Rădoi A, Poca M A, Cañas V, Cevallos J M, Membrado L, Saavedra M C, Vidal M, Martínez-Ricarte F, Sahuquillo J
Unidad de Investigación de Neurotraumatología y Neurocirugía (UNINN), Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, España.
Unidad de Investigación de Neurotraumatología y Neurocirugía (UNINN), Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, España; Servicio de Neurocirugía, Hospital Universitario Vall d'Hebron, Barcelona, España.
Neurologia (Engl Ed). 2018 Sep;33(7):427-437. doi: 10.1016/j.nrl.2016.10.003. Epub 2016 Dec 20.
Mild traumatic brain injury (mTBI) has traditionally been considered to cause no significant brain damage since symptoms spontaneously remit after a few days. However, this idea is facing increasing scrutiny. The purpose of this study is to demonstrate the presence of early cognitive alterations in a series of patients with mTBI and to link these findings to different markers of brain damage.
We conducted a prospective study of a consecutive series of patients with mTBI who were evaluated over a 12-month period. Forty-one (3.7%) of the 1144 included patients had experienced a concussion. Patients underwent a routine clinical evaluation and a brain computed tomography (CT) scan, and were also administered a standardised test for post-concussion symptoms within the first 24hours of mTBI and also 1 to 2 weeks later. The second assessment also included a neuropsychological test battery. The results of these studies were compared to those of a control group of 28 healthy volunteers with similar characteristics. Twenty patients underwent an MRI scan.
Verbal memory and learning were the cognitive functions most affected by mTBI. Seven out of the 20 patients with normal CT findings displayed structural alterations on MR images, which were compatible with diffuse axonal injury in 2 cases.
Results from this pilot study suggest that early cognitive alterations and structural brain lesions affect a considerable percentage of patients with post-concussion syndrome following mTBI.
轻度创伤性脑损伤(mTBI)传统上被认为不会造成显著的脑损伤,因为症状会在几天后自行缓解。然而,这一观点正面临越来越多的审视。本研究的目的是证明一系列mTBI患者存在早期认知改变,并将这些发现与脑损伤的不同标志物联系起来。
我们对一系列连续的mTBI患者进行了前瞻性研究,这些患者在12个月的时间里接受了评估。在纳入研究的1144名患者中,有41名(3.7%)经历过脑震荡。患者接受了常规临床评估和脑部计算机断层扫描(CT),并在mTBI后的头24小时内以及1至2周后接受了标准化的脑震荡后症状测试。第二次评估还包括一套神经心理测试。这些研究结果与28名具有相似特征的健康志愿者组成的对照组的结果进行了比较。20名患者接受了磁共振成像(MRI)扫描。
言语记忆和学习是受mTBI影响最大的认知功能。20名CT检查结果正常的患者中有7名在MR图像上显示出结构改变,其中2例与弥漫性轴索损伤相符。
这项初步研究的结果表明,早期认知改变和脑结构损伤在相当比例的mTBI后脑震荡综合征患者中存在。