概述

慢性创伤性脑病(简称 CTE)这个术语用来描述可能由反复的头部外伤引起的脑退化。CTE 是只有在尸体解剖时通过研究大脑各部分才能做出的诊断。

CTE 是一种非常罕见的疾病,人们尚未透彻理解这种疾病。CTE 与晚年发作的头部外伤的直接后果无关。CTE 与生命早期出现的头部外伤(例如脑震荡后综合征和二次损伤综合征)之间有复杂关系。

专家们仍在努力了解反复头部外伤(包括多少次头部外伤以及这些外伤的严重程度)以及其他因素对于导致 CTE 的脑部变化有什么影响。

在足球和其他接触性运动的(包括拳击)运动员大脑中发现了 CTE。接触过爆炸冲击的军事人员也可能发生 CTE。CTE 的某些体征和症状被认为包括思维(认知)困难、身体问题、情绪和其他行为。可以这样认为,CTE 是在头部外伤后数年至数十年之后发生。

无法在生前诊断出 CTE,除非是极少数有过高风险接触的人群。研究人员尚不清楚群体中 CTE 的发生频率,也不了解原因。CTE 尚无治愈方法。

症状

目前还没有明确与 CTE 相关的具体症状。CTE 的一些可能体征和症状可发生在许多其他疾病中,但在少数已证实 CTE 的患者中,症状包括:

  • 思考困难(认知损害)
  • 行为冲动
  • 抑郁或情感淡漠
  • 短期记忆丧失
  • 计划和执行任务困难(执行能力)
  • 情绪不稳定
  • 药物滥用
  • 自杀想法或行为

CTE 症状不会在头部受伤后立即出现,但专家认为,这些症状可能会在反复的头部外伤后的几年或几十年内出现。

目前没有完整清单,说明解剖 CTE 患者时应检查哪些体征和症状。尚不清楚 CTE 可能引起什么样的症状(如果有的话)。目前对 CTE 进展情况知之甚少。

Cognitive impairment

  • Difficulty thinking (cognitive impairment)
  • Memory loss
  • Problems with planning, organization and carrying out tasks (executive function)

Behavioral changes

  • Impulsive behavior
  • Aggression

Mood disorders

  • Depression or apathy
  • Emotional instability
  • Substance misuse
  • Suicidal thoughts or behavior

Motor symptoms

  • Parkinsonism
  • Motor neuron disease

CTE symptoms don't develop right after a head injury, but experts believe that they might develop over years or decades after repeated head trauma. Experts currently believe that CTE symptoms appear in two forms. In early life between the late 20s and early 30s, the first form of CTE may cause mental health and behavioral issues including depression, anxiety, impulsivity and aggression. The second form of CTE is thought to cause symptoms later in life, around age 60. These signs and symptoms include memory and thinking problems that are likely to progress to dementia.

The full list of signs to look for in people with CTE at autopsy is still unknown. It is unclear what kind of symptoms, if any, CTE may cause during life. Little is known right now about how CTE progresses.

何时就诊

慢性创伤性脑部病变被认为是在反复脑损伤过后多年发生的,这种损伤可能是轻度的,也可能是重度的。但是,如果出现以下情况,请就医:

  • 自杀想法。研究表明,患有慢性创伤性脑部病变的人自杀的风险可能会增加。如果您有伤害自己的想法,请拨打 911、当地的紧急电话号码或拨打全美自杀预防生命热线 800-273-TALK(800-273-8255)。
  • 头部受伤。如果您头部受伤,即使不需要急救护理,也应就医。如果孩子头部受伤让您担忧,请立即联系孩子的医生。根据体征和症状,医生可能会建议立即就医。
  • 记忆力问题。如果您担心自己的记忆力或其他思维(认知)或行为问题,请就医。
  • 人格或情绪变化。如果出现抑郁、焦虑、攻击性或冲动,请就医。

病因

头部反复受伤可能是 CTE 的原因。橄榄球和冰球运动员以及在战争地区服役的军人一直是大多数 CTE 研究的重点,不过其他运动和身体虐待等因素也可导致头部反复受伤。

然而,并不是所有的运动员,也不是所有经历过反复脑震荡的人,包括军人,都会发展成 CTE。一些研究表明,头部反复受伤的人发生 CTE 的几率并没有增加。

CTE 会导致脑部区域萎缩。神经细胞传导电脉冲的部分受损会影响细胞之间的通信。

CTE 患者可能会表现出另一种神经退行性疾病的体征,包括阿尔茨海默病、肌萎缩侧索硬化症(ALS,也称为 Lou Gehrig 病)、帕金森氏病或额颞叶变性(额颞叶痴呆症)。

风险因素

人们认为导致CTE 的主要风险因素是反复发生头部损伤。但专家仍在研究导致 CTE 的风险因素。

预防

CTE 尚无治疗方法。但是 CTE 可以预防,因为它与反复脑震荡有关。有过一次脑震荡的人更有可能再次出现头部受伤。目前预防 CTE 的建议是减少轻度脑外伤和防止脑震荡后的额外损伤。

在 Mayo Clinic 治疗

May 25, 2021
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