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面试官: 你在早年经历过某种创伤性脑损伤, 然后你接受治疗，你的症状减轻或消失了, and then 年后 you start to notice some symptoms again that you might think have something to do with that traumatic brain injury you had earlier in your life.
Dr. 德里克埃 在犹他健康大学的尼尔森康复中心. And I guess the first question for this is can somebody experience symptoms later from an injury that they had to their brain earlier in their life?
脑损伤后迟发性症状
Dr. 奥尔雷德: 这个问题的答案是，“嗯，这要看情况.“所以人们通常认为创伤性脑损伤是最常见的形式, 也就是脑震荡, 或者轻微的创伤性脑损伤. But the scope of brain injury and the damage that you can do can be on the milder side or it can be on the more severe side.
我在诊所看到的一个常见的抱怨是, 假设, 高中时踢足球时多次脑震荡. 十年后，他们开始头疼了. 于是他们说：“医生，我得了脑震荡. 现在我头疼. 我担心是我以前的创伤性脑损伤造成的." And then we'll go through a series of, “嗯, let's see if we can find other causes. 你的饮食有问题吗? Are there other stressors or are there other issues that are contributing to the headaches?"
认知问题、情绪问题和睡眠问题也是如此. 这些都是大发娱乐在临床中看到的典型问题, after some一个 has sustained a concussion and they come back several 年后 with concerns after the fact.
把现在的症状和过去的创伤联系起来
面试官: And when somebody comes in and they're concerned that a concussion earlier in their life is causing some issues later in their life, 和他们的对话是什么样的? 你要怎么做才能弄清楚是不是这样?
Dr. 奥尔雷德: 好吧, the first thing we would do is get a very complete and comprehensive history of the event surrounding the brain injury. 尽病人所能, 发生的机制, 之后出现的症状, 他们治疗这些症状多久了, 以及经济复苏的情况.
然后大发娱乐会取什么症状, 说, 头痛或情绪紊乱, and we would really dig down with questioning and physical exam to try and tease out other potential possibilities of what could or could not be causing the symptoms that the patient is presenting with.
因为它把某些东西归因于脑损伤, 无论是心情, 认知, 疼痛, 感觉障碍, 或者在任何方面发挥作用, 诊断是排除性的吗. So we just have to be thorough and comprehensive in making sure that we are familiar with other potential causes before we would attribute it to a brain injury.
这就是检查的一部分. It's not so much to attribute it to the brain injury as much as it is to make sure that it's not something else that's going on.
面试官: Do you find that patients that come in tend to think that these new symptoms are a result of the brain injury they had, 然后你会发现, no, 其实是别的东西?
Dr. 奥尔雷德: The vast majority of the time, if some一个 truly did just have a single concussion . . . And there are complaints in the clinic that most of the time we can find other potential causes. 然而，这也取决于脑损伤的性质.
有时人们会说, “嗯, 我得了脑震荡," and then actually maybe the nature of their brain injury was a little more severe than what they thought. There are protocols and there are things that we look at in terms of testing that we would pursue depending on what your history and symptoms are.
治疗方法：全面解决症状
面试官: 当你弄明白之后, what's your kind of rate of success of being able to uncover that mystery and solve that mystery and help the patient with whatever it is they happen to be suffering from?
Dr. 奥尔雷德: 我有偏见，但我觉得大发娱乐做得很好. 幸运的是，在我的领域里，大发娱乐没有在孤岛里工作. 所以在康复管理中, 尤其是在脑损伤管理方面, 大发娱乐有多个学科来满足特定的需求, 无论是心理学家, 或者是不同专业的治疗师, to really look at the patient holistically and take both pharmacologic and non-pharmacologic approaches to manage patients.
每个病人都不一样. 我告诉病人，每个人的脑损伤都是不同的. 没有两个脑损伤是相同的. And so we really have to take inventory of what that patient's presentation is and what they need to do to get back to what they would deem normal life and really structure a rehab and treatment program to help them reach their goals.
管理病人的关注和期望
面试官: 在我看来，这有点 . . . 你在解开一个谜，对吧? 你真的在试图弄清楚，“这是什么原因?“这通常需要很长时间还是很短的时间? 我的意思是，一般来说，你看起来像什么样的时间框架?
Dr. 奥尔雷德: 通常不会花太长时间，但是，每个人都是不同的. 大发娱乐是彻底的. 如果大发娱乐能在短时间内解决问题，那就太好了. Sometimes we have to go down rabbit holes to help the patients and we’re more than willing to do that. 所以这要看情况.
面试官: 我知道这也会让病人感到沮丧，对吧? 有人走进来说：“你们为什么不解决这个问题呢?" But sometimes it's a little bit more complicated than that and some detective work has to be d一个. 通常不是，但有时是.
Dr. 奥尔雷德: 有时候是没有答案的. 医学不是一门精确的科学. But we always strive to do our best to at least make sure that serious issues aren't occurring and then go from there.
面试官: 是的, and try to take care of the symptoms as best 一个 can even if there isn't an answer, trying to help that patient manage those and live their life as normal as possible.
Dr. 奥尔雷德: There is no shame in seeking out medical attention when you have worrisome symptoms. 绝大多数病人, 当他们脑震荡的时候, if later in life they're having some symptoms that they may attribute to a potential brain issue, 然后再. Let us evaluate that and we can tease out whether or not it is related to the brain or if there are some other things that we can do to intervene to help you get back the reassurance or to address any issues that need to be treated or dealt with.
面试官: 我可以想象对病人来说, 有时候突然之间会让人担心, 年后, they develop these symptoms that they think might be a result of a brain injury that they had earlier in their life. 这就有点令人担忧了. 我是说，这会导致更糟的事情吗? 一般来说，是做还是不做?
Dr. 奥尔雷德: 一般来说, in the setting of a concussion or even in the setting of a few isolated concussions, 大多数病人最后都没事了. And I think getting that reassurance is probably 一个 of the more important things.
But I don't want patients to think that they had a concussion and so they shouldn't worry about being seen. 任何时候你有任何担心, 我的意思是, it's certainly an appropriate step to reach out to a provider to make sure you go through an evaluation.
If there's a concern of something going on in the brain years after a concussion, 这样大发娱乐就更有能力也更愿意进行调查，以确保, 一个, 没有别的事情发生, 并在问题出现时解决这些问题.
更新日期：2024年3月7日
最初发布日期：2022年12月7日