Case Report

Chronic Traumatic Encephalopathy, Traumatic Encephalopathy Syndrome, Post-Concussion Syndrome, and the Therapeutic Potential of Hyperbaric Oxygen Therapy: A Comprehensive Case Study and Discussion

by Zemer Wang1*, Sherif Khairy1, Umair Qureshi1, Mouzayan Ginzarly1, Raghda Zaitoun1, Suzette Van Wyk1, Shai Efrati2,3

1Aviv-Clinics by DP world, JLT, Dubai, United Arab Emirates.

2Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Israel

3Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Israel.

*Corresponding author: Zemer (Semer) Wang, Aviv-Clinics by DP world, JLT, Dubai, United Arab Emirates.

Received Date: 07 December 2023

Accepted Date: 12 December 2023

Published Date: 14 December 2023

Citation: Wang Z, Khairy S, Qureshi U, Ginzarly M, Zaitoun R, et al. (2023) Chronic Traumatic Encephalopathy, Traumatic Encephalopathy Syndrome, Post-Concussion Syndrome, and the Therapeutic Potential of Hyperbaric Oxygen Therapy: A Comprehensive Case Study and Discussion. Ann Case Report 08: 1550.


Chronic Traumatic Encephalopathy (CTE), Traumatic Encephalopathy Syndrome (TES), and Post-Concussion Syndrome (PCS) are increasingly recognized as significant consequences of repetitive head trauma, spanning both contact sports and nonsports-related injuries. This article presents a compelling case study of a patient afflicted by these conditions, elucidates the differential diagnosis, and explores the therapeutic promise of the new protocols of Hyperbaric Oxygen Therapy (HBOT).

Our case centers on ‘FC,’ a 36-year-old former captain of the English rugby national team, whose retirement was precipitated by progressive neuro-cognitive decline. Drawing upon an array of diagnostic modalities, including metabolic brain imaging (SPECT), perfusion MRI+DTI, computerized neurocognitive assessments, and physical evaluations, we arrived at the diagnosis of TES. FC underwent HBOT protocol, proved effective for PCS, leading to the resolution of his symptoms and marked improvements in neurocognitive functions that correlated with enhancements in his brain SPECT and MRI.

In addition to the clinical case, this article illuminates the critical distinctions between CTE, TES, and PCS, emphasizing the significance of early diagnosis and methods for confirmation. Furthermore, it delves into the emerging frontier of Hyperbaric Oxygen Therapy as a potential treatment avenue for individuals grappling with TES, and PCS. We scrutinize the underlying physiological mechanisms of HBOT and its neuroplasticity effects, underpinned by recent research findings and promising outcomes from clinical trials.

Keywords: Hyperbaric Oxygen Therapy; HBO; HBOT; Traumatic Brain Injury; CTE; TES; Post-Concussion Syndrome; Sports Injuries.


Chronic Traumatic Encephalopathy (CTE) looms as a pressing concern for retired athletes from full-contact sports, such as rugby and American football [1]. While these sports are renowned for their intense physical demands and full-contact nature, in the context of rugby, the spotlight has primarily focused on the potential risks of recurrent Traumatic Brain Injuries (TBI) including its long-term consequence Post-Concussion Syndrome (PCS), with relatively less attention given to CTE. Both conditions share a critical commonality: the mechanism of action and the potential for long-term consequences. The primary distinction lies in CTE being a progressive neurodegenerative disease while PCS tends to be stable or to improve over time. A possible progression from PCS to CTE is being discussed [2].

A definitive diagnosis of CTE can only be obtained postmortem through autopsy [3]. To address the challenges in diagnosing CTE during an individual’s lifetime, the National Institute of Neurological Disorders and Stroke has developed clinical criteria for Traumatic Encephalopathy Syndrome (TES), a clinical disorder closely associated with CTE [4].

In this article, we present the case of a recently retired senior professional rugby player, formerly the captain of the UK national team, who exhibited symptoms suggesting CTE. This player underwent protocols of Hyperbaric Oxygen Therapy (HBOT), which have shown promise in treating PCS. Alongside the case presentation, we underscore the critical importance of raising awareness for the early diagnosis of TES and discuss the biological effects of the used HBOT protocol.

Case Presentation

A 36-year-old male, formerly the captain of the English rugby national team (with consent, hereafter referred to as ‘FC’), retired from professional rugby two years prior due to concerns about his cognitive health. Despite his retirement, FC’s cognitive challenges persisted to deteriorate and did not show any sign of improvement. Motivated by the potential benefits of Hyperbaric Oxygen Therapy (HBOT) for brain injuries, he sought medical evaluation at the AVIV hyperbaric clinic in Dubai.

Medical history: Over a twenty-year rugby career, FC sustained 20 documented concussions and numerous undocumented head injuries. Many of these went unreported due to their frequent occurrence. These repetitive traumas culminated in noticeable changes in FC’s cognitive function: memory lapses, heightened sound sensitivity, difficulty maintaining grip, stuttering, dizziness during rapid head movements, and mood changes. Even though he retired from professional sports, these symptoms intensified over time, leading him to seek potential therapeutic intervention.

Initial Evaluation: A thorough pre-HBOT evaluation encompassed:

  • A detailed physical assessment.
  • A computerized neurocognitive test (NeuroTraxTM & CANTAB®) administered by a neuropsychologist.
  • Advanced brain imaging, including MRI with perfusion and DTI, and a SPECT scan.

Physical examination revealed bilateral hematoma auris [5] and a mild horizontal nystagmus to the right. Brain MRI exhibited hyperintensities in both frontal and the right parietal regions, categorized as Fazekas grade 1 (Figure 1). The SPECT scan showed areas with reduced uptake, signifying decreased/altered brain metabolism in the frontal and parietal regions of the brain. Neurocognitive assessments identified significant impairments in focused and sustained attention, alongside reduced information processing speed.


Figure 1: Brain MRI exhibited hyperintensities in both frontal and the right parietal regions.

Intervention: FC underwent 60 HBOT sessions, performed daily, 5 days per week. Each session, lasting 90 minutes, exposing him to 100% oxygen at two atmospheres (2ATA), interspersed with 5-minute air breaks every 20 minutes.

Post-HBOT Evaluation: Following the HBOT protocol, the initial assessments were repeated and compared to the baseline tests with the following findings:

  • SPECT scan comparisons revealed evidence of enhanced uptake/activity in the previously affected brain regions and could determine improved uptake in areas related to facial recognition, written word meaning, attention, spatial memory, directionality, somatosensory integration, visuo-motor coordination, memory and control networks, language perception, processing and memory (Table 2).

Anatomical structure


After intervention

Change in %

Functional domain

Entorhinal Cortex Right




Spatial memory, directionality

Superior temporal gyrus Right





Medial temporal lobe, parahippocampus





Memory encoding and retrieval

Superior parietal lobule Right




Visuo-motor coordination

Transverse temporal lobe Right




Auditory processing

Medial temporal gyrus Right





Superior temporal gyrus Right




Auditory processing and language

Transverse temporal lobe Right




Auditory processing

Table 1: Perfusion MRI

  • MRI-perfusion scan showed marked improvements in the post-treatment MRI perfusion as compared to the baseline, in brain regions related to spatial memory, directionality, smell, memory encoding and retrieval, visuo-motor coordination, hearing and language processing (Figure 2, Table 1).