Lux Warren E
U.S. Environmental Protection Agency, 1200 Pennsylvania Ave, NW, Mail Code 8105R, Washington, DC 20460, USA.
J Rehabil Res Dev. 2007;44(7):951-62. doi: 10.1682/jrrd.2007.01.0009.
Traumatic brain injury (TBI) due to closed mechanisms causes strain injuries to axons that increase in number and severity as injury severity increases. Axons that project up from the brain stem are vulnerable, even in milder concussive injuries, and include axons that participate in key monoaminergic pathways. Although called diffuse axonal injury, the supra-tentorial injury component typically shows an anterior preponderance in humans. As the injury forces increase, cerebral contusions may be superimposed on the axonal strain injuries, and these contusions show an anterior preponderance as well. The chronic neuropsychiatric manifestations of TBI reflect this injury distribution. In the cognitive sphere, these manifestations almost always include power function disturbances marked by difficulties with cognitive processing speed, multitasking, and cognitive endurance. These disturbances may then be followed by disturbances in executive function and self-awareness as injury severity increases. In the behavioral sphere, mood disturbances and disorders of behavioral control and regulation are particularly common.
闭合性机制导致的创伤性脑损伤（TBI）会引起轴突的牵拉伤，随着损伤严重程度的增加，其数量和严重程度也会增加。即使在较轻的脑震荡损伤中，从脑干向上投射的轴突也很脆弱，其中包括参与关键单胺能通路的轴突。尽管被称为弥漫性轴索损伤，但幕上损伤部分在人类中通常表现为前部优势。随着损伤力的增加，脑挫裂伤可能叠加在轴突牵拉伤之上，这些脑挫裂伤也表现出前部优势。TBI的慢性神经精神表现反映了这种损伤分布。在认知领域，这些表现几乎总是包括以认知处理速度、多任务处理和认知耐力困难为特征的执行功能障碍。随着损伤严重程度的增加，这些障碍可能随后会出现执行功能和自我意识的障碍。在行为领域，情绪障碍以及行为控制和调节障碍尤为常见。
