#Charge syndrome and aggressive behavior series
3 Specifically, repetitive axonal perturbations caused by severe hits to the head may initiate a series of metabolic, ionic, membrane, and cytoskeletal disturbances that trigger a pathological cascade evidenced by extensive tau-immunoreactive inclusions scattered throughout the cerebral cortex. More recent research speculates that the syndrome can initiate a form of neurodegenerative tauopathy occurring years or decades following recovery from the acute or post-acute effects of head trauma. Martland 1 recognized the latent brain injury associated with this syndrome and attributed the long-term pathophysiological cascade to traumatic cerebral hemorrhage caused by “multiple concussion hemorrhages in the deeper portions of the cerebrum.” Half a century later, aided by advanced examination techniques, the syndrome’s late manifestations were linked to the formation of neurofibrillary tangles, 2 which are aggregates of hyperphosphorylated tau protein and considered a primary marker for Alzheimer’s disease. Since Martland’s original paper there has been an evolving understanding of the punch drunk syndrome as, primarily, a neurological condition with potential for long-term neurodegenerative effects. At the time of Martland’s publication, the syndrome was coined “punch drunk” in the boxing arena, as the condition could occur when a boxer, after a serious blow or repeated blows to his head, would appear disoriented as if he was drunk
Specifically, Martland identified several long-term physical and behavioral symptoms often associated with the syndrome, including speech problems, gait disorders, Parkinsonism, vertigo, cognitive confusion, neuroses and psychoses, or even mental deterioration to a level requiring psychiatric hospitalization. Martland 1 was among the first to describe a neuropsychiatric syndrome in which the individual, following a single blow or multiple blows to the head, presents as “’cuckoo,’ ‘goofy,’ ‘cutting paper dolls,’ or ‘slug nutty’.” Martland believed the syndrome was a result of one or more concussions, and that the severity of symptoms ranged from mild to severe mental and physical deterioration, and, in some cases, death.
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