从DSM-5和ICD-11中撤除后的持续性脑震荡后综合征：定义分歧与神经认知缺口

文献信息

中文摘要

相当一部分少数患者在轻度创伤性脑损伤后未能完全康复。持续性脑震荡后综合征包括认知和非认知表现，然而DSM-5和ICD-11撤除了该综合征作为独立诊断，并将其持续性后遗症完全重新归类于神经认知类别。虽然这一重新分类处理了该综合征的认知成分，但未为其非认知后果提供单一类别，包括前庭、眼动、头痛相关、自主神经、睡眠和疼痛相关表现。在某些患者中，这些可能是损伤后最具致残性的后果。本叙述性综述审视了由此产生的诊断缺口及其他持续存在的分歧。已发表的诊断标准在症状数量、持续时间和其他要求上存在差异，导致患病率估计范围过宽，从11.4%到38.7%，令人难以接受。我们回顾了该综合征的现状，并提出一种将诊断与归因分离的方法。最后，我们讨论了认知与非认知后果通过共享神经基质之间的相互作用，因此一个领域的异常可能影响另一领域的功能。由于认知和非认知表现可能分离，患者可能在一个领域表现正常或仅有轻微发现，而在另一领域存在功能显著的异常；因此，仅局限于一个领域的评估（如新分类所反映的）不能排除该综合征。

英文摘要

A substantial minority of patients do not recover fully after mild traumatic brain injury. Persistent post-concussion syndrome includes both cognitive and non-cognitive manifestations, yet DSM-5 and ICD-11 withdrew the syndrome as a distinct diagnosis and reorganized its persistent sequelae exclusively within neurocognitive categories. While this reorganization addresses the cognitive component of the syndrome, it provides no single category for its non-cognitive consequences, including vestibular, oculomotor, headache-related, autonomic, sleep, and pain-related manifestations. In some patients, these may be the most disabling consequences of the injury. This narrative review examines the resulting diagnostic gap and other continuing disagreements. Published criteria differ in symptom count, duration, and other requirements, yielding an unacceptably wide range of prevalence estimates, from 11.4% to 38.7%. We review the current status of this syndrome and propose an approach that separates diagnosis from attribution. Finally, we discuss the interactions between cognitive and non-cognitive consequences through shared neural substrates, so abnormalities in one domain may influence function in another. Because cognitive and non-cognitive manifestations may dissociate, a patient may have normal or minimal findings in one domain and functionally significant abnormalities in the other; therefore, evaluation confined to one domain alone (as reflected in the new classifications) cannot exclude the syndrome.