From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA.
Neurology. 2020 Oct 27;95(17):e2398-e2408. doi: 10.1212/WNL.0000000000010825. Epub 2020 Sep 9.
To understand how, biologically, the acute event of traumatic brain injury gives rise to a long-term disease, we address the relationship between evolving cortical and subcortical brain damage and measures of functional outcome and cognitive functioning at 6 months after injury.
For this longitudinal analysis, clinical and MRI data were collected in a tertiary neurointensive care setting in a continuous sample of 157 patients surviving moderate to severe traumatic brain injury between 2000 and 2018. For each patient, we collected T1- and T2-weighted MRI data acutely and at the 6-month follow-up, as well as acute measures of injury severity (Glasgow Coma Scale), follow-up measures of functional impairment (Glasgow Outcome Scale-extended), and, in a subset of patients, neuropsychological measures of attention, executive functions, and episodic memory.
In the final cohort of 113 subcortical and 92 cortical datasets that survived (blind) quality control, extensive atrophy was observed over the first 6 months after injury across the brain. However, only atrophy within subcortical regions, particularly in the left thalamus, was associated with functional outcome and neuropsychological measures of attention, executive functions, and episodic memory. Furthermore, when brought together in an analytical model, longitudinal brain measurements could distinguish good from bad outcome with 90% accuracy, whereas acute brain and clinical measurements alone could achieve only 20% accuracy.
Despite great injury heterogeneity, secondary thalamic pathology is a measurable minimum common denominator mechanism directly relating biology to clinical measures of outcome and cognitive functioning, potentially linking the acute event and the longer-term disease of traumatic brain injury.
为了了解创伤性脑损伤的急性事件如何导致长期疾病，我们研究了皮质和皮质下脑损伤的演变与损伤后 6 个月的功能结局和认知功能测量之间的关系。
在 2000 年至 2018 年期间，我们在一家三级神经重症监护病房对 157 例中度至重度创伤性脑损伤幸存者进行了连续样本的纵向分析，收集了临床和 MRI 数据。对于每位患者，我们收集了 T1 和 T2 加权 MRI 数据，包括急性期和 6 个月随访期，以及急性损伤严重程度（格拉斯哥昏迷量表）、随访期功能损伤（格拉斯哥预后量表扩展版）的测量值，以及在亚组患者中，注意力、执行功能和情景记忆的神经心理学测量值。
在最终的皮质下和皮质数据集（113 个亚组和 92 个）中，我们观察到在损伤后的前 6 个月内，整个大脑都出现了广泛的萎缩。然而，只有皮质下区域的萎缩，特别是左侧丘脑，与功能结局和注意力、执行功能和情景记忆的神经心理学测量值有关。此外，当这些测量值被纳入分析模型时，可以以 90%的准确率区分良好和不良结局，而急性脑和临床测量值单独使用时，准确率仅为 20%。
尽管存在很大的损伤异质性，但继发性丘脑病变是一种可测量的最小共同发病机制，直接将生物学与结局和认知功能的临床测量值联系起来，可能将创伤性脑损伤的急性事件和长期疾病联系起来。
