Szczupak M, Hoffer M E, Murphy S, Balaban C D
Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL, USA; University of Medicine Sports Medicine and Performance Institute, Miami, FL, USA.
Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL, USA; University of Medicine Sports Medicine and Performance Institute, Miami, FL, USA; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
Handb Clin Neurol. 2016;137:295-300. doi: 10.1016/B978-0-444-63437-5.00021-2.
Traumatic brain injury is an increasingly common public health issue, with the mild variant most clinically relevant for this chapter. Common causes of mild traumatic brain injury (mTBI) include motor vehicle accidents, athletics, and military training/deployment. Despite a range of clinically available testing platforms, diagnosis of mTBI remains challenging. Symptoms are primarily neurosensory, and include dizziness, hearing problems, headaches, cognitive, and sleep disturbances. Dizziness is nearly universally present in all mTBI patients, and is the easiest symptom to objectify for diagnosis. Aside from a thorough history and physical exam, in the near future specialized vestibular function tests will be key to mTBI diagnosis. A battery of oculomotor (antisaccade, predictive saccade) and vestibular tasks (head impulse test) has been demonstrated to sensitively and specifically identify individuals with acute mTBI. Vestibular therapy and rehabilitation have shown improvements for mTBI patients in cognitive function, ability to return to activities of daily living, and ability to return to work. Dizziness, as a contributor to short- and long-term disability following mTBI, is ultimately crucial not only for diagnosis but also for treatment.
创伤性脑损伤是一个日益常见的公共卫生问题，本章中最具临床相关性的是轻度创伤性脑损伤。轻度创伤性脑损伤（mTBI）的常见原因包括机动车事故、体育运动以及军事训练/部署。尽管有一系列临床可用的检测平台，但mTBI的诊断仍然具有挑战性。症状主要是神经感觉方面的，包括头晕、听力问题、头痛、认知和睡眠障碍。头晕在所有mTBI患者中几乎普遍存在，并且是最容易客观化以用于诊断的症状。除了详细的病史和体格检查外，在不久的将来，专门的前庭功能测试将成为mTBI诊断的关键。一系列动眼神经（反扫视、预测性扫视）和前庭任务（头部脉冲试验）已被证明能够敏感且特异地识别急性mTBI患者。前庭治疗和康复已显示出对mTBI患者的认知功能、恢复日常生活活动的能力以及恢复工作的能力有改善作用。头晕作为mTBI后导致短期和长期残疾的一个因素，不仅对诊断至关重要，对治疗也至关重要。
