Nimmo Alan, Younsi Alexander
College of Medicine and Dentistry, James Cook University, Cairns, QLD 4870, Australia.
Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Int J Mol Sci. 2025 Aug 20;26(16):8066. doi: 10.3390/ijms26168066.
Traumatic brain injuries (TBI) represent a leading cause of morbidity and mortality globally. Whilst clinical care has significantly improved in recent years, there is still significant scope to improve patient outcomes, particularly in relation to quality of life. However, there is a window of opportunity for clinical intervention, since most of the mortality and morbidity is associated with secondary injury processes that arise after the initial trauma. In the brain, as with any tissue, inflammation plays an important role in the response to injury. However, particularly with severe injuries, an excessive inflammatory response can have detrimental effects. Following TBI, inflammation can lead to the development of cerebral oedema and a rise in intracranial pressure. Without effective control, these processes can rapidly lead to patient deterioration. This narrative review focusses on the role of inflammation in TBI in order to examine the strategies that may help improve patient outcomes. Whilst there is clearly a relationship between the development of cerebral oedema, rising intracranial pressure (ICP), and poor patient prognosis, there are also discrepancies in terms of their impact on patient outcomes. In addition to causing a rise in ICP, this review examines in what other ways inflammation and the development of cerebral oedema may contribute to the injury process. The potential for these factors to impact upon microvascular function and reduce cerebral tissue perfusion and oxygenation is explored. In addition, the impact of TBI on glymphatic function is discussed. Following an evaluation of the potential injury processes, the scope for intervention and the development of novel therapeutic approaches is explored.
创伤性脑损伤（TBI）是全球发病和死亡的主要原因之一。尽管近年来临床护理有了显著改善，但仍有很大的空间来改善患者的预后，特别是在生活质量方面。然而，临床干预存在一个机会窗口，因为大多数的发病率和死亡率与初始创伤后出现的继发性损伤过程有关。在大脑中，与任何组织一样，炎症在损伤反应中起着重要作用。然而，特别是对于严重损伤，过度的炎症反应可能会产生有害影响。TBI后，炎症可导致脑水肿的发展和颅内压升高。如果没有有效的控制，这些过程会迅速导致患者病情恶化。这篇叙述性综述聚焦于炎症在TBI中的作用，以探讨可能有助于改善患者预后的策略。虽然脑水肿的发展、颅内压（ICP）升高与患者预后不良之间显然存在关联，但它们对患者预后的影响也存在差异。除了导致ICP升高外，本综述还研究了炎症和脑水肿的发展可能以其他哪些方式导致损伤过程。探讨了这些因素影响微血管功能以及减少脑组织灌注和氧合的可能性。此外，还讨论了TBI对类淋巴功能的影响。在评估了潜在的损伤过程后，探索了干预的范围和新型治疗方法的开发。
