Neuropathologic “predecessors” to Chronic Traumatic Encephalopathy (CTE) ie. dementia pugilistica/punch drunk syndrome.

The first article with the term "Chronic Traumatic Encephalopathy" was a 1949 publication by Macdonald Critchley titled Punch Drunk syndromes: The Chronic Traumatic Encephalopathy of Boxers. Prior to the use of the term, which today has become fairly well known, repetitive brain injury was studied primarily in boxers and termed dementia pugilistica and punch drunk syndrome. This blog post will delve into dementia pugilistica/punch drunk syndrome to provide background information on the conditions such as those at risk, and clinical manifestations.

Dementia pugilistica/punch drunk was first introduced in medical literature by Dr. Harrison Martland in 1928. It is unknown who truly first coined the term "punch drunk", but it is suspected to be a layman (Critchley, 1956). As with every subject we have learned about in medical school, history of present illness is important in evaluating the extent of the disease. Punch drunk is more often found in fighters of what would be considered brawling type today, those who take a substantial amount of abuse in hopes of landing a haymaker that ends the fight (Martland, 1928). This is a fighting characteristic of lower caliber boxers as compared to the champion boxers who incorporate an intelligent component to their fights. A couple select populations at risk for punch drunkenness piqued my interest; boxers traveling with fairs who worked the boxing booth, taking on anyone, at any weight and boxers who resigned themselves to be sparring partners for championship heavyweights and would be knocked out several times a day (Critchley, 1956. Martland, 1928). Another interesting component, is the amount of matches that boxers had at this time in the early 20th century as well. One case study remarked on the 21 year career of an Algerian boxer who had competed in 310 bouts, winning 285 and never being knocked out (Lepreux, S. et al, 2015). For comparison, boxing legend Muhammad Ali participated in 61 bouts throughout his 21 year career.

Clinical manifestations varied widely. As a rule, gradual evolution of mental and physical anomalies marks the insidious onset of the encephalopathy (Critchley, 1956). Early symptoms present in the extremities with very slight flopping in the foot/leg with walking or a slight unsteadiness (Martland, 1928). Speech and thought slow with memory deterioration as well (Critchley, 1956). For example, the aforementioned Algerian boxer initially presented with memory issues and his wife noting loss of leisure and household chores that he once managed (Lepreux, S. et al, 2015). This boxer eventually disoriented at home, developed aggressiveness and was placed in a psychiatric hospital then institutionalized prior to his death.

Sources
Martland, Harrison S. "Punch Drunk."  Journal of the American Medical Association. 91.15 (1928): 1103. Web.
Critchley, Macdonald. "Medical Aspects of Boxing, Particularly from a Neurological Standpoint." Bmj 1.5015 (1957): 357-62. Web.
Lepreux, Sébastien, Sophie Auriacombe, Claude Vital, Bruno Dubois and Anne Vital. "Dementia Pugilistica: A Severe Tribute to a Career." Clinical Neuropathology 34.07 (2015): 193-98. Web.