Heitger Marcus H, Anderson Tim J, Jones Richard D, Dalrymple-Alford John C, Frampton Chris M, Ardagh Michael W
Christchurch Brain Research Group, Christchurch Hospital, Christchurch, New Zealand.
Brain. 2004 Mar;127(Pt 3):575-90. doi: 10.1093/brain/awh066. Epub 2004 Jan 21.
Based on increasing evidence that even mild closed head injury (CHI) can cause considerable neural damage throughout the brain, we hypothesized that mild CHI will disrupt the complex cerebral networks concerned with oculomotor and upper-limb visuomotor control, resulting in impaired motor function. Within 10 days following mild CHI (Glasgow Coma Scale 13-15, alteration of consciousness <20 min), we compared 30 patients (15-37 years) and 30 matched controls on different types of saccades, oculomotor smooth pursuit (sine and random), upper-limb visuomotor performance and several neuropsychological tests known to be sensitive to head trauma. Simple reflexive saccades were not impaired, whereas, on the antisaccade task, the CHI group demonstrated prolonged saccadic latencies, a marginally higher number of directional errors and poorer spatial accuracy. The CHI group exhibited more directional errors and impaired motor accuracy on memory-guided sequences of saccades and produced fewer self-paced saccades within 30 s. Most measures of sinusoidal and random oculomotor smooth pursuit showed no deficits, with the exception of a prolonged lag on random smooth pursuit in the CHI group. While arm movement reaction time and arm steadiness were not impaired, the CHI group showed decreased arm movement speed and decreased upper-limb motor accuracy. Conversely, after controlling for IQ, the CHI group had few head trauma-related neuropsychological deficits. These results indicate that multiple motor systems can be impaired following mild CHI and that this can occur independently of neuropsychological impairment. Our study also indicates that quantitative tests of oculomotor and upper-limb visuomotor function may provide sensitive markers of cerebral dysfunction, suggesting the potential use of such tests to supplement patient assessment. To our knowledge, this study is the first to demonstrate the presence of oculomotor or visuomotor deficits following mild CHI.
越来越多的证据表明，即使是轻度闭合性颅脑损伤（CHI）也会在全脑造成相当大的神经损伤。基于此，我们推测轻度CHI会扰乱与眼球运动和上肢视觉运动控制相关的复杂脑网络，从而导致运动功能受损。在轻度CHI（格拉斯哥昏迷量表评分为13 - 15分，意识改变<20分钟）后的10天内，我们比较了30例患者（年龄15 - 37岁）和30例匹配的对照组在不同类型扫视、眼球运动平稳跟踪（正弦和随机）、上肢视觉运动表现以及多项已知对头部创伤敏感的神经心理学测试中的表现。简单反射性扫视未受损，而在反扫视任务中，CHI组表现出扫视潜伏期延长、方向错误数量略多以及空间准确性较差。CHI组在记忆引导的扫视序列中表现出更多方向错误和运动准确性受损，并且在30秒内自发扫视次数减少。除了CHI组在随机平稳跟踪中延迟延长外，大多数正弦和随机眼球运动平稳跟踪测量指标均未显示出缺陷。虽然手臂运动反应时间和手臂稳定性未受损，但CHI组显示出手臂运动速度降低和上肢运动准确性下降。相反，在控制智商后，CHI组几乎没有与头部创伤相关的神经心理学缺陷。这些结果表明，轻度CHI后多个运动系统可能受损，并且这种情况可能独立于神经心理学损伤而发生。我们的研究还表明，眼球运动和上肢视觉运动功能的定量测试可能提供脑功能障碍的敏感标志物，提示此类测试可能用于补充患者评估。据我们所知，本研究首次证明了轻度CHI后存在眼球运动或视觉运动缺陷。
