Immediate coma following inertial brain injury dependent on axonal damage in the brainstem.
Immediate coma following inertial brain injury dependent on axonal damage in the brainstem.
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DOI：
10.3171/jns.2000.93.2.0315
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发表时间：
2000-08
影响因子：
4.1
通讯作者：
D. Smith;M. Nonaka;R. Miller;M. Leoni;X. H. Chen;D. Alsop;D. Meaney
中科院分区：
文献类型：
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作者：
D. Smith;M. Nonaka;R. Miller;M. Leoni;X. H. Chen;D. Alsop;D. Meaney
弥漫性轴索损伤（DAI）可导致脑外伤后即刻和长期昏迷。然而，轴突损伤的分布和创伤后昏迷之间的关系还没有被检查。在本研究中，作者研究了这种关系。方法采用猪惯性性脑损伤模型，探讨创伤后昏迷的解剖学起源。麻醉的小型猪进行非冲击诱导的头部旋转加速度沿着无论是冠状面或轴向平面（每组6头猪）。即刻长时间昏迷始终由头部轴向平面旋转产生，而不是由头部冠状面旋转产生。损伤脑的免疫组织化学检查显示，所有动物的DAI都是由头部沿沿着平面旋转产生的。然而，在通过头部轴向平面旋转损伤的猪中发现脑干中广泛的轴突损伤。在这些动物中，发现昏迷的严重程度与脑干中轴突损伤的程度（p < 0.01）和施加的动力负荷条件（p < 0.001）两者相关。昏迷和其他脑区轴突损伤的程度之间没有关系。结论脑干轴突损伤在创伤后即刻昏迷的发生中起主要作用，DAI可在无昏迷的情况下发生。
OBJECT Immediate and prolonged coma following brain trauma has been shown to result from diffuse axonal injury (DAI). However, the relationship between the distribution of axonal damage and posttraumatic coma has not been examined. In the present study, the authors examine that relationship. METHODS To explore potential anatomical origins of posttraumatic coma, the authors used a model of inertial brain injury in the pig. Anesthetized miniature swine were subjected to a nonimpact-induced head rotational acceleration along either the coronal or axial plane (six pigs in each group). Immediate prolonged coma was consistently produced by head axial plane rotation, but not by head coronal plane rotation. Immunohistochemical examination of the injured brains revealed that DAI was produced by head rotation along both planes in all animals. However, extensive axonal damage in the brainstem was found in the pigs injured via head axial plane rotation. In these animals, the severity of coma was found to correlate with both the extent of axonal damage in the brainstem (p < 0.01) and the applied kinetic loading conditions (p < 0.001). No relationship was found between coma and the extent of axonal damage in other brain regions. CONCLUSIONS These results suggest that injury to axons in the brainstem plays a major role in induction of immediate posttraumatic coma and that DAI can occur without coma.