Valoración del daño axonal difuso en los traumatismos cráneo-encefálicos

Carmen Junqué

doi:10.24310/espsiescpsi.v2i1.13359

Autores/as

Carmen Junqué Departament de Psiquiatria i Psicobiologia Clínica. Universitat de Barcelona. España

DOI:

https://doi.org/10.24310/espsiescpsi.v2i1.13359

Palabras clave:

Traumatismo cráneo-encefálico, daño axonal difuso, resonancia magnética, imágenes de tensor de difusión

Resumen

El daño axonal difuso (DAD) en los traumatismos cráneo-encefálicos (TCE) se produce como consecuencia de daño axonal primario y secundario. Es el responsable de la mayoría de las alteraciones de atención, memoria, velocidad de procesamiento y alteraciones ejecutivas en los TCE moderados y graves. Las técnicas de resonancia magnética clínicas permiten visualizar las microhemorragias en secuencias de T2*clásicas y permiten evaluarlo de forma indirecta mediante las medidas de volumen del sistema ventricular y de superficie del cuerpo calloso. Las imágenes de tensor de difusión (ITD) son las idóneas para identificar y cuantificar el DAD. Los valores de anisotropía fraccional (AF) han demostrado ser sensibles incluso en TCE leves y a partir de las pocas horas tras el TCE y correlacionan con parámetros de gravedad tales como la escala de coma de Glasgow o la amnesia postraumática. Los decrementos de AF evolucionan con el tiempo pero parecen permanecer como secuelas definitivas de los TCE graves incluso en niños. Las correlaciones de la ITD con los trastornos neuropsicológicos han mostrado que en especial los valores de AF en el cuerpo calloso y las medidas globales de AF de todo el cerebro reflejan las secuelas clásicas de los TCE difusos.

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