Brain Injury Research Institute, Morgantown, West Virginia, USA.
Neurosurg Focus. 2011 Nov;31(5):E3. doi: 10.3171/2011.9.FOCUS11178.
Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.
继他在 2002 年发现足球运动员患有慢性创伤性脑病（CTE）之后，Bennet Omalu 博士推测，退伍军人的创伤后应激障碍（PTSD）可能属于 CTE 疾病谱。因此，脑损伤研究所的 CTE 监测范围扩大到包括被诊断患有 PTSD 的已故退伍军人。作者报告了一名 27 岁的美国海军陆战队（USMC）伊拉克战争退伍军人的病例，他是一名两栖突击车船员，在两次部署到费卢杰和拉马迪后，通过上吊自杀。他经历了战斗，并暴露在距离不到 50 米的迫击炮爆炸和简易爆炸装置爆炸中。第二次部署后，他出现了进行性认知障碍、记忆障碍、行为和情绪障碍以及酗酒的病史。神经精神病学评估显示 PTSD 诊断为警觉性增高（易怒和失眠）和麻木。他在从美国海军陆战队光荣退伍后大约 8 个月自杀。他的大脑尸检除了充血性脑肿胀外，大体上没有明显异常。没有萎缩或远处局灶性创伤性脑损伤，如挫裂坏死或出血。组织化学和免疫组织化学脑组织分析显示 CTE 变化，包括多灶性、皮质和皮质下神经原纤维缠结和神经原纤维丝（从无到稀疏到频繁），伴有跳跃现象，在脑沟深处和额皮质中加重。皮质下白质显示轻度稀疏，组织细胞稀疏浸润血管周围和神经毡，轻度纤维星形胶质增生。载脂蛋白 E 基因型为 3/4。作者报告了这一病例，作为 PTSD 退伍军人 CTE 的哨兵病例，以可能激发关于 PTSD 在退伍军人中的可能病理生理学和发病机制的新思维和研究，作为 CTE 疾病谱的一部分，以及作为重复性创伤性脑损伤的慢性后遗症和结果。
