Not Just Concussions — What You Need to Know About "Minor" Head Injuries and CTE

Boy heading soccer ball - possible CTE / Head injury

Not all that many years ago, people, especially athletes, who got concussions shrugged them off. "Got my bell rung," they might say, with a touch of pride at having taken the hit. Now, of course, we know that repeated concussions can lead to a serious brain disease: chronic traumatic encephalopathy, or CTE. In this disease, a protein known as Tau forms clumps. The clumps spread through the brain, slowly, killing brain cells in the process. The repeated concussions that have led to CTE (which can be conclusively diagnosed only on autopsy) often happen to football players and those in the military. Newer research suggests that it is not just concussions that lead to CTE; even repeated, "minor" head injuries can lead to CTE.

What is CTE?

Chronic traumatic encephalopathy (CTE) has been identified in people in their late teens, but usually, symptoms do not start to appear until at least a decade later, in the patient's twenties or thirties. Some of the first symptoms that emerge are changes in behavior and mood. Since this is also the time frame in which many mental illnesses first start to manifest, symptoms of CTE could be attributed to another disorder and mistreated. Common symptoms include depression, impulse control issues, paranoia, and aggression toward others.

As CTE progresses, cognitive symptoms may also begin to emerge. This typically happens later than the behavioral and mood symptoms described above. Cognitive changes due to CTE typically begin to appear in a patient's forties or fifties. They include confusion, difficulty with thought processes, memory problems including memory loss, and impaired judgment. Eventually, these symptoms may develop into progressive dementia.

With CTE, a patient's symptoms may be stable for years before getting worse, or may steadily get worse over time.

What is the Link Between Minor Head Injuries and CTE?

While the connection between repeated concussions and the development of CTE has been known for a few years, the link between minor head injuries and CTE is just coming to light. A study published in Brain, a neurology journal, makes a strong argument that even repeated blows to the head that don't result in concussion symptoms (loss of consciousness, confusion, dizziness, blurred vision, or headaches) can cause CTE.

Dr. Lee Goldstein, an associate professor of psychiatry at Boston University's School of Medicine, and the study's lead investigator, points out that researchers have suspected that so-called "subconcussive hits" might lead to CTE. He believes the study offers the first scientific evidence that this is really the case.

What do these subconcussive hits look like? Most of us have seen a football player take a hard hit on the field, only to jump to his feet a few seconds later, indicating his readiness to resume play. Until now, observers might think, "Okay, no concussion, he's fine." Goldstein's research suggests otherwise.

The study, took seven years and involved researchers from numerous prestigious institutions, including Boston University, Harvard Medical School, Lawrence Livermore National Laboratory, Ben-Gurion University of the Negev, and Oxford University. The researchers analyzed both human brains and experiments on laboratory mice that re-created the types of head injuries seen in humans. Goldstein said that pathologies associated with CTE were associated with even a small number of hits.

What Should My Doctor Do if I am at Risk for CTE?

As noted above, CTE is currently diagnosed by autopsy. However, researchers are currently working to develop diagnostic criteria for CTE so that doctors can spot the disease while there is still time to help the patient.

Those who take repeated hits to the head, such as football players, hockey players, soccer players, those in the military, and victims of domestic abuse are at higher risk for CTE. That said, having experienced repeated hits to the head or even multiple concussions does not mean that you will develop CTE. However, as the science in this area evolves, treatment should evolve with it, and doctors should be on the lookout for symptoms of CTE.

At this time, because understanding of CTE is just beginning to unfold and there is no reliable way to diagnose the disease, the standard of care is unclear. However, doctors should be held to account for their failure to adequately diagnose and treat concussion and subconcussive head injuries. Proper treatment of head injuries in which immediate damage is not apparent might help minimize problems in the future. Misdiagnosis or mistreatment could lead to exposure to more injury, especially before the original injury is healed.

If you believe that your concussion, or that of your child was misdiagnosed or mistreated, your doctor's failure could rise to the level of medical malpractice. To assess whether you have a claim. we invite you to contact our law office to talk to an experienced Oregon medical malpractice attorney.

Categories: Medical Malpractice