UCLA Department of Neurosurgery, 300 Stein Plaza, Los Angeles, CA 90095, United States.
UCLA Department of Neurosurgery, 300 Stein Plaza, Los Angeles, CA 90095, United States.
Exp Neurol. 2019 Jul;317:206-213. doi: 10.1016/j.expneurol.2019.01.012. Epub 2019 Mar 8.
Traumatic brain injury (TBI) has drawn national attention for its high incidence and mechanistic complexity. The majority of TBI cases are "mild" in nature including concussions and mild TBI (mTBI). Concussions are a distinct form of mTBI where diagnosis is difficult, quantification of the incidence is challenging and there is greater risk for subsequent injuries. While concussions occur in the general population, it has become a hallmark injury consistently observed among adolescent and young adult athletes and the risks for repeat TBI (rTBI) is significant. Clinical and experimental evidence shows that the magnitude and duration of deficits is dependent on the number and the interval between injuries. Several studies suggest that metabolic vulnerabilities after injury may contribute to the window for cerebral vulnerability from rTBI. In addition to metabolism, this review addresses how age, sex and hormones also play an important role in the response to repeat concussions. Understanding how these factors collectively contribute to concussion and rTBI recovery is critically important in establishing age/sex appropriate return to play guidelines, injury prevention, therapeutic interventions and mitigation of long-term consequences of rTBI.
创伤性脑损伤（TBI）因其高发病率和机制复杂性而引起了全国的关注。大多数 TBI 病例性质为“轻度”，包括脑震荡和轻度 TBI（mTBI）。脑震荡是 mTBI 的一种特殊形式，其诊断困难，发病率难以量化，并且随后受伤的风险更大。虽然脑震荡在普通人群中发生，但它已成为青少年和年轻成年运动员中一致观察到的标志性损伤，重复 TBI（rTBI）的风险显著增加。临床和实验证据表明，损伤后的缺陷程度和持续时间取决于损伤的数量和间隔。几项研究表明，损伤后代谢脆弱性可能导致 rTBI 时脑易损性的窗口期。除了代谢，本综述还探讨了年龄、性别和激素如何在重复脑震荡反应中发挥重要作用。了解这些因素如何共同导致脑震荡和 rTBI 恢复，对于制定适合年龄/性别的重返赛场指南、预防损伤、治疗干预以及减轻 rTBI 的长期后果至关重要。
