McAllister T W
Section of Neuropsychiatry, Dartmouth Medical School, Hanover, New Hampshire.
Psychiatr Clin North Am. 1992 Jun;15(2):395-413.
Based on the above review several general points can be highlighted: Head injuries are extremely common, affecting probably close to 2,000,000 people in this country each year. The most common are nonmissile, closed-head injuries, the majority of which occur in association with motor vehicle accidents. Virtually all studies of head injury suggest a peak incidence in the 15 to 24 years of age group. Coarse measures of outcome suggest that the very young and the elderly have poorer outcomes. Because of improved acute care, however, a large number of young, otherwise healthy patients are surviving head injuries with a variety of profound neuropsychiatric sequelae. Because of the mechanics of brain injury in acceleration-deceleration injuries, certain brain injury profiles are common including orbitofrontal, anterior and inferior temporal contusions, and diffuse axonal injury. The latter particularly affects the corpus callosum, superior cerebellar peduncle, basal ganglia, and periventricular white matter. The neuropsychiatric sequelae follow from the above injury profiles. Cognitive impairment is often diffuse with more prominent deficits in rate of information processing, attention, memory, cognitive flexibility, and problem solving. Prominent impulsivity, affective instability, and disinhibition are seen frequently, secondary to injury to frontal, temporal, and limbic areas. In association with the typical cognitive deficits, these sequelae characterize the frequently noted "personality changes" in TBI patients. In addition, these changes can exacerbate premorbid problems with impulse control. Marked difficulties with substance use, sexual expression, and aggression often result. The constellation of symptoms, which make up the postconcussive syndrome, are seen across the whole spectrum of brain injury severity. Even in so-called mild or minor head injury, these symptoms are likely to have an underlying neuropathologic, neurochemical, or neurophysiologic cause. Higher than expected rates of certain psychopathologic disorders occur in the TBI population, including psychotic syndromes and depressive syndromes. Manic syndromes also are associated with TBI; however, the incidence has not been established. Assessment and treatment of the neuropsychiatric sequelae is a complex and challenging process. The mixture of diffuse and focal injuries, the combination of cognitive, language, somatic, and behavioral difficulties do not fit easily into current diagnostic categories.
基于上述综述，可突出几个要点：头部损伤极为常见，该国每年可能有近200万人受影响。最常见的是非投射性闭合性头部损伤，其中大多数与机动车事故有关。几乎所有头部损伤研究都表明，15至24岁年龄组的发病率最高。粗略的结果衡量表明，非常年幼和年长的患者预后较差。然而，由于急性护理的改善，大量原本健康的年轻患者在头部受伤后存活下来，但伴有各种严重的神经精神后遗症。由于加速 - 减速损伤中的脑损伤机制，某些脑损伤类型很常见，包括眶额、颞叶前部和下部挫伤以及弥漫性轴索损伤。后者尤其影响胼胝体、小脑上脚、基底神经节和脑室周围白质。上述损伤类型会导致神经精神后遗症。认知障碍通常是弥漫性的，在信息处理速度、注意力、记忆、认知灵活性和问题解决方面存在更明显的缺陷。由于额叶、颞叶和边缘区域受损，经常会出现明显的冲动性、情感不稳定和去抑制现象。与典型的认知缺陷相关，这些后遗症是创伤性脑损伤患者中经常提到的“人格改变”的特征。此外，这些变化会加剧病前的冲动控制问题。物质使用、性表达和攻击行为往往会出现明显困难。构成脑震荡后综合征的一系列症状在整个脑损伤严重程度范围内都可见到。即使在所谓的轻度或轻微头部损伤中，这些症状也可能有潜在的神经病理学、神经化学或神经生理学原因。创伤性脑损伤人群中某些精神病理障碍的发生率高于预期，包括精神病综合征和抑郁综合征。躁狂综合征也与创伤性脑损伤有关；然而，其发病率尚未确定。神经精神后遗症的评估和治疗是一个复杂且具有挑战性的过程。弥漫性和局灶性损伤的混合，认知、语言、躯体和行为困难的组合不容易纳入当前的诊断类别。
