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慢性创伤性脑病最新临床及神经病理学标准综述

A Review of the Most Recent Clinical and Neuropathological Criteria for Chronic Traumatic Encephalopathy.

作者信息

Mavroudis Ioannis, Balmus Ioana-Miruna, Ciobica Alin, Luca Alina-Costina, Gorgan Dragos Lucian, Dobrin Irina, Gurzu Irina Luciana

机构信息

Department of Neurology, Leeds Teaching Hospitals NHS Trust and Leeds University, Leeds LS9 7TF, UK.

Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, Alexandru Ioan Cuza University of Iasi, Alexandru Lapusneanu Street, No. 26, 700057 Iasi, Romania.

出版信息

Healthcare (Basel). 2023 Jun 8;11(12):1689. doi: 10.3390/healthcare11121689.

DOI:10.3390/healthcare11121689
PMID:37372807
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10298260/
Abstract

(1) Background: Chronic traumatic encephalopathy (CTE) is a complex pathological condition characterized by neurodegeneration, as a result of repeated head traumas. Currently, the diagnosis of CTE can only be assumed postmortem. Thus, the clinical manifestations associated with CTE are referred to as traumatic encephalopathy syndrome (TES), for which diagnostic multiple sets of criteria can be used. (2) Objectives: In this study, we aimed to present and discuss the limitations of the clinical and neuropathological diagnostic criteria for TES/CTE and to suggest a diagnostic algorithm enabling a more accurate diagnostic procedure. (3) Results: The most common diagnostic criteria for TES/CTE discriminate between possible, probable, and improbable. However, several key variations between the available diagnostic criteria suggest that the diagnosis of CTE can still only be given with postmortem neurophysiological examination. Thus, a TES/CTE diagnosis during life imposes a different level of certainty. Here, we are proposing a comprehensive algorithm of diagnosis criteria for TES/CTE based on the similarities and differences between the previous criteria. (4) Conclusions: The diagnosis of TES/CTE requires a multidisciplinary approach; thorough investigation for other neurodegenerative disorders, systemic illnesses, and/or psychiatric conditions that can account for the symptoms; and also complex investigations of patient history, psychiatric assessment, and blood and cerebrospinal fluid biomarker evaluation.

摘要

(1)背景:慢性创伤性脑病(CTE)是一种复杂的病理状况,其特征为神经退行性变,由反复头部创伤所致。目前,CTE的诊断只能在死后进行。因此,与CTE相关的临床表现被称为创伤性脑病综合征(TES),对此可使用多套诊断标准。(2)目的:在本研究中,我们旨在阐述并讨论TES/CTE临床及神经病理学诊断标准的局限性,并提出一种能实现更准确诊断流程的诊断算法。(3)结果:TES/CTE最常见的诊断标准区分了可能、很可能和不太可能。然而,现有诊断标准之间的几个关键差异表明,CTE的诊断仍只能通过死后神经生理学检查得出。因此,生前对TES/CTE的诊断具有不同程度的确定性。在此,我们基于先前标准的异同,提出一种全面的TES/CTE诊断标准算法。(4)结论:TES/CTE的诊断需要多学科方法;对可能导致这些症状的其他神经退行性疾病、全身性疾病和/或精神疾病进行全面调查;以及对患者病史进行复杂调查、进行精神评估并评估血液和脑脊液生物标志物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a897/10298260/0633d737d1b4/healthcare-11-01689-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a897/10298260/31f3e172024e/healthcare-11-01689-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a897/10298260/0633d737d1b4/healthcare-11-01689-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a897/10298260/31f3e172024e/healthcare-11-01689-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a897/10298260/0633d737d1b4/healthcare-11-01689-g002.jpg

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Int J Mol Sci. 2023 Jan 17;24(3):1847. doi: 10.3390/ijms24031847.
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Chronic Traumatic Encephalopathy in the Brains of Military Personnel.军人脑部的慢性创伤性脑病。
N Engl J Med. 2022 Jun 9;386(23):2169-2177. doi: 10.1056/NEJMoa2203199.
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Post-Concussion Syndrome and Chronic Traumatic Encephalopathy: Narrative Review on the Neuropathology, Neuroimaging and Fluid Biomarkers.
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Diagnostics (Basel). 2022 Mar 18;12(3):740. doi: 10.3390/diagnostics12030740.
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Neurosyphilis.神经梅毒。
Continuum (Minneap Minn). 2021 Aug 1;27(4):1018-1039. doi: 10.1212/CON.0000000000000982.
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Neuronally-derived tau is increased in experienced breachers and is associated with neurobehavioral symptoms.经验丰富的突破者中神经元衍生的 tau 增加,并且与神经行为症状相关。
Sci Rep. 2021 Sep 30;11(1):19527. doi: 10.1038/s41598-021-97913-0.
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The Second NINDS/NIBIB Consensus Meeting to Define Neuropathological Criteria for the Diagnosis of Chronic Traumatic Encephalopathy.第二届 NINDS/NIBIB 共识会议:定义慢性创伤性脑病的神经病理学诊断标准。
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