protected) nerve cells.


Girls get concussed as much if not more than boys (but less play football)


Takes longer to heal with subsequent concussions


NFL players have significantly higher risk of Alzheimer’s, ALS


Contact in sports in QC:

In QC hockey hitting starts at bantam (age 13-15) double letters


Football always has contact


The U.S. Soccer Federation has banned heading the ball in youth soccer for players under 10 years of age after a class action lawsuit revolving around concussions.

The federation also restricted heading the ball for players aged 11–13; they are allowed to head in practice sessions, but not in games.

The Canadian Paediatric Society has warned against heading in youth games


Helmets:  Helmets are good at preventing skull fractures, which is what they were made to do.


Risk factors for concussion:


Learning disabilities

Attention disorder

Migraine headache


What do you recommend for kids who play sports?


Consider having kids with risk factors not play contact sports

General Recommendations:

(Dr. Robert Cantu, sports med expert)

No contact sports until 14

No heading in soccer until 14

No head first sliding in bball


Need to teach proper body checking, heading technique in soccer, tackling in football


Individualize decision on contact sports — which sport, has child had prev concussions


Credit to Dr. Scott Delaney, top Quebec sport-related brain injury expert


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