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Chronic Traumatic Brain Injury

The long-term sequelae of multiple concussive events remain unclear. In boxers, dementia puglistica or punch drunk syndrome, which includes a pattern of ataxia, pyramidal tract dysfunction, tremor, impaired memory, dysarthria, and behavioral changes, has long been recognized as a result of the cumulative effects of concussions.

More recently, the term chronic traumatic brain injury (CTBI) has been applied to the long-term neurologic consequences of repetitive concussive and subconcussive blows to the brain. The proposed symptoms of CTBI include decreased processing speed, short-term memory impairment, concentration deficit, irritability or depression, fatigue and sleep disturbance, a general feeling of fogginess, and academic difficulties.

Although CTBI has been described primarily in boxers, with up to 17% of retired fighters exhibiting symptoms, more subtle forms of CTBI may be seen after repetitive MTBI from other sports. Recent studies have implicated repeated concussions in cognitive impairments among college football players.

In addition, diminished neuropsychological functioning has been seen in amateur soccer players suffering from multiple concussions. Two studies have demonstrated a cumulative effect of concussion on neuropsychological performance.

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