机动车碰撞后持续性脑震荡后综合征：一例27个月多模式康复纵向病例研究

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中文摘要

背景： 持续性脑震荡后综合征（PPCS）在轻度创伤性脑损伤（mTBI）后发生于10%至30%的患者中，然而最有效的管理方法仍是一个未决问题。本报告描述了一名37岁女性，她在机动车碰撞中受伤，并被前瞻性随访27个月。基线时的结构化评估发现了眼动、前庭、自主神经、认知和神经生理多个领域的功能障碍。一个强化多模式康复方案与症状负担减少86%相关（脑震荡后症状量表：80降至11），到第六个月时达到这一效果。此后，尽管继续治疗，症状逐渐复发，在27个月时患者仍报告中度至重度头痛（6至7分，满分10分）、持续性头晕（5至6分，满分10分）以及有意义的功能受限。这里观察到的轨迹，以初始改善随后进行性复发为特征，说明了PPCS患者亚组中常见的波动性且往往不完全的恢复。临床医生应预期这一模式并据此设定结果预期，同时将持续、适应性的管理策略纳入长期护理计划。

英文摘要

Persistent post-concussion syndrome (PPCS) develops in 10 to 30 percent of patients following mild traumatic brain injury (mTBI), yet the most effective management approach remains an open question. This report describes a 37-year-old female who sustained a motor vehicle collision and was followed prospectively over 27 months. Structured evaluation at baseline identified dysfunction across oculomotor, vestibular, autonomic, cognitive, and neurophysiological domains. An intensive multimodal rehabilitation programme was associated with an 86 percent reduction in symptom burden (Post-Concussion Symptom Scale: 80 to 11) by the six-month mark. Thereafter, symptoms gradually returned in spite of continued treatment, and at 27 months the patient still reported moderate-to-severe headache (6 to 7 out of 10), persistent dizziness (5 to 6 out of 10), and meaningful functional limitations. The trajectory observed here, marked by initial gains followed by progressive relapse, illustrates the fluctuating and often incomplete recovery seen in a subgroup of PPCS patients. Clinicians should anticipate this pattern and frame outcome expectations accordingly, while building sustained, adaptive management strategies into long-term care plans.