Journal of Clinical Neuroscience 42 (2017) 193–195

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Journal of Clinical Neuroscience

journal homepage: www.elsevier.com/locate/jocn

Short communication

Cleomedes of Astypalaea: A possible early sufferer of chronic traumatic

encephalopathy
Rodolfo Savica ⇑, Mario Roberto Vaz Carneiro Filho, Christopher J. Boes
Mayo Clinic, College of Medicine, Department of Neurology, 200 First Street SW, Rochester, MN 55905, United States

a r t i c l e i n f o a b s t r a c t

Article history: Dementia pugilistica was the term adopted by H. Martland in 1928 to identify boxers with cognitive
Received 26 January 2017 decline. In more recent years, the syndrome of dementia pugilistica with pathological correlates has been
Accepted 22 April 2017 defined as chronic traumatic encephalopathy (CTE). A number of sportsmen have been recently diag-
nosed with CTE; and we may have identified an ancient Greek athlete of pankration who presented with
the symptoms that have been associated with CTE. Our study reports the history and the known clinical
Keywords: information about Cleomedes of Astypalaea, possibly the first athlete ever affected by CTE.
Dementia pugilistica
Ó 2017 Elsevier Ltd. All rights reserved.
Chronic traumatic encephalopathy
Head trauma
History

Since the beginning of the last century, it has been noted that
repetitive head trauma (HT) associated with certain sports may
cause a progressive neurodegenerative disease later in life. The
first observation was reported in 1928 in boxers [1] described
by Martland and defined as ‘‘punch drunk”. Various labels were
used to identify this disease until the term ‘‘dementia pugilis-
tica” was adopted in the 1970s. [2] Over the subsequent decades,
it became more evident that the consequences of repetitive brain
injury were not limited only to boxing, but also to American
football, soccer, fighting sports, hockey, and other activities.
The term chronic traumatic encephalopathy (CTE) was coined
in 1949 [3]. The pathologic entity associated with repetitive HT
is now referred to as chronic traumatic encephalopathy [2].
CTE cannot be diagnosed with confidence in life, and may have
clinical features that resemble Alzheimer’s disease dementia
(AD), frontotemporal dementia (FTD), Parkinson’s disease (PD),
PD with dementia (PDD), and amyotrophic lateral sclerosis
(ALS) [4,5]. CTE pathology may cause early-onset neurodegener-
ative disorders. The immediate and late consequences of head
trauma were discussed and questioned in the original paper of
Martland [1].
Although Martland was the first to report this syndrome in
boxers, we believe that a description of ‘‘dementia pugilistica”
or ‘‘punch drunk” can be identified in Pausanias’ master-
piece Description of Greece (Ἑkkάdo1 peqiήcgri1), written
around 174 AD. Pausanias was a famous geographer and
traveler who lived from 110 to 180 AD. Description of Greece is
a 10-book-long work that describes Ancient Greece. Each
book describes a region of Greece; the books are not strictly
topographical and Pausanias took the liberty to tell stories and
myths from the areas. Although not completely accurate,
Description of Greece was used by archeologists to identify
remains.
Pausanias relayed several stories of Olympic athletes, who
were highly admired in Greek society. In book 6.9, he reported
the story of Cleomedes of Astypalaea, a citizen of one of the
Dodecanese islands. He was a pankratiast who, after killing his
opponent during the fight in the Olympic games of 406 BC,
started to have inappropriate behaviors that lead to loss of his
mind, a mass murder of sixty children, and death by possible
suicide.
These behaviors have been historically interpreted as punch
drunkenness [6]. We postulate that these symptoms may be equiv-
alent to what has been reported in some athletes exposed to mul-
tiple head traumas, leading to traumatic encephalopathy
syndrome with CTE pathological findings.

⇑ Corresponding author. Fax: +1 507 284 1516.

E-mail address: savica.rodolfo@mayo.edu (R. Savica).

http://dx.doi.org/10.1016/j.jocn.2017.04.040
0967-5868/Ó 2017 Elsevier Ltd. All rights reserved.
194 R. Savica et al. / Journal of Clinical Neuroscience 42 (2017) 193–195
Pausanias on Cleomedes of Astypalaea
. . .[6.9.6] At the Festival previous to this it is said that Cleo-
medes of Astypalaea killed Iccus of Epidaurus during a boxing-
match. On being convicted by the umpires of foul play and being
deprived of the prize he became mad through grief and returned
to Astypalaea. Attacking a school there of about sixty children he
pulled down the pillar which held up the roof.
[6.9.7] This fell upon the children, and Cleomedes, pelted with
stones by the citizens, took refuge in the sanctuary of Athena. He
entered a chest standing in the sanctuary and drew down the lid.
The Astypalaeans toiled in vain in their attempts to open the chest.
At last, however, they broke open the boards of the chest, but
found no Cleomedes, either alive or dead. So they sent envoys to
Delphi to ask what had happened to Cleomedes.
[6.9.8] The response given by the Pythian priestess was, they
say, as follows:
‘‘Last of heroes is Cleomedes of Astypalaea; Honor him with sac-
rifices as being no longer a mortal”.
So from this time have the Astypalaeans paid honors to Cleo-
medes as to a hero.
Translated by Jones [7].
3. Discussion
Cleomedes was a fighter of Pankration (from Greek: ‘‘total fight
or total war”), which represented the ancient version of mixed
martial arts; thus, he was involved in fights that required him to
master boxing and wrestling techniques. No weapons or inflicting
penetrating wounds were allowed. The fights did not have time
limits or rounds, and a win was determined by knock out or sub-
mission of the opponent. It is possible that Cleomedes was exposed
to multiple head traumas during training sessions. A fighter rou-
tinely trained or sparred for months or years before competing in
the main event.
Pausanias stated that Cleomedes killed his opponent Iccus dur-
ing the fight. Death during these fights was not a common or a
well-tolerated occurrence in ancient Greece. It was quite an excep-
tional event [6], and not accepted by the general public. Despite
winning he was disqualified and deprived of his prize. This latter
action was a serious consequence and a permanent sign of loss
of honor and respect; one of the worst actions that could be
inflicted on an athlete at that time.
After the fight, Cleomedes was mad and suffering of grief. He
may have had behavioral problems secondary to trauma before
the fight, such that he killed his opponent. It is possible that the
fight and disqualification worsened his symptoms by triggering
depression, lack of behavioral control, and destructive behaviors.
After he went back home to Astypalaea he committed an awful
crime. Pausanias does not offer a motive for the murders in his
text. Cleomedes killed 60 children by removing a column from a
school, highlighting his great strength. The citizens went to search
for him and were ready to stone him; however, he escaped and
went in the sanctuary of Athena were he may have committed sui-
cide by locking himself in a chest. Interestingly, they did not find
the body afterwards and when they asked the oracle of Delphi
about him, she mentioned that he was no longer a mortal. Pythian,
the oracle of Delphi, seemed to have a special affinity for the ath-
letes of that era [8] similar to the relationship that our society
has developed towards our athletes. Plutarch also reported the
story of Cleomedes of Astypalaea in Parallel Lives, reporting a slight
different version of the story. According to Plutarch he did not lose
his mind, but he was impulsive and violent as baseline; also, he
reported that he did not commit suicide, but with the help of Del-
phi was able to escape and avoid the punishment [9].
Although posthumous diagnosis is speculative and fraught with
danger, the authors have tried to be sensitive to historical context;
despite it is possible that Cleomedes has never existed and was
only a myth. However, the story of Cleomedes may represent the
clinical scenario that has been described in the last decades as ‘‘de-
mentia pugilistica”, and that more recently has been pathologically
correlated with tau protein deposition in the brain and called CTE.
Cleomedes may have been exposed to multiple head traumas, and
then had psychiatric symptoms that lead him to commit crime and
suicide at a young age. This scenario matches the current clinical
symptoms and signs of CTE (memory loss leading to dementia,
depression, psychosis, behavioral dyscontrol, parkinsonism, and
amyotrophic lateral sclerosis, at a younger age that expected)
[4,5]. On the other hand, we also consider that he may be affected
by other disorders such as acute mania. Although we do not know
the exact age of Cleomedes, we may assume he was not older than
30–35 years of age, considering the shorter average life-expectancy
at the time and the physical demands that were required to be an
Olympic fighter.
Unfortunately, we will never be able to have autopsy data or a
better description of symptoms, but we propose that Cleomedes
could have been one of the first athletes affected by the symptoms
of CTE.
Financial disclosure
Dr. Savica reports no disclosure
Dr. Vaz Carneiro Filho reports no disclosure
Dr. Boes reports no disclosure
Author contribution
Dr. Savica, Vaz Carneiro Filho – Study concept and design
Dr. Savica, Vaz Carneiro Filho – acquisition of data
Dr. Savica, Vaz Carneiro Filho, Boes – analysis and interpretation
 R. Savica et al. / Journal of Clinical Neuroscience 42 (2017) 193–195
Dr. Savica, Vaz Carneiro Filho, Boes – critical revision of the
manuscript for important intellectual content
Dr. Savica, Dr. Boes – study supervision
References
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