Role of subconcussion in repetitive mild traumatic brain injury

慢性创伤性脑病 医学 运动员 创伤性脑损伤 神经心理学 脑震荡 无症状的 神经炎症 磁共振弥散成像 神经影像学 头部受伤 物理医学与康复 神经科学 毒物控制 伤害预防 病理 物理疗法 磁共振成像 外科 精神科 认知 心理学 放射科 医疗急救 疾病
作者
Julian E. Bailes,Anthony L. Petraglia,Bennet I. Omalu,Eric A. Nauman,Thomas M. Talavage
出处
期刊:Journal of Neurosurgery [Journal of Neurosurgery Publishing Group]
卷期号:119 (5): 1235-1245 被引量:482
标识
DOI:10.3171/2013.7.jns121822
摘要

Research now suggests that head impacts commonly occur during contact sports in which visible signs or symptoms of neurological dysfunction may not develop despite those impacts having the potential for neurological injury. Recent biophysics studies utilizing helmet accelerometers have indicated that athletes at the collegiate and high school levels sustain a surprisingly high number of head impacts ranging from several hundred to well over 1000 during the course of a season. The associated cumulative impact burdens over the course of a career are equally important. Clinical studies have also identified athletes with no readily observable symptoms but who exhibit functional impairment as measured by neuropsychological testing and functional MRI. Such findings have been corroborated by diffusion tensor imaging studies demonstrating axonal injury in asymptomatic athletes at the end of a season. Recent autopsy data have shown that there are subsets of athletes in contact sports who do not have a history of known or identified concussions but nonetheless have neurodegenerative pathology consistent with chronic traumatic encephalopathy. Finally, emerging laboratory data have demonstrated significant axonal injury, blood-brain barrier permeability, and evidence of neuroinflammation, all in the absence of behavioral changes. Such data suggest that subconcussive level impacts can lead to significant neurological alterations, especially if the blows are repetitive. The authors propose “subconcussion” as a significant emerging concept requiring thorough consideration of the potential role it plays in accruing sufficient anatomical and/or physiological damage in athletes and military personnel, such that the effects of these injuries are clinically expressed either contemporaneously or later in life.
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