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脑弥漫性轴索损伤的康复训练效果
脑弥漫性轴索损伤(brain diffuse axonal injury,DAI)是闭合性脑外伤的一种原发性脑损伤,受伤时头部处于活动状态,病情严重、致残率及死亡率的影响.近一年来,我们对6例DAI患者进行了系统的康复训练,疗效显著.
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The accumulation of myelin debris may be a major contributor to the inlfammatory response after diffuse axonal injury. In this study, we examined the accumulation and clearance of myelin debris in a rat model of diffuse axonal injury. Oil Red O staining was performed on sections from the cerebral cortex, hippocampus and brain stem to identify the myelin debris. Seven days after diffuse axonal injury, many Oil Red O-stained particles were observed in the cerebral cortex, hippocampus and brain stem. In the cerebral cortex and hippocampus, the amount of myelin debris peaked at 14 days after injury, and decreased signiifcantly at 28 days. In the brain stem, the amount of myelin debris peaked at 7 days after injury, and decreased signiifcantly at 14 and 28 days. In the cortex and hippocampus, some myelin debris could still be observed at 28 days after diffuse axonal injury. Our ifndings suggest that myelin debris may persist in the rat central ner-vous system after diffuse axonal injury, which would hinder recovery.
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Fractional anisotropy values in diffusion tensor imaging can quantitatively relfect the consistency of nerve ifbers after brain damage, where higher values generally indicate less damage to nerve ifbers. Therefore, we hypothesized that diffusion tensor imaging could be used to evaluate the effect of mild hypothermia on diffuse axonal injury. A total of 102 patients with diffuse axonal injury were randomly divided into two groups:normothermic and mild hypothermic treatment groups. Patient’s modiifed Rankin scale scores 2 months after mild hypothermia were signiifcant-ly lower than those for the normothermia group. The difference in average fractional anisotropy value for each region of interest before and after mild hypothermia was 1.32-1.36 times higher than the value in the normothermia group. Quantitative assessment of diffusion tensor imaging indicates that mild hypothermia therapy may be beneifcial for patients with diffuse axonal injury.
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Previous neuropathological studies regarding traumatic brain injury have primarily focused on changes in large structures, for example, the clinical prognosis after cerebral contusion, intrace-rebral hematoma, and epidural and subdural hematoma. In fact, many smaller injuries can also lead to severe neurological disorders. For example, cerebral microbleeds result in the dysfunc-tion of adjacent neurons and the disassociation between cortex and subcortical structures. These tiny changes cannot be adequately visualized on CT or conventional MRI. In contrast, gradient echo sequence-based susceptibility-weighted imaging is very sensitive to blood metabolites and microbleeds, and can be used to evaluate traumatic cerebral microbleeds with high sensitivity and accuracy. Cerebral microbleed can be considered as an important imaging marker for dif-fuse axonal injury with potential relevance for prognosis. For this reason, based on experimental and clinical studies, this study reviews the role of imaging data showing traumatic cerebral mi-crobleeds in the evaluation of cerebral neuronal injury and neurofunctional loss.
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弥漫性轴索损伤临床诊断与治疗进展
弥漫性轴索损伤(diffuse axonal iniury,DAI)是头部遭受加速和(或)减速惯性力引起的脑损伤,以广泛轴索断裂为特征,常见于车祸伤及坠落伤.其诊断与治疗比较困难,患者多预后不良,病死率达42%~62%,重残及植物状态生存者占30%~40%[1].为此,笔者拟对近年弥漫性轴索损伤的临床诊断与治疗进展进行扼要介绍.
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典型脑弥漫性轴索损伤的康复方法与转归l例报告
DATA OF CASEThe patient was male and married, aged 45 years old. He was a en-geneerer, which was hospitalized because hypolegia after traumacaused by traffic accident and memory was bad for half onemonth. The result of skull CT showed diffuse swelling of brainparenchyma and shrink of ventricular system. Fracture and hematomawere not seen (diagnosed as brain contusion).
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早期纳洛酮治疗弥漫性轴索损伤的临床观察
弥漫性轴索损伤是外伤直接引起的脑白质广泛轴索损伤,患者伤情一般较重,是外伤后长期昏迷和严重神经功能障碍的主要原因之一.本院采用盐酸纳洛酮治疗脑弥漫性轴索损伤50例,取得良好疗效,现报告如下.
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脑弥漫性轴索损伤40例临床诊治
脑弥漫性轴索损伤(diffuse.axonal.injurg,DAI)是由Adrims等在1982年正式命名.并被国际学术界所公认.
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弥漫性轴索损伤32例诊疗体会
弥漫性轴索损伤(DAI diffuse axonal injury)属重型颅脑损伤的一种,其诊断和治疗极为困难,预后极差.我院1998年~2002年有32例病人被诊断为弥漫性轴索损伤.讨论如下.
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颅脑特殊结构对弥漫性轴索损伤形成的影响
弥漫性轴索损伤(diffuse axonal injury,DAI)是颅脑损伤中一种常见的原发性损伤,以胼胝体、脑干等脑中线部位局灶性病变及脑白质广泛性轴索损伤为特征,患者常伤情重,治疗难,预后差[1].临床及生物力学研究表明,DAI的发生有其独特的致伤机制,即由外力使颅脑产生旋转和(或)直线加速度,脑组织内部发生剪应力作用导致神经轴索和小血管损伤,同时颅脑特殊结构对于应力分布和应变响应也起着重要作用,进而影响DAI病灶的形成和分布.
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提高弥漫性轴索损伤的临床诊治水平
1956年,Strich首次报告了15例因头部外伤持续昏迷5~15个月后死亡的病例,镜下检查发现全脑白质神经纤维缺失和明显变性,残留数量不等的正常神经纤维和髓鞘.当时,Strich将这种损伤命名为弥漫性白质变性(diffuse degeneration of matter).1961年,Strich又发现头部外伤后存活48 h者,脑组织中有神经轴索收缩球形成[1].1977年以后,Adams等做了大量工作,并于1982年正式提出弥漫性轴索损伤(diffuse axonal injury,DAI),它是指由颅脑损伤导致的大脑半球、胼胝体、脑干(有时为小脑)轴突的弥漫性损伤[2].目前多数学者认为,只要头部遭受具有一定加速度的暴力打击,均可引起脑组织的神经纤维损伤而发生DAI,这是闭合性脑外伤中的一种原发性脑损伤,几乎是脑损伤的基本病理改变[3].
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Objective: To analyze the mechanism of diffuse axonal injury (DAI) and study the relationship between DAI and brain concussion, brain contusion, and primary brain stem injury.Methods: The clinical data and iconographic characteristics of 56 patients with DAI were analyzed retrospectively.Results: Traffic accidents were the main cause of DAI. Among the 56 cases, 34 were injured for at least twice, and 71.43% of the patients were complicated with contusion.Conclusions: It is considered that DAI is a common pattern of primary brain injury, which is often underestimated. And DAI includes cerebral concussion and primary brain injury, and is often complicated by cerebral cortex contusion. Therefore, it is very simple and practical to divide primary brain injuries into local and diffuse injuries.
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Cerebral atrophy is one of the serious sequelae ofsevere head injury. 1 Neuropathologicalinvestigation has revealed that cerebral atrophy iscaused by either diffuse axonal injury or cerebralhypoxia and ischemia. Secondary ipsilateral cerebralatrophy caused by acute subdural hematomas in infantshas been reported recently, but this unilateral cerebralatrophy after head injury in adult patients has rarelybeen reported.
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Treatment of Diffuse Axonal Injury
The clinical manifestation, treatment and the outcome of 26 patients with diffuse axonal injury (DAI) in recent 3 years were analyzed retrospectively. To improve the efficiency of comprehensive treatment and to avoid complications were the classical methods we advocated.