There is increased concern regarding the prevalence of chronic traumatic encephalopathy [5] following repeated head impact exposure in a variety of sports [2, 4, 6, 7] and the military [3] but the existence in other populations is unknown. We present the first-confirmed case of a professional bull rider with CTE. Following sustainment of at least 15 head injuries over a 10-year period confirmed by collateral sources, records review, and ante-mortem imaging studies, the majority witnessed and documented on videotape, he committed suicide. Unique to this case, we performed imaging-guided brain tissue sampling for neuropathological investigation. This approach may provide for more focused tissue sampling that is sensitive and flexible to the heterogeneity of brain injury complementing standard neuropathological evaluation strategies.

Past medical history identified first-diagnosed concussion at age 16 with confirmed loss of consciousness (LOC) and additional exposures approximately biennially until age 21 when he sustained five head injuries over the course of a 12-month period. Each incident involved LOC for minutes followed by disorientation, confusion, ocular disturbance including photophobia, and periods of anterograde amnesia lasting hours to days. The decedent was evaluated by onsite medical personnel and/or admitted to a hospital for observation with radiographic CT examination, noted as unremarkable each time. At age 23, he sustained a blow to the head after being stepped on by a rearing bull crushing his helmet with LOC for 1 h, meeting criteria for moderate brain injury