Chronic Traumatic Encephalopathy in a 24-year-old former soccer player (P6.165)

Objective: To present clinical and neuropathological features of chronic traumatic encephalopathy (CTE) in a young, former high school soccer player. Background: CTE is a neurodegenerative disease that currently only can be diagnosed neuropathologically. It is associated with exposure to repetitive head impacts (RHI), usually from contact sports. CTE has been observed in fewer than 10 soccer players, all of whom played semi-professionally or professionally. Design/Methods: As part of the Understanding Neurological Injury and Traumatic Encephalopathy (UNITE) Study, a panel of clinicians, blinded to neuropathology, makes clinical consensus diagnoses, based on detailed retrospective informant interviews, using published criteria, including proposed CTE clinical research criteria. Here, we present an instructive case of a 24-year-old former soccer player. Results: He played soccer from age 4 until his senior year of high school. He suffered approximately 20 concussions, of which 19 were soccer-related. In high school, he developed headaches and attentional difficulties. In college, he had intermittent depressive episodes, mild memory impairment and problematic substance use. He left college before graduating and lived with his parents. They observed angry outbursts, self-mutilation, passive suicidal ideation, poor decision making and ongoing substance use. He died from an accidental overdose. Panel members supported bipolar disorder as a primary diagnosis, and CTE and substance use disorder as possible contributing diagnoses. Neuropathological examination showed hyperphosphorylated tau containing neurofibrillary tangles and neurites around small blood vessels that were diagnostic of CTE based on NINDS/NIBIB neuropathological criteria. Conclusions: To our knowledge, this is the youngest soccer player diagnosed with CTE and the first case to have only played high school-level soccer. Although CTE should be considered in the differential diagnosis of a young adult with extensive RHI exposure and persistent mood and behavioral symptoms, prospective studies are needed before we can infer the likelihood of CTE in this setting. Disclosure: Dr. Phalen has nothing to disclose. Dr. Alosco has nothing to disclose. Dr. Kiernan has nothing to disclose. Dr. Montenigro has nothing to disclose. Dr. Solomon has nothing to disclose. Dr. Stern has received personal compensation for activities with Biogen, Avanir Pharmaceuticals, the NCAA, and Eli Lilly. Dr. Stern has received royalty payments from Psychological Assessment Resources, Inc. Dr. Stern has received research support from Avid Radiopharmaceuticals, Amarantus, Eisai, and Eli Lilly. Dr. Katz has nothing to disclose. Dr. McKee has nothing to disclose. Dr. Mez has nothing to disclose.