创伤性脑损伤后认知障碍的MRI研究进展

创伤性脑损伤(traumatic brain injury,TBI)后可有一系列并发症发生,认知障碍是最常见、最持久的并发症之一。目前关于TBI后认知障碍的临床诊断大多停留在应用神经心理学的方法,缺乏认知障碍发生的客观结构改变证据,从而影响了TBI后认知障碍的早期诊断、治疗方案确定及预后评价。近年来,随着影像技术尤其是磁共振成像(magnetic resonance imaging,MRI)新序列的研发,多种新兴、无创MRI新序列可以清晰显示全脑的微细结构并可构建出脑网络结构。笔者通过阅读大量文献总结了各种MRI新技术在评价TBI后认知障碍发生的研究进展。     

超急性期轻度脑外伤患者静息态功能性磁共振成像研究

目的利用静息态功能磁共振成像(resting-state functional magnetic resonance imaging,rs-f MRI)低频振幅(amplitude of low-frequency fluctuation,ALFF)探讨超急性期(24 h)轻度脑外伤(mild traumatic brain injury,m TBI)患者脑功能的异常变化。材料与方法选取符合纳入标准的52例m TBI患者(m TBI组)及与之相匹配的21名健康者(对照组)行rs-f MRI扫描,并应用静息态脑功能数据辅助处理(data processing assistant for resting state f MRI,DPARSF)软件进行预处理,对2组的ALFF进行对比分析。结果与健康对照组相比,ALFF显著减低的区域有小脑后叶、右枕叶中回及中央后回;ALFF显著增高的区域有双侧额叶、内侧前额叶、双侧尾状核及岛叶。结论在常规磁共振成像无异常发现的情况下,ALFF技术可以更好地发现m TBI患者超急性期静息态脑功能的异常。     

多学科合作下救治1例重型颅脑损伤合并肺挫伤患者的护理

正颅脑损伤(traumatic brain injury,TBI)是指由于外力导致脑组织发生功能障碍或病理改变的一类疾病。通常重型颅脑损伤(severe traumatic brain injury,STBI)是指格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)[1]为3~8分,伤后昏迷6 h以上或在伤后24 h内意识情况恶化再次昏迷6h以上者[2]。据报道,STBI     

促血管生成可能是脑外伤治疗的新策略

创伤性颅脑损伤(traumatic brain injury,TBI)的社会危害严重,但国际上尚缺乏公认有效的治疗TBI的药物或方法,亟需加强研究。TBI或者其他机制导致脑损伤的关键病理损伤是血管损伤,血管损伤可导致出血、缺血,而出血或缺血可导致脑水肿,继而引起缺血缺氧。这些破坏性因素可诱导血管生成,进而增加损     

干细胞移植治疗创伤性脑外伤的研究进展

正创伤性脑外伤(traumatic brain injury,TBI)是临床上常发生的一种因头部被撞击、突然加速或者突然减速等机械力造成的脑部损伤疾病。TBI主要表现为平衡能力和协调能力差,此外TBI患者多出现学习认知能力、记忆能力和情感障碍。近年来,神经外科学的飞速发展极大地提高了颅脑损伤患者术后成活率。但是大部分脑损伤幸存者都会存在严     

重症颅脑损伤后意识障碍的精准康复

<正>1颅脑损伤颅脑损伤(traumatic brain injury,TBI)是外界暴力直接或间接作用于头部所造成的损伤,是世界上年轻人致死致残的首要因素~([1]),尤其在发展中国家,由于交通事故增多,TBI的发生率呈现逐年上升的趋势~([2])。而随着社会人口老龄化,因跌倒和其他意外事故导致TBI的老年人也逐渐成为新的患者群体~([3])。我国是TBI的高发地区,就中国颅脑损伤资料库初步统计结果显示,中国重症颅     

颅脑损伤后垂体功能减退的研究进展

人们在80多年前就认识到了创伤后垂体功能减退症(post-traumatic hypopituitarism,PTHP),但是认为PTHP很少发生.最近的临床研究证实,颅脑损伤(traumatic brain injury,TBI)可能经常引起下丘脑-垂体功能障碍,可能导致恢复延迟或阻碍TBI的恢复[1-5].     

脑干听觉诱发电位对重型颅脑损伤患者预后评估的meta分析

国内流行病学调查显示,颅脑损伤(traumatic brain inju-ry,TBI)发生率为0.03％,其中中重度颅脑损伤患者占总数的26％,其死亡比例高达0.05％[1].而重型TBI患者多伴随意识障碍,大多数在长期治疗后转变为持续性植物状态甚至死亡,对患者家庭和社会产生巨大的精神和经济负担[2].因此,选择一种...     

神经干细胞移植治疗创伤性颅脑损伤的研究进展

创伤性颅脑损伤(traumatic brain injury,TBI)目前仍是威胁人类生命的主要伤病之一.国内外神经外科和创伤外科医护工作者经过不懈努力,对颅脑创伤发病机制的认识已不断深入,临床治疗药物不断增加,外科手术方法有所改进,重症监测条件和护理水平逐步提高,TBI的基础研究和临床防治应用研究取得了一定进展.     

早期康复护理对重型颅脑损伤患者综合功能的影响

近年来,交通事故和各种意外伤害引起的颅脑损伤(traumatic brain injury,TBI)已成为人们致死、致残的一个重要原因。本研究采用病例对照研究,探讨早期综合性康复护理对重型TBI患者运动认知综合功能的影响,以总结有利于TBI患者早日全面康复的护理方法,提高患者的生活质量,现报道     

结构和功能MRI预测脑震荡后综合征的研究进展

轻度创伤性脑损伤(mild traumatic brain injury,mTBI)是脑损伤最常见的类型,mTBI发生后患者有短暂的意识丧失、失忆及精神状态改变。大部分患者的症状在短期内恢复,部分患者的不适症状持续存在,发展为脑震荡后综合征(post-concussion syndrome,PCS)。PCS的出现严重影响患者的日常工作和生活,但目前PCS的病理生理机制尚不明确。随着先进的MRI技术的发展,越来越多的研究探索mTBI的脑微观结构和功能改变,探讨PCS的发生机制并对其进行预测。笔者从脑结构和功能MRI对mTBI的异常发现进行综述。     

脑震荡后综合征MRI研究进展

轻度脑外伤（mTBI）是临床常见病,部分患者伤后数月或数年仍存在持久的脑震荡后综合征（PCS）。早期识别高PCS风险患者、评估mTBI伤情及监测预后已成为当代医学的重点难题之一。随着MR性能的不断提高和设备的普及,新技术如弥散峰度成像、动脉自旋标记成像、磁敏感加权成像及静息态功能MRI等可用于分析脑微观结构和功能变化,从而提高对mTBI的认识。本文对PCS的MRI诊断进展进行综述。     

磁共振扩散张量成像对轻型颅脑损伤患者评价的临床应用

目的通过核磁共振扩散张量成像(diffusion tensor imaging,DTI)评估轻型颅脑损伤患者颅内损伤情况,探讨DTI在轻型颅脑损伤患者诊断中的应用价值。材料与方法收集CT检查未见出血及骨折的轻型颅脑损伤患者30人,正常对照组30人。在受伤后7天内,行头部MRI检查,并在行头MRI检查当天用Rivermead脑震荡后综合征评估表进行评分。结果轻型颅脑损伤组Rivermead脑震荡后综合征评分高于对照组。轻型颅脑损伤组FA值升高区域有:右侧小脑半球、右侧枕叶及小脑山坡,舌回,右侧额下回的三角部,楔前叶灰质。轻型颅脑损伤组FA值降低区域有:视辐射,大脑脚,右侧胼胝体膝,左侧胼胝体膝,右侧额中回下白质,中央前回下白质。结论轻型颅脑损伤患者存在器质性颅内改变。扩散张量成像对于轻型颅脑损伤造成的颅内病变非常敏感,可以为临床诊断轻型颅脑损伤提供参考依据,并为判断轻型颅脑损伤预后提供一定帮助。     

Diffuse and spatially variable white matter disruptions are associated with blast-related mild traumatic brain injury

Mild traumatic brain injury (mTBI) due to explosive blast is common among military service members and often associated with long term psychological and cognitive disruptions. Little is known about the neurological effects of blast-related mTBI and whether they differ from those of civilian, non-blast mTBI. Given that brain damage from blasts may be diffuse and heterogeneous, we tested the hypothesis that blast mTBI is associated with subtle white matter disruptions in the brain that are spatially inconsistent across individuals. We used diffusion tensor imaging to examine white matter integrity, as quantified by fractional anisotropy (FA), in a group of American military service members with (n = 25) or without (n = 33) blast-related mTBI who had been deployed as part of Operation Iraqi Freedom or Operation Enduring Freedom. History of civilian non-blast mTBI was equally common across groups, which enabled testing of both blast and non-blast mTBI effects on measures sensitive to (1) concentrated, spatially consistent (average FA within a region of interest [ROI]), (2) concentrated, spatially variable (number of ROIs with low average FA), and (3) diffuse (number of voxels with low FA) disruptions of white matter integrity. Blast mTBI was associated with a diffuse, global pattern of lower white matter integrity, and this pattern was not affected by previous civilian mTBI. Neither type of mTBI had an effect on the measures sensitive to more concentrated and spatially consistent white matter disruptions. Additionally, individuals with more than one blast mTBI tended to have a larger number of low FA voxels than individuals with a single blast injury. These results indicate that blast mTBI is associated with disrupted integrity of several white matter tracts, and that these disruptions are diluted by averaging across the large number of voxels within an ROI. The reported pattern of effects supports the conclusion that the neurological effects of blast mTBI are diffuse, widespread, and spatially variable.     

Health Care Resource Utilization and Costs for Adults With Mild Traumatic Brain Injury With Chronic Vestibular Impairment

ObjectiveTo quantify the economic burden of all-cause health care resource utilization (HCRU) among adults with and without chronic vestibular impairment (CVI) after a mild traumatic brain injury (mTBI).DesignRetrospective matched cohort study.SettingIQVIA Integrated Data Warehouse.ParticipantsPeople with mTBI+CVI (n=20,441) matched on baseline age, sex, year of mTBI event, and Charlson Comorbidity Index (CCI) score to people with mTBI only (n=20,441) (N=40,882).InterventionsNot applicable.Main Outcome MeasuresAll-cause health HCRU and costs at 12 and 24 months post mTBI diagnosis.ResultsPeople with mTBI+CVI had significantly higher all-cause HCRU and costs at both time points than those with mTBI only. Multivariable regression analysis showed that, when controlling for baseline variables, costs of care were 1.5 times higher for mTBI+CVI than mTBI only.ConclusionsPeople who developed CVI after mTBI had greater overall HCRU and costs for up to 2 years after the injury event compared with people who did not develop CVI after controlling for age, sex, region, and CCI score. Further research on access to follow-up services and effectiveness of interventions to address CVI is warranted.     

Alteration of brain functional network at rest and in response to YMCA physical stress test in concussed athletes: RsFMRI study

There is still controversy in the literature whether a single episode of mild traumatic brain injury (mTBI) results in short- and/or long-term functional and structural deficits in the concussed brain. With the inability of traditional brain imaging techniques to properly assess the severity of brain damage induced by a concussive blow, there is hope that more advanced applications such as resting state functional magnetic resonance imaging (rsFMRI) will be more specific in accurately diagnosing mTBI. In this rsFMRI study, we examined 17 subjects 10±2 days post-sports-related mTBI and 17 age-matched normal volunteers (NVs) to investigate the possibility that the integrity of the resting state brain network is disrupted following a single concussive blow. We hypothesized that advanced brain imaging techniques may reveal subtle alterations of functional brain connections in asymptomatic mTBI subjects. There are several findings of interest. All mTBI subjects were asymptomatic based upon clinical evaluation and neuropsychological (NP) assessments prior to the MRI session. The mTBI subjects revealed a disrupted functional network both at rest and in response to the YMCA physical stress test. Specifically, interhemispheric connectivity was significantly reduced in the primary visual cortex, hippocampal and dorsolateral prefrontal cortex networks (p<0.05). The YMCA physical stress induced nonspecific and similar changes in brain network connectivity patterns in both the mTBI and NV groups. These major findings are discussed in relation to underlying mechanisms, clinical assessment of mTBI, and current debate regarding functional brain connectivity in a clinical population. Overall, our major findings clearly indicate that functional brain alterations in the acute phase of injury are overlooked when conventional clinical and neuropsychological examinations are used.     

Alteration of brain default network in subacute phase of injury in concussed individuals: resting-state fMRI study

There are a number of symptoms, both neurological and behavioral, associated with a single episode of r mild traumatic brain injury (mTBI). Neuropsychological testing and conventional neuroimaging techniques are not sufficiently sensitive to detect these changes, which adds to the complexity and difficulty in relating symptoms from mTBI to their underlying structural or functional deficits. With the inability of traditional brain imaging techniques to properly assess the severity of brain damage induced by mTBI, there is hope that more advanced neuroimaging applications will be more sensitive, as well as specific, in accurately assessing mTBI. In this study, we used resting state functional magnetic resonance imaging to evaluate the default mode network (DMN) in the subacute phase of mTBI. Fourteen concussed student-athletes who were asymptomatic based upon clinical symptoms resolution and clearance for aerobic exercise by medical professionals were scanned using resting state functional magnetic resonance imaging. Nine additional asymptomatic yet not medically cleared athletes were recruited to investigate the effect of a single episode of mTBI versus multiple mTBIs on the resting state DMN. In concussed individuals the resting state DMN showed a reduced number of connections and strength of connections in the posterior cingulate and lateral parietal cortices. An increased number of connections and strength of connections was seen in the medial prefrontal cortex. Connections between the left dorso-lateral prefrontal cortex and left lateral parietal cortex showed a significant reduction in magnitude as the number of concussions increased. Regression analysis also indicated an overall loss of connectivity as the number of mTBI episodes increased. Our findings indicate that alterations in the brain resting state default mode network in the subacute phase of injury may be of use clinically in assessing the severity of mTBI and offering some insight into the pathophysiology of the disorder.     

Management of post‐traumatic headaches in children and adolescents

Traumatic brain injuries (TBI) occur in an estimated 475,000 children aged 0–14 each year. Worldwide, mild traumatic brain injuries (mTBI) represent around 75–90% of all hospital admissions for TBI. mTBI are a common occurrence in children and adolescents, particularly in those involved in athletic activities. An estimated 1.6–3.8 million sports‐related TBIs occur each year, including those for which no medical care is sought. Headache is a common occurrence following TBI, reported in as many as 86% of high school and college athletes who have suffered from head trauma. As most clinicians who manage concussion and post‐traumatic headaches (PTHs) can attest, these headaches may be difficult to treat. There are currently no established guidelines for the treatment of PTHs, especially when persistent, and practices can vary widely from one clinician to the next. Making medical management more challenging, there are currently no randomized controlled trials evaluating the efficacy of therapies for PTHs in children and adolescents.     

Assessing the Longer-Term Effects of Mild Traumatic Brain Injury on Self-Reported Driving Ability

Background

Mild traumatic brain injury (mTBI) can have long-term cognitive and functional consequences, and recent mTBI has been associated with impaired performance on measures related to driving ability. However, it remains unclear whether mTBI history is associated with poorer driving performance.