Thread by @TheNeuroTimes

A recent opinion published in Nature Reviews Neurology includes a "CTE" timeline which is sort of "truthy". So I'd like to offer a bit of historical comment on it: /thread

Let's start with the 1954 "first neuropathological description." This is undoubtedly a reference to Brandenburg and Hallervorden's 1954 classic paper. In it, the authors have no problem indicting repeated blows to the head as a cause. But is it the first?

Well that is tricky. Because of course Harrison Martland in 1928 did not note the tangle pathology associated with CTE. He did, however, do "neuropathology" when he classically described "Punch Drunk". Here's a picture included in his paper.

If noting the "tangle pathology" is what counts, then Martland was the first pathologist but not the first neuropathologist. You can decide.

Let's move on to the 1957 reference. This is a reference to Macdonald Critchley's famous essay establishing the tangle pathology in English language literature. Here's the citation:"Medical aspects of boxing, particularly from a neurological standpoint." BMJ 1, no. 5015 (1957).

It is true that Critchley used the expression "chronic traumatic encephalopathy" in this publication. But it was not the first usage. The first usage I have identified appears in Bowman and Blau's essay "Psychotic States Following Head and Brain Injury in Adults and Children."

That essay appeared in an edited book entitled "Injuries of the Brain and Spinal Cord". My edition is 1949 - and that was the 3rd edition. The 1st appeared in 1940

Does it matter? Priority is aways a problem in the history of science and medicine. So it probably doesn't matter per se. But now we have two data points in a chronology of CTE that are sort of accurate, sort of not accurate. Is this pointing in a worrying direction?

I have a meeting now. But I'll be back in an hour to finish this thread. Stand by.

Back as promised. Let's look at the 1973 paper (see the picture). This description is largely accurate. Corsellis certainly does note a distinct specific pathology. But notice what he terms it: "Alzheimer's neurofibrillary tangles". This comment is line with Critchley 1957.

In other words, the timeline seems to imply that Corsellis was claiming a distinct type of neuropathology. He wasn't per se. Instead he was noting (as Critchley had before him) a pathology characteristic of senility of the Alzheimer's form.

In the 1973 paper, Corsellis did note that there was "a tendency for neurofibillary tangles to occur in the absence of senile plaques" (p. 289). It is this point, that the timeline is presumably focused upon.

But it is important to see that Corsellis et al's information about brain damage in the brain was far more extensive than simply this one observation. Indeed, the 1973 paper made note of some individuals with Alzheimer's plaques. Corsellis' table below is quite exacting.

Notice, moreover, that Corsellis was offering a yet broader point in his study about the occurrence of Alzheimer's disease and its relationship to brain trauma. Look here, for instance, at what he has to say about evidence of a connection between blows to the head and dementia.

That's important. Because the 1990 paper, the last one I'll focus on here, is presented as calling into question Corsellis' findings. Here's what the timeline says:

The problem is that the 1990 paper doesn't set out to critique Corsellis - far from it in fact. The authors are quite explicit that they see reasons for concern that DP and AD share similar pathogenic mechanisms.

Why are Roberts et al concerned? In the paper, it is clear that they are hoping that analysis of CTE can help understand the pathogenesis of AD. Here's what they say:

In other words, they are saying that blunt force trauma to the head results in multiple pathological processes. It doesn't call CTE into question. It doesn't call AD into question. It doesn't call trauma as a cause into question. It agrees in short with Corsellis 1973.

This thread is an analysis of four data points in one image. Each one has been found wanting in accuracy. The whole opinion perspective contains similarly artful truthiness throughout. But does it matter beyond historical pedantry?Perhaps every review has to be like this?

I don't know the answer. As an historian of medicine, I find the representation of the historical record diminishing of the work of science and medicine. But largely the review and the literature it cites (no matter how accurately) do lead to a similar conclusion.

Don't get hit in the head. End/