Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.
Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, USA.
Neuroscientist. 2022 Dec;28(6):594-612. doi: 10.1177/10738584211012264. Epub 2021 May 8.
The diagnosis, prognosis, and treatment of mild traumatic brain injuries (mTBIs), such as concussions, are significant unmet medical issues. The kinetic forces that occur in mTBI adversely affect the cerebral vasculature, making cerebrovascular injury (CVI) a pathophysiological hallmark of mTBI. Given the importance of a healthy cerebrovascular system in overall brain function, CVI is likely to contribute to neurological dysfunction after mTBI. As such, CVI and related pathomechanisms may provide objective biomarkers and therapeutic targets to improve the clinical management and outcomes of mTBI. Despite this potential, until recently, few studies have focused on the cerebral vasculature in this context. This article will begin by providing a brief overview of the cerebrovascular system followed by a review of the literature regarding how mTBI can affect the integrity and function of the cerebrovascular system, and how this may ultimately contribute to neurological dysfunction and neurodegenerative conditions. We then discuss promising avenues of research related to mTBI biomarkers and interventions that target CVI, and conclude that a clinical approach that takes CVI into account could result in substantial improvements in the care and outcomes of patients with mTBI.
轻度创伤性脑损伤（mTBI），如脑震荡的诊断、预后和治疗是重大未满足的医学问题。mTBI 中发生的动力学力会对脑血管造成不利影响，使脑血管损伤（CVI）成为 mTBI 的病理生理学标志。鉴于脑血管系统对整体大脑功能的重要性，CVI 很可能导致 mTBI 后的神经功能障碍。因此，CVI 及相关病理机制可能提供客观的生物标志物和治疗靶点，以改善 mTBI 的临床管理和预后。尽管有这种潜力，但直到最近，很少有研究关注这方面的脑血管。本文将首先简要概述脑血管系统，然后回顾文献，探讨 mTBI 如何影响脑血管系统的完整性和功能，以及这如何最终导致神经功能障碍和神经退行性疾病。然后，我们讨论了与 mTBI 生物标志物和针对 CVI 的干预措施相关的有前途的研究途径，并得出结论，考虑到 CVI 的临床方法可能会使 mTBI 患者的护理和预后得到实质性改善。
