Changes in the metabolism of sphingolipids after subarachnoid hemorrhage

We previously described how ceramide (Cer), a mediator of cell death, increases in the cerebrospinal fluid (CSF) of subarachnoid hemorrhage (SAH) patients. This study investigates the alterations of biochemical pathways involved in Cer homeostasis in SAH. Cer, dihydroceramide (DHC), sphingosine‐1‐phosphate (S1P), and the activities of acid sphingomyelinase (ASMase), neutral sphingomyelinase (NSMase), sphingomyelinase synthase (SMS), S1P‐lyase, and glucosylceramide synthase (GCS) were determined in the CSF of SAH subjects and in brain homogenate of SAH rats. Compared with controls (n = 8), SAH patients (n = 26) had higher ASMase activity (10.0 ± 3.5 IF/µl· min vs. 15.0 ± 4.6 IF/µl ? min; P = 0.009) and elevated levels of Cer (11.4 ± 8.8 pmol/ml vs. 33.3 ± 48.3 pmol/ml; P = 0.001) and DHC (1.3 ± 1.1 pmol/ml vs. 3.8 ± 3.4 pmol/ml; P = 0.001) in the CSF. The activities of GCS, NSMase, and SMS in the CSF were undetectable. Brain homogenates from SAH animals had increased ASMase activity (control: 9.7 ± 1.2 IF/µg ? min; SAH: 16.8 ± 1.6 IF/µg ? min; P < 0.05) and Cer levels (control: 3,422 ± 26 fmol/nmol of total lipid P; SAH: 7,073 ± 2,467 fmol/nmol of total lipid P; P < 0.05) compared with controls. In addition, SAH was associated with a reduction of 60% in S1P levels, a 40% increase in S1P‐lyase activity, and a twofold increase in the activity of GCS. In comparison, NSMase and SMS activities were similar to controls and SMS activities similar to controls. In conclusion, our results show an activation of ASMase, S1P‐lyase, and GCS resulting in a shift in the production of protective (S1P) in favor of deleterious (Cer) sphingolipids after SAH. Additional studies are needed to determine the effect of modulators of the pathways described here in SAH. © 2015 Wiley Periodicals, Inc.     

丹颐防治蛛网膜下腔出血后脑血管痉挛

目的观察丹颐防治蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的疗效。方法将SAH患者44例,随机分为丹颐组(20例)和对照组(24例),2组均于发病48 h内接受治疗。SAH对照组用脱水,止血等常规疗法,丹颐组在常规疗法基础上加用丹颐100ml,静脉滴注,1/d,共10 d。结果1个月内,丹颐组的CVS发生率,死亡率明显低于SAH对照组(P<0.05),再出血发生率2组比较无显著差异(P>0.05)。发病第14 d时,丹颐组患者的病情级别明显低于SAH对照组(P<0.05)。结论丹颐防治SAH后CVS疗效确切,并能促进神经功能的尽快恢复,且无增加再出血的危险。     

以自发性蛛网膜下腔出血为首发症状左迷走锁骨下动脉多发动静脉瘘治疗分析

目的探讨以自发性蛛网膜下腔出血为首发症状左迷走锁骨下动脉多发动静脉瘘的临床表现、诊断及治疗经验。方法回顾性分析1例以自发性蛛网膜下腔出血为首发症状左迷走锁骨下动脉多发动静脉瘘患者的临床资料。结果本例头部CT示蛛网膜下腔出血伴脑室出血,320排CTA及DSA诊断为左迷走锁骨下动脉多发动静脉瘘,行弹簧圈、ONYX胶联合真丝线段栓塞治疗。术后患者恢复良好,未发生其他并发症。术后8 d复查320排CTA见降主动脉弓迷走血管仅留残端,瘘完全消失。结论左迷走锁骨下动脉多发动静脉瘘是一种罕见血管性疾病,3D-DSA仍是诊断动静脉瘘的金标准,治疗成功的关键必须先控制供血迷走动脉血流,再栓塞或夹闭瘘口,要彻底治愈本病必须闭塞瘘口。     

脑血流储备与蛛网膜下腔出血后迟发性脑缺血相关性的临床分析

目的：探讨脑血流储备（ CVR ）与蛛网膜下腔出血（ SAH ）后迟发性脑缺血（ DCI ）的相关性。方法研究采用双盲法,对SAH患者进行CO2吸入试验,并用TCD测定试验前后的血流速度,根据公式计算CVR值。将患者分为CVR下降的病例组、CVR正常的病例组、CVR下降的对照组及CVR 正常的对照组。结果对4组DCI发生率进行校正的卡方检验,有统计学意义,说明CVR下降可作为DCI发生的预测指标。结论对SAH患者进行CVR的评估可作为临床预测DCI发生的指标之一。     

Predictors of early left ventricular systolic dysfunction in duchenne muscular dystrophy patients

Introduction: Early detection of left ventricular systolic dysfunction (LVSD) is important for therapeutic strategies for Duchenne muscular dystrophy (DMD) patients. We analyzed myocardial strain using echocardiography for early detection of LVSD and determined the predictors of early LVSD. Methods: This investigation was a cross‐sectional study of 40 DMD patients with normal left ventricular ejection fraction. Global longitudinal strain (GLS) was used to analyze subtle disturbances in longitudinal contraction of the myocardium. Patients were determined to have early LVSD (GLS > –18) or normal left ventricular systolic function (GLS ≤ –18). Results: Patients who had early LVSD were older and had a higher frequency of corticosteroid therapy and of mutations in exons 45, 46, 47, 48, 49, 50, and 52. Discussion: Myocardial strain measurements are useful for the early diagnosis of LVSD in DMD patients. Older age, use of corticosteroids, and mutations within the “hot‐spot” region of the DMD gene are associated with early LVSD. Muscle Nerve 58 : 84–89, 2018     

Comparison of lumbar drainage and external ventricular drainage for clearance of subarachnoid clots after Guglielmi detachable coil embolization for aneurysmal subarachnoid hemorrhage

Objective

Subarachnoid clots play an important role in development of delayed vasospasm after subarachnoid hemorrhage (SAH). The purpose of this study was to compare clearance of subarachnoid clots using external ventricular drainage (EVD) or lumbar drainage (LD) after Guglielmi detachable coil (GDC) embolization for aneurysmal SAH.

Methods

The subjects were 51 treated with GDC coil embolization for aneurysmal Fisher group 3 SAH within 72 h of ictus. Software-based volumetric quantification of the subarachnoid clots was performed on CT scans and the hemoglobin (Hb) level was measured in CSF drained from each catheter.

Results

Clearance of subarachnoid clots was more rapid in patients treated with LD (n = 34) compared to those treated with EVD (n = 17). The Hb level in CSF was significantly higher in the LD group on Days 4–5 after onset of SAH (P < 0.05), but was higher in the EVD group on Days 8–9. The incidence of symptomatic vasospasm did not differ between the two groups. The rate of occurrence of a new low density area on CT scans was higher in patients treated with EVD, but not significantly higher than the rate in the LD group.

Conclusion

GDC embolization followed by lumbar drainage accelerates the reduction of subarachnoid clots, but EVD may contribute to stasis of hemorrhage within subarachnoid spaces.