Johnstone Daniel M, Mitrofanis John, Stone Jonathan
School of Biomedical Sciences and Pharmacy, University of Newcastle and School of Medical Sciences, The University of Sydney, Darlington, NSW, Australia.
Fonds de Dotation Clinatec, Université Grenoble Alpes, France and Institute of Ophthalmology, University College London, London, United Kingdom.
Front Neurosci. 2023 Mar 2;17:1141568. doi: 10.3389/fnins.2023.1141568. eCollection 2023.
Of all our organs, the brain is perhaps the best protected from trauma. The skull has evolved to enclose it and, within the skull, the brain floats in a protective bath of cerebrospinal fluid. It is becoming evident, however, that head trauma experienced in young adult life can cause a dementia that appears decades later. The level of trauma that induces such destruction is still being assessed but includes levels well below that which cracks the skull or causes unconsciousness or concussion. Clinically this damage appears as dementia, in people who played body-contact sports in their youth or have survived accidents or the blasts of combat; and appears also, we argue, in old age, without a history of head trauma. The dementias have been given different names, including dementia pugilistica (affecting boxers), chronic traumatic encephalopathy (following certain sports, particularly football), traumatic brain injury (following accidents, combat) and Alzheimer's (following decades of life). They share common features of clinical presentation and neuropathology, and this conceptual analysis seeks to identify features common to these forms of brain injury and to identify where in the brain the damage common to them occurs; and how it occurs, despite the protection provided by the skull and cerebrospinal fluid. The analysis suggests that the brain's weak point in the face of trauma is its capillary bed, which is torn by the shock of trauma. This identification in turn allows discussion of ways of delaying, avoiding and even treating these trauma-induced degenerations.
在我们所有的器官中，大脑或许是受创伤保护最好的。颅骨经过进化将其包裹，在颅骨内部，大脑漂浮在脑脊液这一保护性液体中。然而，越来越明显的是，青壮年时期经历的头部创伤可能会在数十年后引发痴呆症。引发这种损害的创伤程度仍在评估中，但包括远低于导致颅骨骨折、失去意识或脑震荡的程度。临床上，这种损害在年轻时从事身体接触性运动、经历过事故或战斗爆炸并幸存下来的人身上表现为痴呆症；我们认为，在没有头部创伤史的老年人中也会出现。这些痴呆症有不同的名称，包括拳击性痴呆（影响拳击手）、慢性创伤性脑病（在某些运动之后，尤其是足球运动）、创伤性脑损伤（在事故、战斗之后）以及阿尔茨海默病（在数十年的生活之后）。它们在临床表现和神经病理学方面有共同特征，本概念分析旨在识别这些脑损伤形式的共同特征，确定它们共同的损伤在大脑中的位置；以及损伤是如何发生的，尽管有颅骨和脑脊液的保护。分析表明，大脑在面对创伤时的弱点在于其毛细血管床，它会因创伤冲击而撕裂。这一识别反过来又使得能够讨论延迟、避免甚至治疗这些创伤性退变的方法。
