Why we can’t diagnose you with CTE

Repetitive head injury is a large concern, but a CTE diagnosis is a postmortem one

FootballCROPFORBLOGIt’s hard to miss all the news articles about CTE, the degenerative disease found in some former NFL players’ brains. Although it’s great that awareness of the dangers of repeated head trauma is up, we can’t diagnose you with CTE in our clinic. No other neurologist can, either.

That’s because CTE, or chronic traumatic encephalopathy, is pathologically diagnosed, not clinically. Translation: you can’t get a diagnosis while you’re still alive. Pathologists had to examine the brains of deceased former athletes to diagnose them with CTE.

So what happens in our clinic, Michigan NeuroSport, if you’re worried about possible long term consequences of repeated head injury and wonder if you have something you saw in the Will Smith movie “Concussion”?

Although we can’t diagnose you with CTE, we are very concerned about repeated head injuries but also recognize that other conditions could be causing your symptoms. It’s important for us to diagnosis these other medical conditions, because they often have effective treatment.  We care for our repetitive head trauma patients now, while we continue researching what could lead to CTE after death.

Neurologists have been concerned about the effects of repeated head trauma for many years, all the way back to the 1920s-30s when some boxers were said to have “punch-drunk syndrome” after too many hits.

Here are some symptoms we ask about in our patients who are concerned about repeated head trauma:

  • Memory problems
  • Sleep disturbances (like obstructive sleep apnea or insomnia)
  • Psychiatric disorders
  • Behavior changes
  • Headache or migraines
  • Substance abuse

If you’ve experienced some of the above symptoms for more than two years, have a history of repetitive head impacts, and the symptoms seem to be getting worse, that signals to us that we should  look into whether you fit our new criteria for TES.

TES, or traumatic encephalopathy syndrome, is something we’re clinically diagnosing instead of CTE. TES refers to a neurologic disease that worsens over time, and may occur as the result of repeated head trauma.  Symptoms of TES include difficulty with memory, emotional problems, behavioral changes, tremor, slowness, or difficulty with walking or speaking.

The first step is looking into, and if we find them, treating other causes of your symptoms.  We may suggest additional testing and will address all of the symptoms we are able to.  We find that medications for headache, treatment of sleep or mood problems, vestibular therapy if your balance is off or seeing a neuropsychologist for behavioral and memory changes can provide significant benefit.

Looking forward, we’re working to understand the long term consequences of repeated head trauma, and bring the diagnosis from under the microscope into the clinic.

Take the next step:

Matthew Lorincz (Matt Lorincz)

Matt Lorincz, M.D., Ph.D., is co-director of Michigan NeuroSport and associate professor of neurology. He completed his medical and graduate school training at Wayne State University, and his residency at the University of Michigan. Along with treating student athletes at all levels and in all sports, Lorincz is a team physician for the U.S. Ski Team, has provided neurological care at the NBA combine, and as neurologist for Eastern Michigan University and the University of Michigan athletes.