Shannon P, Smith C R, Deck J, Ang L C, Ho M, Becker L
Department of Pediatric Laboratory Medicine, Hospital For Sick Children and University of Toronto, Ontario, Canada.
Acta Neuropathol. 1998 Jun;95(6):625-31. doi: 10.1007/s004010050849.
We examined an autopsy series of 14 children with shaken baby syndrome (SBS) who lacked skull fracture. Evidence of axonal injury was sought using immunohistochemical stains for neurofilament, 68-kDa neurofilament and beta-amyloid precursor protein (betaAPP). BetaAPP-positive axons were present in the cerebral white matter of all cases of SBS but were also present in 6 of 7 children dying of non-traumatic hypoxic ischemic encephalopathy (HIE). Swollen axons were present in 11 of 14 cases of SBS and in 6 of 7 cases of HIE. BetaAPP-positive axons were present in both groups in the midbrain and medulla. The cervical spinal cord in SBS contained betaAPP-positive axons in 7 of 11 cases; 5 of 7 contained swollen axons within the white matter tracts; in 2 immunoreactivity was localized to spinal nerve roots; in all 7 there was a predilection for staining at the glial head of the nerve root. Among cases of HIE, none showed abnormal axons or betaAPP-positive reactivity in the cervical cord white matter. We conclude that cerebral axonal injury is common in SBS, and may be due in part to hypoxic/ischemic injury. Cervical cord injury is also common, and cannot be attributed to HIE. These findings corroborate suggestions that flexion-extension injury about the cervical spinal column may be important in the pathogenesis of SBS.
我们检查了14例无颅骨骨折的摇晃婴儿综合征（SBS）患儿的尸检系列。使用针对神经丝、68 kDa神经丝和β-淀粉样前体蛋白（βAPP）的免疫组织化学染色来寻找轴突损伤的证据。βAPP阳性轴突存在于所有SBS病例的脑白质中，但在7例死于非创伤性缺氧缺血性脑病（HIE）的儿童中也有6例存在。14例SBS病例中有11例存在肿胀轴突，7例HIE病例中有6例存在肿胀轴突。两组的中脑和延髓均存在βAPP阳性轴突。SBS组11例中有7例颈脊髓含有βAPP阳性轴突；7例中有5例白质束内含有肿胀轴突；2例免疫反应定位于脊神经根；所有7例在神经根胶质头部均有染色倾向。在HIE病例中，颈髓白质均未显示异常轴突或βAPP阳性反应。我们得出结论，脑轴突损伤在SBS中很常见，可能部分归因于缺氧/缺血性损伤。颈髓损伤也很常见，不能归因于HIE。这些发现证实了关于颈椎屈伸损伤可能在SBS发病机制中起重要作用的观点。
