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脑震荡后综合征

Author
Randolph W Evans, MD, FAAN
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editor
Janet L Wilterdink, MD

引言

脑震荡后综合征(postconcussion syndrome, PCS)是创伤性脑损伤(traumatic brain injury, TBI)的常见后遗症，是一种症候群，包括头痛、头晕、神经精神症状和认知损害[1]。PCS最常见于轻度TBI，也可能发生在中度和重度TBI后，类似的症状还可见于挥鞭伤(whiplash injury)后[2]。意识丧失不是PCS发生的必要条件。

目前关于PCS，尤其是其迁延型，尚有争议[3]。其症状模糊、主观，并常见于一般人群。受累患者群体具有异质性，有不同程度的头部和脑损伤。个体患者特征可能改变损伤的表现。PCS的基础病理生理学尚未明确。检查结果可能异常，也可能正常，即使异常存在，也不遵循一致性确定的模式。

轻度TBI发生在头部钝力性非穿透性损伤后。它最常被定义为头部损伤后30分钟，经格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分13-15分确定为轻度(表 1)。脑震荡属于轻度TBI，是一种创伤诱导的精神状态改变，可能伴或不伴意识丧失[4]。本专题将讨论PCS的病理生理学、临床特征、诊断和处理。脑震荡和轻度TBI的急性表现、处理及其他后遗症将单独讨论。 (参见“脑震荡和轻度创伤性脑损伤”和“婴儿和儿童的头部轻微创伤：评估”)

流行病学

30%-80%的轻度到中度脑损伤患者会出现PCS的一些症状。所报道的发病率范围如此之广，反映出所研究的患者人群的差异性，以及PCS诊断标准(根据各个症状或已定义的临床标准)的差异性。常用的有两种临床标准，即国际疾病分类(International Classification of Diseases, ICD)ICD-10以及精神障碍诊断与统计手册-Ⅳ(Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM-Ⅳ)，但所得到的结果差异很大，即使在相同患者人群内亦如此[5]。

一些研究已尝试通过多种指标在轻度TBI患者中将PCS与脑损伤严重程度联系起来，包括GCS(表 1)、意识丧失或创伤后遗忘持续时间，以及CT或MRI上是否存在显像异常或异常范围[2,5-8]。总的来说，损伤的严重程度与PCS风险无明确关联。然而，至少一项研究提示，既往脑震荡史(尤其在近期发生或多次发生)是脑震荡后症状持续时间延长的危险因素[9]。

                      

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Literature review current through: 2017-06 . | This topic last updated: 2013-10-10.
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