Diffuse axonal injury in head trauma
Diffuse axonal injury in head trauma
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DOI：
10.1097/00001199-200307000-00003
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发表时间：
2003-07-01
影响因子：
2.4
通讯作者：
Shull, WH
中科院分区：
文献类型：
--
作者：
Smith, DH;Meaney, DF;Shull, WH
背景：弥漫性轴索损伤（DAI）是创伤性脑损伤（TBI）最常见、最重要的病理特征之一。轴突对机械损伤的易感性似乎是由于它们的粘弹性特性和它们在白质束中的高度组织。虽然轴突在正常情况下是柔软的，但当它们暴露在与脑外伤相关的快速变形中时，它们会变得脆弱。因此，轴突的快速拉伸会损伤轴突细胞骨架，导致弹性丧失和轴浆运输受损。随后的轴突肿胀出现在离散的球茎形成或长形的静脉曲张中，这些静脉曲张积聚了运输蛋白。钙进入受损的轴突被认为通过蛋白酶的激活引发进一步的损伤。最终，肿胀的轴突可能会断开连接，并导致脑组织中额外的神经病理变化。DAI可能在很大程度上解释了脑外伤的临床表现。然而，DAI非常难以无创检测，并且很难定义为临床综合征。结论：DAI的诊断和治疗的未来进展将取决于我们对损伤生物力学、颞轴突病理生理学及其在患者预后中的作用的共同理解。
Background: Diffuse axonal injury (DAI) is one of the most common and important pathologic features of traumatic brain injury (TBI). The susceptibility of axons to mechanical injury appears to be due to both their viscoelastic properties and their high organization in white matter tracts. Although axons are supple under normal conditions, they become brittle when exposed to rapid deformations associated with brain trauma. Accordingly, rapid stretch of axons can damage the axonal cytoskeleton resulting in a loss of elasticity and impairment of axoplasmic transport. Subsequent swelling of the axon occurs in discrete bulb formations or in elongated varicosities that accumulate transported proteins. Calcium entry into damaged axons is thought to initiate further damage by the activation of proteases. Ultimately, swollen axons may become disconnected and contribute to additional neuropathologic changes in brain tissue. DAI may largely account for the clinical manifestations of brain trauma. However, DAI is extremely difficult to detect noninvasively and is poorly defined as clinical syndrome. Conclusions: Future advancements in the diagnosis and treatment of DAI will be dependent on our collective understanding of injury biomechanics, temporal axonal pathophysiology, and its role in patient outcome.