Krauss J K, Tränkle R, Kopp K H
Department of Neurosurgery, Albert-Ludwigs-Universität, Freiburg, Germany.
Neurology. 1996 Dec;47(6):1488-92. doi: 10.1212/wnl.47.6.1488.
The present study investigates the occurrence of post-traumatic movement disorders in survivors of severe head injury. We studied a series of 398 consecutive patients who were admitted to the hospital with a Glasgow Coma Score of 8 or less after they sustained a head trauma. One hundred thirty-four out of 398 patients (34%) died after they were admitted to the hospital or in the further course. A recent follow-up was obtained in 221 of the 264 remaining patients (84%). Follow-up consisted of a three-level assessment, including questionnaires, telephone interviews, and personal examinations. Fifty out of 221 patients (22.6%) had developed movement disorders secondary to the head trauma, which were transient in 23 patients (10.4%) and persistent in 27 patients (12.2%). Forty-two patients (19%) had tremors, nine (4.1%) had dystonia, and seven (3.2%) had other movement disorders. Twelve patients (5.4%) had disabling low-frequency kinetic tremors (2.5 to 4 Hz) or dystonia, or both. Low-frequency kinetic tremors developed with a latency from 2 weeks to 6 months after trauma, and dystonia with a latency from 2 months to 2 years. When compared with patients without movement disorders, this subgroup was characterized by a different distribution profile of Glasgow Coma Scores with a higher proportion of lower scores on admission (p < 0.05). When we compared the initial CT findings, there were highly significant associations between generalized brain edema and the occurrence of any movement disorders, between generalized brain edema and the occurrence of persistent movement disorders, and between generalized brain edema and the occurrence of kinetic tremors and dystonia. We detected similar associations for focal cerebral lesions, but not for subdural and epidural hematomas. In conclusion, transient or persistent movement disorders are common sequelae in survivors of severe head injury. Disabling movement disorders such as kinetic tremors and dystonia, however, occur only in a small group of patients.
本研究调查了重度颅脑损伤幸存者创伤后运动障碍的发生情况。我们研究了一系列连续的398例患者，这些患者在头部外伤后因格拉斯哥昏迷评分8分及以下而入院。398例患者中有134例（34%）在入院后或后续病程中死亡。在其余264例患者中的221例（84%）获得了近期随访。随访包括三级评估，包括问卷调查、电话访谈和体格检查。221例患者中有50例（22.6%）发生了继发于头部外伤的运动障碍，其中23例（10.4%）为短暂性，27例（12.2%）为持续性。42例患者（19%）有震颤，9例（4.1%）有肌张力障碍，7例（3.2%）有其他运动障碍。12例患者（5.4%）有导致功能障碍的低频运动性震颤（2.5至4Hz）或肌张力障碍，或两者皆有。低频运动性震颤在创伤后2周内至6个月出现，肌张力障碍在创伤后2个月至2年出现。与无运动障碍的患者相比，该亚组的格拉斯哥昏迷评分分布特征不同，入院时较低评分的比例更高（p<0.05）。当我们比较初始CT检查结果时，广泛性脑水肿与任何运动障碍的发生、广泛性脑水肿与持续性运动障碍的发生以及广泛性脑水肿与运动性震颤和肌张力障碍的发生之间均存在高度显著的关联。我们在局灶性脑损伤中也检测到了类似的关联，但在硬膜下和硬膜外血肿中未检测到。总之，短暂性或持续性运动障碍是重度颅脑损伤幸存者常见的后遗症。然而，导致功能障碍的运动障碍如运动性震颤和肌张力障碍仅发生在一小部分患者中。
