Pathological Spectrum and β-APP Immunoreactivity as a Diagnostic Tool of Diffuse Axonal Injury following Traumatic Brain Injury: A Novel Classification.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Journal of Laboratory Physicians Pub Date : 2023-09-01 DOI:10.1055/s-0043-1761926
Meenakshi Sharma, Arulselvi Subramaniam, Kangana Sengar, Vaishali Suri, Deepak Agrawal, Nabarun Chakraborty, Ravindra Mohan Pandey, Rajesh Malhotra, Sanjeev Lalwani
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引用次数: 1

Abstract

Aim  Different deposition patterns and grading systems used to define and identify DAI remain discordant and to date these are a challenge in clinical practice. Our main objective was to study the post-mortem axonal changes and develop a grading system to identify DAI on the basis of histopathological and immunoreactive β-amyloid precursor protein (β-APP) observations in severe TBI cases. Methods  Prospective study with 35 decedents with sTBI (GCS score ≤ 8) was conducted and samples were collected from three different sites-corpus callosum, thalamus and brain stem. Serial sections from each site were stained with hematoxylin and eosin (H&E), and immunohistochemistry (IHC) of β-APP. Results  We developed a grading system based on histopathological characteristics to assess the overall damage of axonal injury. We found maximum histopathological changes in cases with prolonged stay. Corpus callosum showed maximum changes in both gradings. Curiously, we also detected axonal swellings with H&E staining. Usually neglected, the thalamus also showed significant histopathological and immunoreactive changes for sTBI. Conclusion  Our study based on histopathological and β-APP scoring system to define and identify DAI thus facilitates accurate diagnosis of DAI post mortem, which has forensic implications, and may further contribute toward survival and improvement of quality of life of sTBI patients.

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病理谱和β-APP免疫反应性作为外伤性脑损伤后弥漫性轴索损伤的诊断工具:一种新的分类。
目的用于定义和识别DAI的不同沉积模式和分级系统仍然不一致,迄今为止,这些在临床实践中是一个挑战。我们的主要目的是研究死后轴突的变化,并根据组织病理学和免疫反应性β-淀粉样前体蛋白(β-APP)的观察,建立一个分级系统来识别严重TBI病例的DAI。方法对35例GCS评分≤8分的sTBI患者进行前瞻性研究,采集胼胝体、丘脑和脑干3个不同部位的样本。每个部位的连续切片用苏木精和伊红(H&E)染色,并用β-APP免疫组化(IHC)染色。结果建立了一套基于组织病理学特征的分级系统来评估轴索损伤的整体损伤程度。我们发现,在住院时间较长的病例中,组织病理学变化最大。胼胝体在两种评分中变化最大。奇怪的是,我们还通过H&E染色检测到轴突肿胀。通常被忽视的丘脑在sTBI中也表现出显著的组织病理学和免疫反应性变化。结论我们的研究基于组织病理学和β-APP评分系统来定义和识别DAI,从而有助于对死后DAI的准确诊断,具有法医意义,并可能进一步有助于sTBI患者的生存和生活质量的提高。
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Journal of Laboratory Physicians
Journal of Laboratory Physicians MEDICINE, GENERAL & INTERNAL-
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审稿时长
31 weeks
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