Institute of Molecular & Clinical Sciences, St George's University of London, SW17 0RE London, UK.
UK DRI Care Research and Technology Centre, Imperial College London, W12 0BZ London, UK.
Brain. 2022 Jun 30;145(6):1906-1915. doi: 10.1093/brain/awac149.
Persistent symptoms following a minor head injury can cause significant morbidity, yet the underlying mechanisms for this are poorly understood. The shortcomings of the current terminology that refer to non-specific symptom clusters is discussed. This update considers the need for a multi-dimensional approach for the heterogenous mechanisms driving persistent symptoms after mild traumatic brain injury. Relevant pathophysiology is discussed to make the case for mild traumatic brain injury to be conceptualized as an interface disorder spanning neurology, psychiatry and psychology. The relevance of pre-injury factors, psychological co-morbidities and their interaction with the injury to produce persistent symptoms are reviewed. The interplay with psychiatric diagnoses, functional and somatic symptom disorder presentations and the influence of the medicolegal process is considered. The judicious use and interpretation of investigations given the above complexity is discussed, with suggestions of how the explanation of the diagnostic formulation to the patient can be tailored, including insight into the above processes, to aid recovery. Moving beyond the one-dimensional concept of 'postconcussional syndrome' and reframing the cause of persistent symptoms following mild traumatic brain injury in a bio-psycho-socio-ecological model will hopefully improve understanding of the underlying contributory mechanistic interactions and facilitate treatment.
轻度头部损伤后的持续症状会导致显著的发病率，但人们对此的了解甚少。本文讨论了当前术语的缺陷，这些术语指的是特定的症状群。本更新考虑了需要采用多维方法来研究轻度创伤性脑损伤后持续症状的异质机制。相关的病理生理学被讨论，以说明轻度创伤性脑损伤可以被概念化为跨越神经科、精神病学和心理学的接口障碍。审查了损伤前因素、心理共病及其与损伤相互作用产生持续症状的相关性。还考虑了与精神科诊断、功能性和躯体症状障碍表现以及医疗法律程序的影响的相互作用。考虑了在上述复杂性下进行调查的谨慎使用和解释，并提出了如何针对患者量身定制诊断公式的解释，包括对上述过程的洞察，以帮助康复。超越“脑震荡后综合征”的一维概念，并用生物-心理-社会-生态模型重新构建轻度创伤性脑损伤后持续症状的原因，有望增进对潜在促成机制相互作用的理解，并促进治疗。
