Bushra Majid  ( Dow Medical College, Karachi. Pakistan )
Zainab Majid  ( Dow Medical College, Karachi. Pakistan )
Faryal Tahir  ( Dow Medical College, Karachi. Pakistan )

Dear Madam, Bennet Omalu's famous autopsy on National Football League (NFL) player Mike Webster, opened doors to Chronic Traumatic Encephalopathy (CTE).¹ Initially defined by Critchley in 1949, CTE is a progressive neurodegeneration that results predominantly from a taupathy following repeated traumatic brain injury. It is characterized by cognitive, behavioural, mood dysfunction and motor symptoms. ² Described for the first time to occur in boxers, people involved in contact sports like football, rugby, soccer and ice hockey, or even military combatants are also at a risk, the latter especially if they had been subjec ted to blast induced injuries. ¹ While several studies have proven CTE to be the consequence of repeated blows to head, the real dilemma arises whether people who have suffered even a single hit can unknowingly be at risk. Our understanding about CTE is insufficient, hence it is not clear whether the frequency, type and severity of injury may have a cumulative effect on the development and course of progression of CTE. ² But a recent study by Pischiutta Fetal 3 has revealed that mice exposed to a single severe traumatic brain injury demonstrated pathological changes in their brain not only on the affected side but also on the contralateral hemisphere that correlated with the sensorimotor and cognitive deficits, one year following the injury. ³ Mild traumatic brain trauma is extremely common yet severely under-reported, majority cases being a consequence of falls or motor vehicle collisions. ⁴ In the current era, where road traffic accidents are on the rise and incidents of domestic violence, physical assaults, and explosions are frequently witnessed worldwide, we are unaware of the accurate proportion of the vulnerable population to developing CTE. ¹ Hay et.al⁵have supported this notion stating that the reason we don't know if a single traumatic brain injury may lead to CTE is because there has been no study to compare and validate this. ⁵Pischiutta's study can provide an insight not only for future research but possibly to validate the importance of screening modalities like magnetic resonance imaging (MRI) for early detection of pathology in high risk groups. Measures need to be taken to address the population in danger and to spread awareness to prevent such accidents that may cause a blow to the head as currently prevention seems a realistic approach to minimize if not halt the longterm implications of a head trauma that may not be a selflimiting event after all.

Disclaimer: None to declare.

Conflict of Interest: None to declare.

Funding Sources: None to declare.

References

1. Steiger B. Meet Bennet Omalu, MD: the physician leader whose research inspired the movie concussion. Physician Leadersh J. 2016; 3: 8-10.
2. Aldag M, Armstrong RC, Bandak F, Bellgowan PS, Bentley T, Biggerstaff S et al. The biological basis of chronic traumatic encephalopathy following blast injury: a literature review. J Neurotrauma. 2017; 1: 1-26.

3. Pischiutta F, Micotti E, Hay JR, Marongiu I, Sammali E, Tolomeo D et al. Single severe traumatic brain injury produces progressive pathology with ongoing contralateral white matter damage one year after injury. Exp Neurol. 2018; 1: 167-78.

4. Gardner RC, Yaffe K. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Mol Cell Neurosci. 2015; 1: 75-80.

5. Hay J, Johnson VE, Smith DH, Stewart W. Chronic traumatic encephalopathy: the neuropathological legacy of traumatic brain injury. Annu Rev Pathol: Mechanisms of Disease. 2016; 23: 21-45.

doi: 10.5455/JPMA.36521.