A leading Australian neurologist has warned of the dangers of head injuries from contact sports after Irish doctors reported the first known case of an amateur rugby union player developing a degenerative brain disease more commonly associated with boxers.
Chronic traumatic encephalopathy, CTE, often called punch-drunk syndrome, is a brain disorder that can develop in people with a history of concussions and head injuries. It can only be diagnosed during a postmortem.
People with CTE often display symptoms of dementia, including memory loss, aggression and confusion, years to decades after the concussions or head trauma. In the past ten years American footballers, military personnel and ice hockey players have been diagnosed with the condition.
Doctors have now described the first case of a man who played semi-professional rugby from his early teens until age 50, and was reported to have experienced countless concussions but none that required hospital visits.
Six years before he died he showed signs of memory loss, confusion and difficulties managing his successful business. After his death an autopsy and brain imaging revealed he had CTE.
In a review of the case published in the Quarterly Journal of Medicine, neuropathologist Michael Farrell and colleagues report that while this is the first case of CTE in an amateur rugby player, and only the second rugby player diagnosed overall, elite-level rugby had the highest incidence of concussion of any contact sport.
Tony Broe from Neuroscience Research Australia said it was now well established that concussions caused some degree of brain damage. Repetitive head injuries are a risk factor for degenerative brain diseases, he said.
While he cautioned that only a couple of rugby players had been diagnosed with CTE to date, he said greater awareness of the risks of head trauma from sport or other incidents such as car and workplace accidents and fights was needed.
"Every concussion causes brain damage and accumulative concussion causes CTE," he said.
World Rugby, previously the International Rugby Board, has acknowledged the risk of head injuries from playing the sport.
Recently they introduced programs that aimed to reduce players' exposure to head trauma during the game, improve concussion diagnosis and ensure injured players do not return to play until cleared by medical professionals.
Dr Farrell, from Beaumont Hospital in Dublin, said the condition was likely under-diagnosed because there was also limited awareness in medical clinics that the CTE occurred in athletes other than boxers.
