Johnson Victoria E, Stewart William, Arena John D, Smith Douglas H
Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.
Adv Neurobiol. 2017;15:383-400. doi: 10.1007/978-3-319-57193-5_15.
Although millions of individuals suffer a traumatic brain injury (TBI) worldwide each year, it is only recently that TBI has been recognized as a major public health problem. Beyond the acute clinical manifestations, there is growing recognition that a single severe TBI (sTBI) or repeated mild TBIs (rTBI) can also induce insidious neurodegenerative processes, which may be associated with early dementia, in particular chronic traumatic encephalopathy (CTE). Identified at autopsy examination in individuals with histories of exposure to sTBI or rTBI, CTE is recognized as a complex pathology featuring both macroscopic and microscopic abnormalities. These include cavum septum pellucidum, brain atrophy and ventricular dilation, together with pathologies in tau, TDP-43, and amyloid-β. However, the establishment and characterization of CTE as a distinct disease entity is in its infancy. Moreover, the relative "dose" of TBI, such as the frequency and severity of injury, associated with risk of CTE remains unknown. As such, there is a clear and pressing need to improve the recognition and diagnosis of CTE and to identify mechanistic links between TBI and chronic neurodegeneration.
尽管全球每年有数百万人遭受创伤性脑损伤（TBI），但直到最近TBI才被公认为一个重大的公共卫生问题。除了急性临床表现外，人们越来越认识到，单次严重创伤性脑损伤（sTBI）或反复轻度创伤性脑损伤（rTBI）也会引发隐匿性神经退行性病变，这可能与早期痴呆有关，尤其是慢性创伤性脑病（CTE）。CTE在有sTBI或rTBI暴露史的个体尸检中被发现，被认为是一种具有宏观和微观异常的复杂病理状态。这些异常包括透明隔腔、脑萎缩和脑室扩张，以及tau蛋白、TDP-43和淀粉样β蛋白的病变。然而，将CTE确立为一种独特的疾病实体并对其进行特征描述尚处于起步阶段。此外，与CTE风险相关的TBI“剂量”，如损伤的频率和严重程度，仍然未知。因此，迫切需要提高对CTE的识别和诊断，并确定TBI与慢性神经退行性变之间的机制联系。
