Salorio Cynthia F, Slomine Beth S, Grados Marco A, Vasa Roma A, Christensen James R, Gerring Joan P
Department of Pediatric Rehabilitation, Kennedy Krieger Institute, Baltimore, Maryland 21205, USA.
J Int Neuropsychol Soc. 2005 Oct;11(6):686-96. doi: 10.1017/S1355617705050885.
Traumatic brain injury (TBI) frequently results in memory problems, and the degree of memory impairment is related to injury severity and is commonly associated with lesions in frontal and temporal brain areas. This study examined the relationship among injury severity, brain lesions, and memory in children with moderate to severe TBI using Donders' (1999) 5-factor model of performance on the California Verbal Learning Test-Children's Version (CVLT-C). Seventy-six children underwent magnetic resonance imaging (MRI) scans 3 months post-TBI and testing 1 year post-TBI. Results showed injury severity (Glasgow Coma Scale) was not predictive of performance on 4 of the 5 factors. Volume of frontal and/or temporal brain lesions was significantly predictive of performance on 3 of the 5 factors. Unexpectedly, lesion volume outside these areas (extra-frontotemporal) was predictive of performance on all 5 factors. In contrast, Verbal IQ at 1 year was most strongly associated with preinjury factors (socioeconomic status and special education involvement), although extra-frontotemporal lesions also contributed to the variability in this measure. Results suggest that in children with moderate to severe TBI, extra-frontal/temporal lesions are predictive of memory outcome 1 year postinjury above and beyond initial severity or frontal/temporal contusions. This finding may relate to widespread diffuse axonal injury, which potentially disconnects brain circuits mediating memory following moderate to severe TBI.
创伤性脑损伤（TBI）常常导致记忆问题，记忆损害的程度与损伤严重程度相关，并且通常与额叶和颞叶脑区的病变有关。本研究使用唐德斯（1999年）关于加利福尼亚言语学习测验儿童版（CVLT-C）表现的五因素模型，检验了中重度TBI儿童的损伤严重程度、脑损伤与记忆之间的关系。76名儿童在TBI后3个月接受了磁共振成像（MRI）扫描，并在TBI后1年接受了测试。结果显示，损伤严重程度（格拉斯哥昏迷量表）对五个因素中的四个因素的表现没有预测作用。额叶和/或颞叶脑损伤的体积对五个因素中的三个因素的表现有显著预测作用。出乎意料的是，这些区域之外（额颞叶外）的损伤体积对所有五个因素的表现都有预测作用。相比之下，1年后的言语智商与伤前因素（社会经济地位和特殊教育参与情况）关联最为紧密，尽管额颞叶外损伤也导致了该指标的变异性。结果表明，在中重度TBI儿童中，额颞叶外损伤在损伤后1年对记忆结果的预测作用超过了初始严重程度或额叶/颞叶挫伤。这一发现可能与广泛的弥漫性轴索损伤有关，这种损伤可能会使中重度TBI后介导记忆的脑回路断开连接。
