Neuropathology of the vegetative state after head injury
Neuropathology of the vegetative state after head injury
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DOI：
10.1080/09602010443000452
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发表时间：
2005-07-01
影响因子：
2.7
通讯作者：
Jennett, B
中科院分区：
文献类型：
--
作者：
Graham, DI;Adams, JH;Jennett, B
对头部受伤后临床上确定为严重残疾（SD，n = 30）或植物人（VS，n = 35）的患者进行了详细的神经病理学研究，以确定构成这些临床状态基础的各种病理的性质和频率。 SD 患者年龄较大（SD 中位数 49.5 岁 vs. VS 中位数 38 岁，p = .04），更有可能出现清醒间隔（SD 31% vs. VS 9%，p = .03），并且更有可能患有急性颅内血肿（SD 70% vs. VS 26%，p < .001）。 SD 患者较少出现严重的 2 级或 3 级创伤性弥漫性轴突损伤（SD 30% vs. VS 71%，p = .001），并且较少出现丘脑损伤（SD 37% vs. VS 80%，p < .001）。一些 SD 和 VS 病例中也存在局灶性和弥漫性损伤的相似特征，两组患者的白质和丘脑都有相当大的损伤。结论是，SD 和 VS 的主要结构基础是弥漫性创伤性轴突损伤 (DAI)，伴有白质广泛损伤和丘脑变化。然而，缺血性脑损伤和颅内压升高的血管并发症导致了临床症状和体征。
A detailed neuropathological study of patients identified clinically after head injury as either severely disabled (SD, n = 30) or vegetative (VS, n = 35) has been carried out to determine the nature and frequency of the various pathologies that form the basis of these clinical states. Patients who were SD were older (SD median 49.5 yrs vs. VS median 38 yrs, p = .04), more likely to have a lucid interval (SD 31% vs. VS 9%, p = .03), and to have had an acute intracranial haematoma (SD 70% vs. VS 26%, p < .001). SD patients less often had severe, Grades (2 or 3) of traumatic diffuse axonal injury (SD 30% vs. VS 71%, p = .001) and less often had thalamic damage (SD 37% vs. VS 80%, p < .001). Similar features of both focal and diffuse damage were present in some SD and VS cases with both groups having considerable damage to white matter and to the thalamus. It is concluded that the principal structural basis of both SD and VS is diffuse traumatic axonal injury (DAI) with widespread damage to white matter and changes in the thalami. However, both ischaemic brain damage and the vascular complications of raised intracranial pressure contributed to the clinical signs and symptoms.