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April 06, 2021; 96 (14) ArticleOpen Access

Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players

Nicole Schwab, Richard Wennberg, Karl Grenier, Carmela Tartaglia, Charles Tator, View ORCID ProfileLili-Naz Hazrati
First published February 24, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011668
Nicole Schwab
From the Department of Laboratory Medicine and Pathobiology (N.S., K.G.), University of Toronto; Toronto Western Hospital Krembil Brain Institute (R.W., C. Tartaglia, C. Tator), Canadian Concussion Centre; Divisions of Neurology (R.W., C. Tartaglia) and Neurosurgery (C. Tator), University Health Network Toronto Western Hospital; The Hospital for Sick Children (L.-N.H.), Pathology; and Canadian Concussion Centre (L.-N.H.), Toronto, Ontario, Canada.
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Richard Wennberg
From the Department of Laboratory Medicine and Pathobiology (N.S., K.G.), University of Toronto; Toronto Western Hospital Krembil Brain Institute (R.W., C. Tartaglia, C. Tator), Canadian Concussion Centre; Divisions of Neurology (R.W., C. Tartaglia) and Neurosurgery (C. Tator), University Health Network Toronto Western Hospital; The Hospital for Sick Children (L.-N.H.), Pathology; and Canadian Concussion Centre (L.-N.H.), Toronto, Ontario, Canada.
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Karl Grenier
From the Department of Laboratory Medicine and Pathobiology (N.S., K.G.), University of Toronto; Toronto Western Hospital Krembil Brain Institute (R.W., C. Tartaglia, C. Tator), Canadian Concussion Centre; Divisions of Neurology (R.W., C. Tartaglia) and Neurosurgery (C. Tator), University Health Network Toronto Western Hospital; The Hospital for Sick Children (L.-N.H.), Pathology; and Canadian Concussion Centre (L.-N.H.), Toronto, Ontario, Canada.
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Carmela Tartaglia
From the Department of Laboratory Medicine and Pathobiology (N.S., K.G.), University of Toronto; Toronto Western Hospital Krembil Brain Institute (R.W., C. Tartaglia, C. Tator), Canadian Concussion Centre; Divisions of Neurology (R.W., C. Tartaglia) and Neurosurgery (C. Tator), University Health Network Toronto Western Hospital; The Hospital for Sick Children (L.-N.H.), Pathology; and Canadian Concussion Centre (L.-N.H.), Toronto, Ontario, Canada.
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Charles Tator
From the Department of Laboratory Medicine and Pathobiology (N.S., K.G.), University of Toronto; Toronto Western Hospital Krembil Brain Institute (R.W., C. Tartaglia, C. Tator), Canadian Concussion Centre; Divisions of Neurology (R.W., C. Tartaglia) and Neurosurgery (C. Tator), University Health Network Toronto Western Hospital; The Hospital for Sick Children (L.-N.H.), Pathology; and Canadian Concussion Centre (L.-N.H.), Toronto, Ontario, Canada.
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Lili-Naz Hazrati
From the Department of Laboratory Medicine and Pathobiology (N.S., K.G.), University of Toronto; Toronto Western Hospital Krembil Brain Institute (R.W., C. Tartaglia, C. Tator), Canadian Concussion Centre; Divisions of Neurology (R.W., C. Tartaglia) and Neurosurgery (C. Tator), University Health Network Toronto Western Hospital; The Hospital for Sick Children (L.-N.H.), Pathology; and Canadian Concussion Centre (L.-N.H.), Toronto, Ontario, Canada.
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  • ORCID record for Lili-Naz Hazrati
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Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players
Nicole Schwab, Richard Wennberg, Karl Grenier, Carmela Tartaglia, Charles Tator, Lili-Naz Hazrati
Neurology Apr 2021, 96 (14) e1835-e1843; DOI: 10.1212/WNL.0000000000011668

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    Figure 1 Neuropathologic Changes in Cases With Isolated Chronic Traumatic Encephalopathy

    (A) Luxol fast blue and hematoxylin-eosin–stained section from superior frontal gyrus used for phospho-tau (p-tau) distribution study. (B and C) Low- and high-power microscopic photos of 1 depth of sulcus perivascular p-tau deposit. High-power photo (C) shows tau-positive tangles in pyramidal-shaped neurons and positivity in astrocytes (smaller cells) and background neuropil around a vessels (*). (D and E) More extensive pathology in the depth of the sulcus and additional subpial tau deposit. (F) Some of the pathologic changes overlap with ARTAG. Scale bar in the top right corner represents 0.5 cm in panel A; 0.1 cm in panel B; 0.03 cm in panels C, E, and F; and 0.05 cm in panel D.

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    Figure 2 Neuropathologic Changes in More Advanced Cases of Chronic Traumatic Encephalopathy

    Widespread cortical tau deposits in superficial cortical layers and involving both gyri and sulci in a continuous pattern. Some of the superficial cortical pathology can be focal and involve the crown of the gyri with widespread white matter punctate tau deposits in the (B and D) white matter and (C) subventricular areas. Other concomitant pathologies are α-synuclein deposits in the shape of Lewy bodies and neurites as depicted in the (E) cingulate cortex and (F) TAR DNA-binding protein 43 deposits as shown in the dentate gyrus. Scale bar in the top left corner represents 0.1 cm in panels A and B and 0.01 cm in panels C–F.

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Disputes & Debates: Rapid online correspondence

  • Author Response: Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players
    • Richard Wennberg, Neurology, University of Toronto
    • Nicole Schwab, Laboratory Medicine and Pathobiology, University of Toronto
    • Lili-Naz Hazrati, Laboratory Medicine and Pathobiology, University of Toronto
    Submitted March 23, 2021
  • Author Response: Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players
    • Richard Wennberg, Neurology, University of Toronto
    • Nicole Schwab, Laboratory Medicine and Pathobiology, University of Toronto
    • Lili-Naz Hazrati, Laboratory Medicine and Pathobiology, University of Toronto
    Submitted March 21, 2021
  • Reader Response: Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players
    • Kristen Dams-O'Connor, Professor of Rehabilitation Medicine and Neurology, Director of Brain Injury Research, Icahn School of Medicine at Mount Sinai
    Submitted February 28, 2021
  • Reader Response: Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players
    • Jesse Mez, Associate Professor of Neurology, Boston University School of Medicine
    • Michael L Alosco, Associate Professor of Neurology, Boston University School of Medicine
    • Christopher J Nowinski, Co-Founder & CEO, Concussion Legacy Foundation
    • Ann C McKee, Professor of Neurology and Pathology, Boston University School of Medicine
    • Yorghos Tripodis, Associate Professor of Biostatistics, Boston University School of Public Health
    Submitted February 27, 2021
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