脑震荡后综合征及其客观评定技术的发展

Postconcussional syndrome and the development of its objective assessment techniques

脑震荡后综合征诊断具有很大的争议性。轻度创伤性脑损伤后脑震荡综合征的发病机制,涉及神经损伤和心理社会因素。迄今,已有大量的研究对现有的检查方法或工具(包括精神检查、常规CT和核磁共振、神经心理学测试和神经生化检查)的评定和诊断价值进行了分析。轻度创伤性脑损伤的受损部位主要分布在灰白质交界附近和大脑深部中线结构,由于大脑损伤的弥漫性,常规影像学检查无阳性发现。本文对脑震荡后综合征的流行病学研究、诊断现状及争议、常规诊断技术、新型核磁共振成像技术在脑震荡后综合征和轻度创伤性脑损伤诊断中的应用及展望进行了综述。现代大脑成像技术可无创定量评定大脑损伤,并可能成为脑震荡后综合征诊断及法医学鉴定更敏感和更有前途的评定工具。

The diagnosis of post-concussion symptoms of that its pathogenesis is often involved in both neural （PCS） has been a controversial issue because damage and psychosocial factors. Recent researches have examined the diagnostic and evaluating value of several available methods or tools, including clinical interview, conventional CT and magnetic resonance imaging （ MRI）, neuropsychologic testing and neuro- chemical test. In mild traumatic brain injury （MTBI）, there exist diffusive damages to white matter distributed particularly near the gray matter-white matter boundary and in the long white-matter tracts in midline structures. The conventional imaging techniques are unable to detect any positive evidence due to the diffusive nature of these injuries. This paper is to review epidemiologic study, diagnostic criteria and relevant disputes, conventional diagnostic strategy and new MRI techniques, and then evaluate the application and prospective value of them in the diagnosis and rating of PCS and MTBI. Non-invasively quantitative assessments of modem brain imaging technique may be developed to sensitive and promising tools in the diagnosis and forensic evaluation of PCS.