Iverson Grant L
Department of Psychiatry, University of British Columbia, Neuropsychiatry Program, Riverview Hospital, Vancouver, British Columbia, Canada.
Curr Opin Psychiatry. 2005 May;18(3):301-17. doi: 10.1097/01.yco.0000165601.29047.ae.
The focus of this review is outcome from mild traumatic brain injury. Recent literature relating to pathophysiology, neuropsychological outcome, and the persistent postconcussion syndrome will be integrated into the existing literature.
The MTBI literature is enormous, complex, methodologically flawed, and controversial. There have been dozens of studies relating to pathophysiology, neuropsychological outcome, and the postconcussion syndrome during the past year. Two major reviews have been published. Some of the most interesting prospective research has been done with athletes.
The cognitive and neurobehavioral sequelae are self-limiting and reasonably predictable. Mild traumatic brain injuries are characterized by immediate physiological changes conceptualized as a multilayered neurometabolic cascade in which affected cells typically recover, although under certain circumstances a small number might degenerate and die. The primary pathophysiologies include ionic shifts, abnormal energy metabolism, diminished cerebral blood flow, and impaired neurotransmission. During the first week after injury the brain undergoes a dynamic restorative process. Athletes typically return to pre-injury functioning (assessed using symptom ratings or brief neuropsychological measures) within 2-14 days. Trauma patients usually take longer to return to their pre-injury functioning. In these patients recovery can be incomplete and can be complicated by preexisting psychiatric or substance abuse problems, poor general health, concurrent orthopedic injuries, or comorbid problems (e.g. chronic pain, depression, substance abuse, life stress, unemployment, and protracted litigation).
本综述的重点是轻度创伤性脑损伤的结果。与病理生理学、神经心理学结果及持续性脑震荡后综合征相关的最新文献将被纳入现有文献。
有关轻度创伤性脑损伤的文献数量众多、内容复杂、存在方法学缺陷且颇具争议。在过去一年里，有数十项关于病理生理学、神经心理学结果及脑震荡后综合征的研究。已发表了两篇主要综述。一些最有趣的前瞻性研究是针对运动员开展的。
认知和神经行为后遗症具有自限性且在一定程度上可预测。轻度创伤性脑损伤的特征是即刻发生的生理变化，可被概念化为一个多层神经代谢级联反应，其中受影响的细胞通常会恢复，尽管在某些情况下少数细胞可能会退化和死亡。主要病理生理学包括离子转移、能量代谢异常、脑血流量减少及神经传递受损。在受伤后的第一周，大脑经历一个动态的恢复过程。运动员通常在2至14天内恢复到受伤前的功能状态（通过症状评分或简短的神经心理学测量进行评估）。创伤患者恢复到受伤前功能状态通常需要更长时间。在这些患者中，恢复可能不完全，并且可能因先前存在的精神疾病或药物滥用问题、总体健康状况不佳、并发的骨科损伤或共病问题（如慢性疼痛、抑郁、药物滥用、生活压力、失业和长期诉讼）而变得复杂。
