Daño axonal difuso secundario a traumatismo craneoencefálico
1. DAÑO AXONAL DIFUSO
SECUNDARIO A TRAUMATISMO
CRANEOENCEFÁLICO
Neurología del paciente en situación critica (Neurocríticos).
2. EPIDEMIOLOGÍA
• TCE: Principal causa de muerte en EEUU en pacientes de 1-45
años.
• Incidencia en Europa: 235/100.000.
• Razón varón/mujer: 2-3/1.
• Daño axonal difuso: 50% lesiones en TCE.
• Mayor causa de morbilidad.
3. EPIDEMIOLOGÍA
Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil
2006; 21:544
6. Marshall LF, Marshall SB, Klauber MR, et al. The diagnosis of head injury requires a classification based on computed axial
tomography. J Neurotrauma 1992; 9 Suppl 1:S287.
7. Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a
comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 2005; 57:1173.
8. Lesión secundaria a fuerzas de
• Aceleración-desaceleración.
• Rotacionales.
No es necesario impacto.
Disociación clínico-radiológica.
Sustancia blanca del tronco, cuerpo calloso y
de ambos hemisferios cerebrales.
MECANISMOS
16. FISIOPATOLOGÍA
• Daño axonal primario.
• Interrupción del transporte
axonal.
• Daño axonal secundario.
• Acúmulo del material
transportado.
• Edema del axón.
17. Siedler DG, Chuah MI, Kirkcaldie MTK, Vickers JC, King AE. Diffuse axonal injury in brain trauma: insights from alterations in
neurofilaments. Frontiers in Cellular Neuroscience. 2014;8:429. doi:10.3389/fncel.2014.00429.
18. Varicosidades a lo largo del axon.
Chen, X. H., Meaney, D. F., Xu, B. N., Nonaka, M., Mcintosh, T. K., Wolf, J. A., et al. (1999). Evolution of neurofilament subtype
accumulation in axons following diffuse brain injury in the pig. J. Neuropathol. Exp. Neurol. 58, 588–596.
Bulbos axonales terminales.
19.
20. Johnson, V. E., Stewart, W., and Smith, D. H. (2013). Axonal pathology in traumatic brain injury. Exp. Neurol. 246, 35–43. doi:
10.1016/j.expneurol.2012.01.013
21. Smith, D. H., Uryu, K., Saatman, K. E., Trojanowski, J. Q., and Mcintosh, T. K. (2003). Protein accumulation in traumatic brain injury.
Neuromolecular Med. 4, 59–72. doi: 10.1385/nmm:4:1-2:59
22. Zhao Y, Song J, Ma X, Zhang B, Li D, Pang H. Rosiglitazone ameliorates diffuse axonal injury by reducing loss of tau and up-regulating
caveolin-1 expression. Neural Regeneration Research. 2016;11(6):944-950.
TRATAMIENTO
23. ESTIMULACIÓN MAGNÉTICA TRANSCRANEAL
Villamar MF, Santos Portilla A, Fregni F, Zafonte R (2012). Noninvasive brain stimulation to modulate neuroplasticity in traumatic
brain injury. Neuromodul: J Int Neuromodul Soc 15(4):326–338.
24. Pathophysiology Associated with Traumatic Brain Injury: Current Treatments and Potential Novel Therapeutics. Cell Mol Neurobiol
2016.