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The subject of brain injury in American football has never been more controversial. For 15 years, the National Football League (NFL) denied any link between football and brain injury or chronic traumatic encephalopathy. It supported this claim with research performed by an NFL appointed committee, which contradicted that of independent researchers. Despite this long history of denial, the NFL recently settled (for $870m (£578m; €822m)) a legal case filed by former players who claimed their neurological deficits were from playing football.1 It remains unclear whether this was an admission by NFL that football can lead to chronic traumatic encephalopathy or other brain injury or a public relations response to an overwhelming media reaction to deaths of prominent retired football players and a perceived lack of concern for retired NFL players and their families. What is clear is that more research is needed to determine how athletes develop brain injury and whether strategies could protect them.
Chronic traumatic encephalopathy (CTE) was first described in American football players (figure 1) as a progressive neurodegenerative syndrome leading to neuronal loss coupled with protein and plaque deposits in the brain as …