在创伤性脑损伤和动脉瘤下关节出血后的下丘脑垂体功能障碍:一个系统性审查
Harald Jörn Schneider1, Ilonka Kreitschmann-Andermahr, Ezio Ghigo
1Neuroendocrinology Group, Max Planck Institute of Psychiatry, Munich, Germany. schneider@mpipsykl.mpg.de
JAMA
|September 27, 2007
概括
脑下垂体是创伤性脑损伤和脑下垂体出血后的常见并发症,影响生活质量. 早期发现和治疗对于更好的康复结果至关重要.
科学领域:
- 神经内分泌学神经内分泌学
- 神经学 神经学
- 内部医学 内部医学
背景情况:
- 神经内分泌功能障碍是创伤性脑损伤 (TBI) 和动脉瘤下关节出血 (aSAH) 后的常见但未被确诊的并发症.
- 这种后果代表了一个严重的,但可以治疗的,影响患者康复的条件.
研究的目的:
- 审查TBI和aSAH后对下丘脑垂体功能障碍的现有研究.
- 了解创伤后的下垂体病的自然史和临床影响.
主要方法:
- 在MEDLINE数据库 (2000-2007年) 上进行了系统的文献搜索.
- 关键词包括TBI,aSAH和特定的脑垂体激素缺乏症.
- 来自19项涉及1137名患者的研究的数据被汇总在一起,以计算患病率.
主要成果:
- 脑下垂体病的综合患病率在TBI后为27.5%,在aSAH后为47%.
- 与轻度/中度病例相比,重度TBI患者的患病率更高.
- 神经内分泌异常可能是暂时的或随着时间的推移而演变,影响生活质量和代谢健康.
结论:
- 脑下垂体是TBI和aSAH后的一个普遍并发症.
- 它显著导致发病率,并可能损害脑损伤后的恢复.
- 对于这种诊断不足的疾病,需要进一步的研究和临床关注.
相关概念视频
Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Traumatic Brain Injury l: Introduction
DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...


