Neuropathological Findings in Disabled Survivors of a Head Injury
Neuropathological Findings in Disabled Survivors of a Head Injury
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DOI：
10.1089/neu.2010.1733
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Graham, David I.
中科院分区：
文献类型：
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作者：
Adams, J. Hume;Jennett, Bryan;Graham, David I.
我们调查了创伤性脑损伤（TBI）的主要神经病理类型的发生和严重程度如何影响头部损伤后残疾的严重程度。85名受害者，每个人都在头部受伤后至少活了一个月，但随后死亡，进行了研究。按格拉斯哥预后量表（GOS）评定，死亡前植物人35例，重残30例，中残20例。神经病理学检查显示71例（84%）患者有持续性脑挫伤，49例（58%）有弥漫性轴索损伤（DAI），57例（67%）有缺血性脑损伤（IBD），58例（68%）有对称性脑室扩大，47例（55%）颅内压（ICP）升高。35例（41%）接受了颅内血肿清除术。脑干损伤仅见于11例（13%）。对这些特征与结果之间关系的分析（趋势卡方检验）显示，DAI、ICP升高、丘脑损害或心室扩大（均p < 0.005）和IBD（p = 0.04）与越来越差的结果相关。相反，中度或重度挫伤（p = 0.001）与更好的结局越来越相关，血肿清除与可能优于植物人结局相关（p = 0.001）。我们的结论是，原发性轴突损伤或继发性缺血性损伤引起的脑外伤的弥漫性或多灶性神经病理学模式最有可能与头部损伤后最严重的损害结果相关。
We investigated how the occurrence and severity of the main neuropathological types of traumatic brain injury (TBI) influenced the severity of disability after a head injury. Eighty-five victims, each of whom had lived at least a month after a head injury but then died, were studied. Judged by the Glasgow Outcome Scale (GOS), before death 35 were vegetative, 30 were severely and 20 were moderately disabled. Neuropathological assessment showed that 71 (84%) victims had sustained cerebral contusions, 49 (58%) had diffuse axonal injury (DAI), 57 (67%), had ischemic brain damage (IBD), 58 (68%) had symmetrical ventricular enlargement, and in 47 (55%) intracranial pressure (ICP) had been increased. Thirty-five (41%) had undergone evacuation of an intracranial hematoma. Brainstem damage was seen in only 11 (13%). Analysis (chi(2) test for trends) of the relationship between these features and outcome showed that findings of DAI, raised ICP, thalamic damage, or ventricular enlargement (all p < 0.005), and IBD (p = 0.04) were associated with an increasingly worse outcome. Conversely, moderate or severe contusions (p = 0.001) were increasingly associated with better outcomes, and evacuation of a hematoma was associated (p = 0.001) with outcomes likely to be better than vegetative. We conclude that diffuse or multifocal neuropathological patterns of TBI from primary axonal injury or secondary ischemic damage are most likely to be associated with the most severely impaired outcomes after a head injury.