中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (6): 859-861.doi: 10.4103/1673-5374.158329

• 观点:脊髓损伤修复保护与再生 • 上一篇    下一篇

脊髓损伤并发急性脑震荡:避免漏诊的策略

  

  • 收稿日期:2015-04-13 出版日期:2015-06-18 发布日期:2015-06-18

Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

David S. Kushner   

  1. Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
  • Received:2015-04-13 Online:2015-06-18 Published:2015-06-18
  • Contact: David S. Kushner, M.D., dkushner@med.miami.edu.
  • Supported by:

    Department of Physical Medicine & Rehabilitation funding by the United States Department of Education, National Institute of Disability Research and Rehabilitation # H133A120099 (TBI Model Systems grant).

摘要:

漏诊脊髓损伤并发急性震荡,会给患者造成临床影响,混淆临床研究结果。研究科学家和临床医生,包括医生、护士、治疗师应意识到脊髓损伤时可能存在创伤性脑损伤漏诊的可能性。脊髓损伤并发创伤性脑损伤(脑震荡)的发生率可能接近60%,这与某些风险因素有关,如车祸碰撞或跌倒,脊髓损伤颈部水平尤其在C1到C4,完全脊髓损伤水平创伤以及与酒精中毒有关的创伤。对脑震荡,尤其是轻度,中度创伤性脑损伤(脑震荡)的诊断对脊髓损伤患者的康复计划和干预措施尤为重要,并能最大限度地改善功能结局,预防预测和早期治疗可能的相关并发症。此外,如果漏诊了脊髓损伤患者的创伤性脑损伤(脑震荡)情况,临床研究的记录结果可能会大打折扣。

Abstract:

Research scientists and clinicians should be aware that missed diagnoses of mild-moderate traumatic brain injuries in post-acute patients having spinal cord injuries may approach 60–74% with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trauma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of validity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

Key words: traumatic brain injury, spinal cord injuries, dual diagnosis, diagnosis, complications, rehabilitation, post-concussion syndrome, brain concussion