Gennarelli TA, Graham DI
Department of Neurosurgery and Center for Neurosciences, Allegheny University of the Health Sciences, Philadelphia, PA, UK
Semin Clin Neuropsychiatry. 1998 Jul;3(3):160-175.
Structural abnormalities develop progressively after trauma to the central nervous system suggesting that injury is a process of events rather than a singular event. Thus, numerous types of neuropathologies can occur, depending on the exact nature of the processes of cellular damage that are set into motion after injury. Four general interrelated processes of delayed cellular damage occur in different amounts and in different locations to result in the numerous types of traumatic brain damage. These include direct damage caused by calcium influx into cells, free radical-mediated damage, receptor-mediated damage, and inflammation. By these mechanisms, the general response of the brain to mechanical energy causes damage to vascular or neural components of the brain, and results in principally focal or diffuse brain damage, respectively. These form the phenotypic types of damage to the brain and the resulting clinically associated traumatic syndromes. Focal brain damage consists principally of vascular injury that results in confusions and hemorrhages in various locations. Diffuse brain damage mainly involves scattered damage to axons in the white matter (diffuse axonal injury) or secondary damage attributable to raised intracranial pressure, hypoxia, or ischemia.
中枢神经系统创伤后，结构异常会逐渐发展，这表明损伤是一个连续的过程，而非单一事件。因此，根据损伤后引发的细胞损伤过程的确切性质，可能会出现多种类型的神经病理学变化。损伤后会发生四种一般相互关联的延迟性细胞损伤过程，其程度和位置各不相同，从而导致多种类型的创伤性脑损伤。这些过程包括钙流入细胞引起的直接损伤、自由基介导的损伤、受体介导的损伤和炎症。通过这些机制，大脑对机械能的一般反应会导致大脑血管或神经成分受损，分别主要导致局灶性或弥漫性脑损伤。这些构成了大脑损伤的表型类型以及由此产生的临床相关创伤综合征。局灶性脑损伤主要由血管损伤组成，导致不同部位出现挫伤和出血。弥漫性脑损伤主要涉及白质中轴突的散在损伤（弥漫性轴索损伤）或由颅内压升高、缺氧或缺血引起的继发性损伤。
