Decision-making deficit of a patient with axonal damage after traumatic brain injury.
Decision-making deficit of a patient with axonal damage after traumatic brain injury.
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脑外伤后轴突损伤患者的决策缺陷。
DOI：
10.1016/j.bandc.2013.11.005
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发表时间：
2014
影响因子：
2.5
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Yasuno F;Matsuoka K;Kitamura S;et al.
据报道，患有创伤性脑损伤（TBI）的患者很难做出有利的决定，但参与这一过程的大脑区域网络的潜在缺陷并未得到直接检查。我们报告了一名 TBI 患者，他在交通事故脑损伤后在危险和复杂的情况下表现出了问题行为。爱荷华州赌博任务（IGT）被用来揭示他在决策过程中的缺陷。为了检查大脑区域网络的潜在缺陷，我们检查了该患者的 T1 加权结构 MRI、扩散张量成像 (DTI) 和 Tc-ECD SPECT。患者出现IGT异常。 DTI-MRI 结果显示，通过丘脑的脑干和皮质区域之间的束的各向异性分数 (FA) 显着下降。他的双侧岛叶皮质、下丘脑和后扣带皮层的灰质体积显着减少，可能反映了继发于束异常的华勒变性。 SPECT 显示包括腹内侧前额皮质 (VM) 在内的广泛皮质区域的血流量显着减少。我们的研究表明患者的决策过程不正常。神经束的微观结构异常（可能是由交通事故引起）导致大脑传入反馈减少，导致决策效率降低。我们的研究结果支持体细胞标记假说（SMH），即对大脑的体细胞反馈会影响决策过程。
Patients with traumatic brain injury (TBI) were reported to have difficulty making advantageous decisions, but the underlying deficits of the network of brain areas involved in this process were not directly examined. We report a patient with TBI who demonstrated problematic behavior in situations of risk and complexity after cerebral injury from a traffic accident. The Iowa gambling task (IGT) was used to reveal his deficits in the decision-making process. To examine underlying deficits of the network of brain areas, we examined T1-weighted structural MRI, diffusion tensor imaging (DTI) and Tc-ECD SPECT in this patient. The patient showed abnormality in IGT. DTI-MRI results showed a significant decrease in fractional anisotropy (FA) in the fasciculus between the brain stem and cortical regions via the thalamus. He showed significant decrease in gray matter volumes in the bilateral insular cortex, hypothalamus, and posterior cingulate cortex, possibly reflecting Wallerian degeneration secondary to the fasciculus abnormalities. SPECT showed significant blood flow decrease in the broad cortical areas including the ventromedial prefrontal cortex (VM). Our study showed that the patient had dysfunctional decision-making process. Microstructural abnormality in the fasciculus, likely from the traffic accident, caused reduced afferent feedback to the brain, resulting in less efficient decision-making. Our findings support the somatic-marker hypothesis (SMH), where somatic feedback to the brain influences the decision-making process.