急性脑出血继发缺血半暗带的研究进展

急性脑出血后血肿周边和远隔部位可出现不同程度的局部脑血流下降,其下降程度可能与血肿的大小、部位及出血时间有关。动物实验已证明,血肿周边可出现缺血半暗带,但在临床试验中并未取得一致结论。弥散加权成像和质子磁共振频谱等成像技术有助于显示血肿周边缺血半暗带,以指导临床对急性脑出血患者的个体化治疗。     

急性脑出血继发缺血半暗带的研究进展

急性脑出血后血肿周边和远隔部位可出现不同程度的局部脑血流下降，其下降程度可能与血肿的大小、部位及出血时间有关。动物实验已证明，血肿周边可出现缺血半暗带，但在临床试验中并未取得一致结论。弥散加权成像和质子磁共振频谱等成像技术有助于显示血肿周边缺血半暗带，以指导临床对急性脑出血患者的个体化治疗。     

大鼠脑出血血肿周围半暗带及其时间窗的探讨

缺血半暗带的概念最早由Astrup于1977年提出。其主要特征为缺血性、可逆性、存在的时限性即时间窗。本文旨在探讨脑出血血肿周边脑组织随着出血时间的不同是否存在着类似脑梗死病理变化的半暗带,并进一步探讨其时间窗。     

微创血肿清除术联合依达拉奉治疗高血压脑出血的临床研究

高血压脑出血是一种致残致死率很高的疾病。近年来，微创血肿清除术在高血压脑出血的血肿清除及降低颅压方面起到了积极的作用。脑出血后血肿周边的缺血半暗带内神经元的病变在一定时间内可逆。因此，改善该区域神经元的功能是脑出血治疗的关键。研究表明，氧自由基在缺血半暗带的继发性损伤中起着重要的作用，如果能在微创血肿清除术后及时有效地清除氧自由基将会对脑组织起到很好的保护作用。     

脑出血后血肿周围半暗带的影像学

脑出血患者的预后和转归与血肿周围组织损伤和恢复密切相关。脑出血后的病理生理学机制十分复杂,血肿周围组织有局部血流改变,但是否存在与脑缺血类似的“半暗带”尚无定论。目前,这方面的研究主要集中在局部脑血流和代谢的影像学检测方面,常用的研究方法包括单光子发射体层摄影、功能磁共振成像、磁共振波谱分析、正电子发射体层摄影和CT灌注成像等。这些影像学技术的应用对于确定是否存在出血周围半暗带提供了有价值的方法,但还需要进一步的研究证实。     

脑出血血肿周围局部脑血流的检测

影像学技术是研究脑血流的主要手段,文章综述了各种神经影像学技术对脑出血血肿周围半暗带的定义以及脑出血血肿周围局部脑血流的研究现状。     

尼莫地平对脑出血后缺血性脑损害保护作用的研究

目的探讨脑出血后继发性缺血性脑损害机制以及尼莫地平对脑出血后继发性缺血性脑损害的保护作用。方法60例脑出血患者随机分为尼莫地平组(30例)与常规治疗组(30例),在治疗前后用单光子发射型计算机断层显像(SPECT)观察原发灶缺血体积,血肿周围及脑部其他区域的局部脑血流量(rCBF)变化。结果尼莫地平组和常规治疗组治疗后原发灶缺血的体积明显缩小,原发灶缺血体积减少值尼莫地平组明显高于常规治疗组(P<0.01)。治疗后原发灶及远隔部位缺血灶rCBF增加值尼莫地平组明显高于常规治疗组(P<0.01)。结论脑出血后血肿周围及远隔区域可出现广泛的rCBF下降,血肿周围可能存在缺血半暗带。尼莫地平治疗脑出血有确切疗效,可改善局部脑缺血。     

急性脑出血损伤的病理生理学机制

脑出血是一种神经科常见病,但对其病理生理学机制在较多方面尚未形成共识。文章就脑出血后的血肿变化和缺血半暗带、脑水肿和纤溶亢进以及血管淀粉样变等进行了综述。     

急性脑梗塞溶栓治疗的研究近况

急性脑梗塞治疗的目的是抢救受缺血损害而尚未死亡的脑细胞,改善缺血脑组织的功能,防止脑损害的扩展,减少梗塞面积。近年来应用溶栓治疗急性脑梗塞取得了较好的疗效,已成为脑梗塞治疗的关键措施。现将研究近况综述如下。1 脑梗塞的病理生理研究显示,缺血脑组织存在3个区带,即梗塞区、半暗带区和正常区;其中缺血半暗带是人们研究的焦点,     

急性脑出血损伤的病理生理学机制

脑出血是一种神经科常见病，但对其病理生理学机制在较多方面尚未形成共识。文章就脑出血后的血肿变化和缺血半暗带、脑水肿和纤溶亢进以及血管淀粉样变等进行了综述。     

口服抗凝剂相关脑出血的再认识

在人口老龄化进程不断加剧的背景下,口服抗凝剂(OAC)越来越多地用于临床实践,尤其是随着新型口服抗凝剂(NOAC)的适应证不断扩大,以NOAC为代表的抗凝时代已经到来.口服抗凝剂相关脑出血(OAC-ICH)是一种发生在抗凝治疗下的医源性效应,研究显示接受OAC治疗的患者脑出血(ICH)发生风险较未接受OAC治疗的患者高...     

脑出血后铁代谢异常

脑出血(intracerebral hemorrhage, ICH)是一种临床常见的高致残率和高死亡率的脑血管病.大量临床和实验研究表明,ICH后血肿周围脑组织铁代谢异常是造成脑水肿和神经细胞凋亡等继发性脑损伤的重要原因,是影响患者转归的重要因素.文章对ICH后铁代谢异常及其意义进行了综述.     

Symptomatic intracerebral hematomas in posterior circulation stroke patients anticoagulated with heparin

Background: A lot of clinicians use heparin in patients with posterior circulation stroke. Frequency and risk factors of symptomatic intracerebral hematoma (ICH) in posterior circulation infarct patients anticoagulated with unfractionated heparin are not known. Methods: To determine the incidence and the risk factors of the heparin-related ICH in posterior circulation infarct patients, we retrospectively reviewed the clinical features of 37 patients who had acute posterior circulation infarct and received intravenous heparin after they underwent brain computed tomographic scans and diffusion-weighted imaging (DWI). Follow-up brain scans were obtained at any time if clinical symptoms worsened. Volumes of acute posterior circulation infarction were calculated on DWI. Results: Of 37 patients, four (10.8%) developed symptomatic ICH during heparin infusion. The location of ICH was cerebellum in all the hemorrhagic worsening patients. We found that the size of an acute infarction calculated on DWI is the risk factor of symptomatic ICH during intravenous heparin therapy in patients with posterior circulation infarct. Conclusions: Until a large prospective study is performed, it may be prudent to avoid heparin infusion in patients with large posterior circulation infarct documented on DWI.     

钙离子与鼠脑出血继发性损伤的关系及尼莫地平的保护作用

目的 探讨Ca^2 与脑出血继发性损伤的关系及其尼莫地平的保护作用。方法 通过脑内注射胶原酶建立大鼠脑出血模型，采用草酸一焦锑酸钾电镜细胞化学技术，从形态学角度在观察脑出血后血肿周围脑组织超微病理变化的同时，直观地了解钙在缺血神经组织的分布，并观察Ca^2 拮抗剂的保护作用。结果 脑出血组神经细胞、胶质细胞及毛细血管的超微结构有肿胀表现，细胞内可见多量Ca^2 颗粒一钙拮抗剂治疗组细胞病理变化显减轻，钙分布明显减少，对照组偶见Ca^2 颗粒。结论 血肿周围组织存在水肿和继发性缺血，细胞内Ca^2 稳态失调在神经细胞损害中起重要作用。     

Computed tomography and clinical parameters predict intracerebral hemorrhage expansion

This study aimed to evaluate the association of imaging signs, and to establish a predictive model through selecting highly relevant imaging signs in combination with clinical parameters for hematoma expansion.Intracerebral Hemorrhage (ICH) patients who received 2 consecutive noncontrast computed tomography scans were examined and recruited through January 2014 to December 2020. Demographic information and clinical characteristics were collected. Two experienced radiologists reviewed baseline noncontrast computed tomography images to assess the imaging characteristics. Correlation analysis was analyzed with Pearson and Spearman correlation tests. The association between clinical and imaging predictors with hematoma expansion was evaluated in multivariate models. Receiver operating characteristic (ROC) curve analysis was adopted to evaluate predictive performance.A total of 232 ICH patients, with mean age of 59.73 years, and 31% of female were included, among which, 32 patients occurred with hematoma expansion. For sex, ICH density, low density in hematoma, the midline shift, and Glasgow Coma Scale score, liquid level, H-tra, edema Cor, H Volume, time from onset to examination, there were significant differences between the 2 groups. As for imaging signs, only blend sign showed a significant difference, that patients with blend sign had a higher incidence of ICH expansion. The logistic analysis found that radiation attenuation, liquid level, the midline shift, Glasgow Coma Scale score, history of ischemic stroke, and smoking could predict the occurrence of ICH expansion.In summary, the model combined radiological characteristics with clinical indicators showed considerable predictive performance. Further validation is needed to verify the findings and help transfer to clinical practice.     

Imaging the penumbra in acute stroke

Imaging continues to have a huge impact on the understanding of the ischemic penumbra and the management of acute stroke. Determinants of penumbral tissue fate, such as age, hyperglycemia, hematocrit, and oxygen concentration, are increasingly being recognized using neuroimaging. The significance of the penumbra in the white matter and in posterior circulation stroke is also becoming clearer. Neuroimaging is also making invaluable contributions to clinical decision making in acute stroke, especially in relation to reperfusion therapies in the 3- to 6-hour time window. Despite ongoing questions over the choice of parameters to identify the penumbra and their respective clinical usefulness, imaging is gaining widespread use in acute stroke management. However, definitive evidence of its benefit is still lacking. This review explores the recent progress and controversies relating to imaging of the penumbra.     

急性脑梗死患者影像学缺血半暗带的临床评价策略

缺血性卒中再灌注治疗近年来取得了重大进展,治疗前快速精准评估缺血半暗带是临床诊治的紧迫需求。目前,影像学是显示缺血半暗带最直观、有效的方法,该方法通过利用组织窗筛选出能够从再灌注治疗中获益的患者,并预估风险和预后。作者介绍了急性脑梗死影像学缺血半暗带的临床评估模式,并对不同发病时间、拟进行再灌注治疗患者的缺血半暗带评价策略进行了分层优先推荐。     

脑出血管涌现象的临床病理学研究

目的对血肿周围脑组织进行病理学观察,探讨"管涌现象"的临床特点。方法随机选取行立体定向微创血肿清除术的脑出血患者18例,对术中吸出的血肿周围脑组织HE染色,光镜下观察病理学改变。结果 18例患者血肿周围组织内均可见分布在血管周围间隙或神经纤维周围间隙内的"管涌现象"病灶。分布在血管周围间隙内的"管涌现象"病灶围绕在小血管周围呈环状分布,分布在神经纤维周围间隙内的"管涌现象"病灶在神经纤维间呈指状分布。结论 "管涌现象"在临床脑出血患者的血肿周围组织内广泛存在。     

Magnetic resonance imaging: Implication in acute ischemic stroke management

Multimodality magnetic resonance imaging (MRI) techniques, including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), fluid-attenuated inversion recovery (FLAIR), T2 susceptibility imaging, and magnetic resonance angiography (MRA), quickly provide accurate information about ischemic penumbra (DWI/PWI mismatch), tissue perfusion, and vascular localization in acute stroke setting. These techniques help physicians to select the proper candidates for thrombolysis and/or neuroprotective treatment to salvage tissue at risk (mismatch) and monitor acute stroke patients after treatment. Recent and ongoing trials demonstrate the benefit of treating acute stroke patients depending on tissue at risk of infarction rather than timing of onset. These techniques will extend timing to salvage ischemic brain tissue beyond the 3-hour window. MRI is a powerful tool for managing acute stroke patients and helps elucidate the pathophysiology of cerebral ischemia in a given patient.     

小覆盖范围CT灌注成像对急性大脑中动脉供血区脑卒中的评价

目的探讨用较小扫描范围的CT灌注成像检查对急性大脑中动脉供血区脑卒中的诊断效能。方法回顾性分析急诊接治的22例连续脑卒中患者,均在发病1～24 h行CT平扫和CT灌注成像检查。应用Z轴80 mm范围灌注参数,得出脑梗死核心区、半暗带的体积。计算半暗带/(半暗带+梗死核心区)比值。根据Z轴长度80 mm的CT灌注结果的治疗方案为基线,将较小覆盖范围获得的结果制定的治疗方案,计算较小范围灌注评价治疗的敏感性与特异性。结果当半暗带/(半暗带+梗死核心区)比值>0.2时,较小覆盖范围应用40 mm范围的CT灌注检查,可以准确评价梗死核心区与半暗带。结论大脑中动脉供血区脑卒中患者,当半暗带/(半暗带+梗死核心区)>0.2时,40 mm的Z轴覆盖范围CT灌注成像能够对病灶的范围与性质做出诊断。