弥漫性脑轴索损伤的病理研究

A Pathological Study on Diffuse Axonal Injury

在脑外伤中弥漫性脑轴索损伤(DAI)较常见,死亡率仅次于急性硬脑膜下血肿。文献报道的DAI多为交通事故伤。作者对15例非交通事故引起的脑损伤死亡病人脑行大体病理学检查、HE染色和嗜银染色组织学检查,诊断出DAI 5例,其中胼胝体和/或脑干肉眼观挫伤出血4例,仅为脑干显微镜下出血1例。在伤后存活48～84 h的3例DAI中,胼胝体、脑干和大脑半球有广泛性分布的轴索回缩球和小胶质细胞簇。4例DAI伤后持续性昏迷,3例临床诊断为"原发性脑干伤",病理学检查提示脑干孤立性损伤的"原发性脑干伤"是很少存在的,"原发性脑干伤"仅是DAI的一种临床表现。

Diffuse axonal injury (DAI) is a common injury and its mortality is the second to the acute subdural hematoma in brain injury. Most of DAI cases reported are caused by traffic accidents. In our study, the detailed pathological examination with macroscopy, haematoxylin and eosin staining and silver impregnation technique were performed in 15 patients with fatal brain injury caused by non-traffic accidants, of which 5 patients were found with DAI. Macroscopic contusion and haemorrhages in corpus callosum and/or brain stem were found in 4 cases, microscopic hemorrhages in brain stem were only local lesions in one case. In the three patients survived from 48 to 84 hours, the axonal retraction halls and small microgliai clusters were widespread in corpus callosum, brain stem and white matter of the cerebral hemisphers. Four patients with DAI had continual primary coma, three of them were clinically diagnosed as 'primary brain stem injury'. The pathological examination suggests 'primary brain stem injury'rarely occur in isolation, it is only a clinical manifestation of DAI.