Detection of Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy with CT Perfusion

We present the case of a 60‐year‐old female patient, who developed symptomatic internal carotid artery stenosis and subsequently underwent carotid endarterectomy. Four days after an uneventful surgery the patient developed confusion, seizures, and was admitted to the ICU. CT perfusion revealed reduced ispilateral time‐to‐peak and mean‐transient‐time and increased cerebral blood volume and cerebral blood flow, confirming the diagnosis of cerebral hyperperfusion syndrome. We thus propose CT perfusion as a diagnostic means for cerebral hyperperfusion syndrome, a syndrome that remains underdiagnosed.     

Update on Intensive Neuromonitoring for Patients with Traumatic Brain Injury: A Review of the Literature and the Current Situation

Intracranial pressure (ICP) measurements are fundamental in the present protocols for intensive care of patients during the acute stage of severe traumatic brain injury. However, the latest report of a large scale randomized clinical trial indicated no association of ICP monitoring with any significant improvement in neurological outcome in severely head injured patients. Aggressive treatment of patients with therapeutic hypothermia during the acute stage of traumatic brain injury also failed to show any significant beneficial effects on clinical outcome. This lack of significant results in clinical trials has limited the therapeutic strategies available for treatment of severe traumatic brain injury. However, combined application of different types of neuromonitoring, including ICP measurement, may have potential benefits for understanding the pathophysiology of damaged brains. The combination of monitoring techniques is expected to increase the precision of the data and aid in prevention of secondary brain damage, as well as assist in determining appropriate time periods for therapeutic interventions. In this study, we have characterized the techniques used to monitor patients during the acute severe traumatic brain injury stage, in order to establish the beneficial effects on outcome observed in clinical studies conducted in the past and to follow up any valuable clues that point to additional strategies for aggressive management of these patients.     

Factors Associated with Blunt Cerebrovascular Injury in Patients with Cervical Spine Injury

Blunt cerebrovascular injury (BCVI) is known to be a potentially fatal complication of cervical spine injury (CSI). Methods for screening the appropriate population remain to be elucidated, especially in Japan. This retrospective study was conducted to predict the risk factors relevant to BCVIs. Among 92 patients with CSI transferred to our institution from April 2007 to March 2012, 40 patients (35 men, 5 women) with neurological deficits and/or significant cervical spine fracture including fracture of transversarium, facet, body, lamina, and spinous process, underwent multi-detector computed tomography angiography (MDCTA) and magnetic resonance angiography (MRA), which identified 10 patients with BCVI [2 carotid artery injuries (BCAIs) and 9 vertebral artery injuries (BVAIs); 1 patient suffered both]. Univariate analyses exploring associations between individual risk factors and BCVI and BVAI were performed using Fisher''s exact test and Chi-square test for dichotomous variables and the unpaired t-test for continuous variables. Multiple logistic regression analyses for BCVI and BVAI were carried out using stepwise methods. On univariate and multivariate analysis, hyperextension injury was significantly associated with BVAI (p = 0.01 and p = 0.02), and subluxation (dislocation of vertebral body > 5 mm) was a significant predictor of BCVI (p = 0.04 and p = 0.03) and BVAI (p = 0.01 and p = 0.01). Prompt evaluation for BCVIs is recommended in CSI patients with hyperextension injury and dislocation of the vertebral body.     

免疫比浊法检验血浆D-二聚体在心脑血管疾病中的临床价值

目的研究免疫比浊法检验血浆D-二聚体在心脑血管疾病中的临床价值。方法对429例心脑血管疾病患者在溶栓治疗前后使用免疫比浊法进行血浆D-二聚体检测,同时与健康人群比对。结果三组疾病患者其治疗后的血浆D-二聚体水平较治疗前相比均下降显著（P〈0．05）,而三组疾病患者其治疗前及治疗后的血浆D-二聚体水平均显著高于志愿者组,以上差异均有统计学意义（P〈0．05）。结论临床上评估心脑血管疾病的病况及疗效预期进行免疫比浊法的血浆D-二聚体含量测定,其临床指导价值巨大。     

Cross‐reactivity between decellularized porcine corneal lamellae for corneal xenobridging and subsequent corneal allotransplants

The purpose of this study is to investigate cross‐reactivity between hypertonic saline‐treated decellularized porcine corneal lamellae for corneal xenobridging and subsequent corneal allotransplants. Five Chinese rhesus macaques, which had undergone anterior partial thickness corneal transplantation using hypertonic saline‐treated decellularized porcine corneal lamellae in preceding experiments, were used as recipients for subsequent full‐thickness corneal allografts. To determine whether sensitization of recipients to xenoantigens leads to cross‐reactivity against alloantigens, we compared; (i) allogeneic one‐way mixed lymphocyte reaction (MLR) of peripheral blood mononuclear cells (PBMCs) from xeno‐sensitized recipients with that of PBMCs from naïve rhesus macaques, and (ii) amounts of IgG antibodies that bound to the PBMCs of a rhesus panel (five monkeys) before and after xeno‐sensitization. Graft survival and immunologic profiles including memory T‐cell subsets and donor rhesus‐specific antibodies were also evaluated. No hyperacute or acute rejection was observed within a month of subsequent allotransplantation in any recipient. Alloreactivity by MLR was not different between xeno‐sensitized rhesus recipients and naïve rhesus monkeys. Panel‐reactive IgG antibodies were unchanged after xeno‐sensitization, and no change in donor rhesus‐specific antibodies was observed in any recipient. No significant changes in memory T‐cell subsets were observed during the early post‐operative period in any recipient. Decellularized porcine corneal lamellae may not increase cross‐reactivity to alloantigens, and thus, porcine corneal lamellae may be used as a bridge to subsequent corneal allografting.     

Cryptogenic stroke following abdominal free flap breast reconstruction surgery

INTRODUCTION

Abdominal free flap breast reconstruction is regarded as the gold standard method of post-mastectomy breast reconstruction by many. It is a major surgery which can be associated with varied systemic complications. To date, there have been no reports of cerebrovascular complications in the literature which examine the possible relation between thromboembolism and patent foramen ovale (PFO) in patients undergoing microvascular breast reconstruction.

PRESENTATION OF CASE

A 54-year old female with a pre-existing PFO developed a stroke following bilateral mastectomies and immediate free flap breast reconstruction on postoperative day 5. This was attributed to an air embolus caused by central venous pressure line removal. After uneventful intra and early postoperative periods, the patient had collapsed suddenly on day 5 and become unresponsive immediately following the removal of a central venous line. Brain magnetic resonance imaging confirmed a cerebrovascular accident. This resolved within 48 h following therapeutic heparinisation. A clinical diagnosis of paradoxical embolism was made and she was subsequently referred to the cardiologists for angiographic closure of the PFO.

DISCUSSION

The case study herein reported gives an account that PFO can have considerable health implications in the early postoperative period and conceivably intraoperatively in patients undergoing major reconstructive surgeries.

CONCLUSION

Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration.     

脑血管病继发体位性低血压的疗效评价

目的 :探讨生脉注射液、黄芪注射液和米多君片治疗脑血管病继发体位性低血压的疗效。方法 :脑血管病继发体位性低血压患者 2 5 3例 ,分为联合组与米多君组 ,分别采用生脉、黄芪、米多君联合治疗及单纯米多君治疗。并进行疗效评价。结果 :治疗 7d后联合组 133例 ,总有效率 91.0 % ;米多君组 12 0例 ,总有效率 72 .5 % ,2组比较差异有显著性 (P <0 .0 0 1)。结论 :生脉、黄芪和米多君对脑血管病继发体位性低血压均有较好的疗效 ,而联合用药较单一用药效果更佳 ,值得临床推广。     

缺血性脑血管病患者血浆溶血磷脂酸及血小板CD62p检测的临床研究

目的　观察智暂性脑缺血发作(TIA)和脑梗死(CI)患者血浆溶血磷脂酸(LPA)的变化,探讨其在缺血性脑血管发生发展以及早期诊断中的临床意义。方法　对78例TIA患者、6 3例脑梗死患者及4 .便健康人分别抽取静脉血,以比色法检测血浆LPA ,同时用流式细胞仪法检测CD6 2p水平,并分析其相关性。结果　TIA组、CI组血浆LPA及血小板CD6 2p水平均显著高于对照组(p <0 .0 1)。而TIA组与脑梗死组比较:血浆LPA水平TIA组明显高于脑梗死组(p <0 .0 1) ;血小板CD6 2p水平,两组之间无显著差(p >0 .0 5 )。结论　血浆LPA和CD6 2p在缺血性脑血管病的发生发展中具有重要作用,检测这些指标,这对TIA的早期诊断和有效控制脑梗死的发生率以及干预治疗等具有重要意义