Scheid Rainer, Walther Kathrin, Guthke Thomas, Preul Christoph, von Cramon D Yves
Day Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany.
Arch Neurol. 2006 Mar;63(3):418-24. doi: 10.1001/archneur.63.3.418.
The results of recent studies on cognitive disability after traumatic brain injury-associated diffuse axonal injury (DAI) are inconsistent. In these studies, the diagnosis of DAI relied on cranial computed tomography.
To further clarify the extent and severity of a possibly DAI-associated cognitive impairment by the use of magnetic resonance imaging (MRI) and detailed neuropsychological testing.
From a databank of 299 patients with traumatic brain injury, 18 patients (age range, 17-50 years; median initial Glasgow Coma Scale score, 5) who showed an MRI lesion pattern compatible with pure DAI were identified. All of the patients had undergone MRI on a 3-T system. Pure DAI was defined by the findings of traumatic microbleeds on T2*-weighted gradient-echo images in the absence of otherwise traumatic or nontraumatic MRI abnormalities.
Neuropsychological performance in the categories of attention and psychomotor speed, executive functions, spans, learning and memory, and intelligence 4 to 55 months (median, 9 months) after traumatic brain injury.
All of the patients showed impairments of 1 or more cognitive subfunctions, and no cognitive domain was fundamentally spared. Memory and executive dysfunctions were most frequent, the former reaching a moderate to severe degree in half of the patients. In comparison, deficits of attention, executive functions, and short-term memory were mostly mild. Correlations between the amount of traumatic microbleeds and specific or global cognitive performance were absent.
An MRI lesion pattern compatible with isolated DAI is associated with persistent cognitive impairment. The traumatic microbleed load is no sufficient parameter for the assessment of DAI severity or functional outcome.
近期关于创伤性脑损伤相关弥漫性轴索损伤（DAI）后认知障碍的研究结果并不一致。在这些研究中，DAI的诊断依赖于头颅计算机断层扫描。
通过使用磁共振成像（MRI）和详细的神经心理学测试，进一步明确可能与DAI相关的认知障碍的程度和严重程度。
从299例创伤性脑损伤患者的数据库中，识别出18例（年龄范围17 - 50岁；初始格拉斯哥昏迷量表评分中位数为5）MRI病变模式与单纯DAI相符的患者。所有患者均在3-T系统上进行了MRI检查。单纯DAI由T2*加权梯度回波图像上的创伤性微出血表现定义，且不存在其他创伤性或非创伤性MRI异常。
创伤性脑损伤后4至55个月（中位数为9个月）在注意力和精神运动速度、执行功能、跨度、学习和记忆以及智力等方面的神经心理学表现。
所有患者均表现出1种或多种认知亚功能受损，没有认知领域完全未受影响。记忆和执行功能障碍最为常见，前者在一半的患者中达到中度至重度。相比之下，注意力、执行功能和短期记忆缺陷大多为轻度。创伤性微出血的数量与特定或整体认知表现之间不存在相关性。
与孤立性DAI相符的MRI病变模式与持续性认知障碍相关。创伤性微出血负荷不是评估DAI严重程度或功能结局的充分参数。
