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脑震荡后综合征诊断的进展:对流行病学、病理生理学、神经病理学、神经影像学和唾液生物标志物的见解

Advancements in diagnosing Post-concussion Syndrome: insights into epidemiology, pathophysiology, neuropathology, neuroimaging, and salivary biomarkers.

作者信息

Mavroudis Ioannis, Petridis Foivos, Ciobica Alin, Kamal Fatima Zahra, Padurariu Manuela, Kazis Dimitrios

机构信息

Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds, UK.

Leeds University, Leeds, UK.

出版信息

Acta Neurol Belg. 2025 Jan 8. doi: 10.1007/s13760-024-02695-7.

DOI:10.1007/s13760-024-02695-7
PMID:39776059
Abstract

Post-Concussion Syndrome (PCS) represents a complex constellation of symptoms that persist following a concussion or mild traumatic brain injury (mTBI), with significant implications for patient care and outcomes. Despite its prevalence, diagnosing PCS presents considerable challenges due to the subjective nature of symptoms, the absence of specific diagnostic tests, and the overlap with other neurological and psychiatric conditions. This review explores the multifaceted diagnostic challenges associated with PCS, including the heterogeneity of symptom presentation, the limitations of current neuroimaging techniques, and the overlap of PCS symptoms with other disorders. We also discuss the potential of emerging biomarkers and advanced imaging modalities to enhance diagnostic accuracy and provide a more objective basis for PCS identification. Additionally, the review highlights the importance of a multidisciplinary approach in the diagnosis and management of PCS, integrating clinical evaluation with innovative diagnostic tools to improve patient outcomes. Through a comprehensive analysis of current practices and future directions, this review aims to shed light on the complexities of PCS diagnosis and pave the way for improved strategies in the identification and treatment of this condition.

摘要

脑震荡后综合征(PCS)表现为脑震荡或轻度创伤性脑损伤(mTBI)后持续存在的一系列复杂症状,对患者的护理和预后具有重大影响。尽管其发病率很高,但由于症状的主观性、缺乏特定的诊断测试以及与其他神经和精神疾病的重叠,诊断PCS面临着相当大的挑战。本综述探讨了与PCS相关的多方面诊断挑战,包括症状表现的异质性、当前神经影像学技术的局限性以及PCS症状与其他疾病的重叠。我们还讨论了新兴生物标志物和先进成像模式在提高诊断准确性以及为PCS识别提供更客观依据方面的潜力。此外,该综述强调了多学科方法在PCS诊断和管理中的重要性,将临床评估与创新诊断工具相结合以改善患者预后。通过对当前实践和未来方向的全面分析,本综述旨在阐明PCS诊断的复杂性,并为改善该疾病的识别和治疗策略铺平道路。

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本文引用的文献

1
Longitudinal Associations Between Persistent Post-Concussion Symptoms and Blood Biomarkers of Inflammation and CNS-Injury After Mild Traumatic Brain Injury.持续的脑震荡后症状与轻度创伤性脑损伤后炎症和中枢神经系统损伤的血液生物标志物之间的纵向关联。
J Neurotrauma. 2024 Apr;41(7-8):862-878. doi: 10.1089/neu.2023.0419. Epub 2024 Jan 24.
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Traumatic brain injury induces TDP-43 mislocalization and neurodegenerative effects in tissue distal to the primary injury site in a non-transgenic mouse.创伤性脑损伤导致 TDP-43 定位错误和神经退行性病变,发生在原发性损伤部位以外的非转基因小鼠组织中。
Acta Neuropathol Commun. 2023 Aug 22;11(1):137. doi: 10.1186/s40478-023-01625-7.
3
Neuronal tau pathology worsens late-phase white matter degeneration after traumatic brain injury in transgenic mice.
神经元 tau 病理学在创伤性脑损伤后加重转基因小鼠晚期白质退化。
Acta Neuropathol. 2023 Oct;146(4):585-610. doi: 10.1007/s00401-023-02622-9. Epub 2023 Aug 14.
4
Review on the Role of Salivary Biomarkers in the Diagnosis of Mild Traumatic Brain Injury and Post-Concussion Syndrome.唾液生物标志物在轻度创伤性脑损伤和脑震荡后综合征诊断中的作用综述
Diagnostics (Basel). 2023 Apr 7;13(8):1367. doi: 10.3390/diagnostics13081367.
5
Current State of Diffusion-Weighted Imaging and Diffusion Tensor Imaging for Traumatic Brain Injury Prognostication.用于创伤性脑损伤预后评估的扩散加权成像和扩散张量成像的现状
Neuroimaging Clin N Am. 2023 May;33(2):279-297. doi: 10.1016/j.nic.2023.01.004.
6
Systematic Review of the Diagnostic and Clinical Utility of Salivary microRNAs in Traumatic Brain Injury (TBI).唾液 microRNAs 在创伤性脑损伤(TBI)中的诊断和临床效用的系统评价。
Int J Mol Sci. 2022 Oct 29;23(21):13160. doi: 10.3390/ijms232113160.
7
Magnetic Resonance Spectroscopy of Traumatic Brain Injury and Subconcussive Hits: A Systematic Review and Meta-Analysis.创伤性脑损伤和亚震荡性打击的磁共振波谱分析:系统评价和荟萃分析。
J Neurotrauma. 2022 Nov;39(21-22):1455-1476. doi: 10.1089/neu.2022.0125. Epub 2022 Aug 16.
8
TDP-43 drives synaptic and cognitive deterioration following traumatic brain injury.TDP-43 导致创伤性脑损伤后的突触和认知功能恶化。
Acta Neuropathol. 2022 Aug;144(2):187-210. doi: 10.1007/s00401-022-02449-w. Epub 2022 Jun 17.
9
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Diagnostics (Basel). 2022 Mar 18;12(3):740. doi: 10.3390/diagnostics12030740.
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Serum glial fibrillary acidic protein is a body fluid biomarker: A valuable prognostic for neurological disease - A systematic review.血清神经胶质纤维酸性蛋白是一种体液生物标志物:对神经疾病有重要的预后价值——系统综述。
Int Immunopharmacol. 2022 Jun;107:108624. doi: 10.1016/j.intimp.2022.108624. Epub 2022 Mar 4.