Cerebral venous angioma associated with varix

A rare case of cerebral varix associated with a venous angioma is reported. Findings on dynamic computed tomography were highly characteristic and closely correlated to those on angiography. To our knowledge, such a combination of cerebral vascular anomalies has been reported only once previously.     

第四脑室出血扩张与预后关系的探讨

作者报道１９８８～１９９５年经ＣＴ扫描证实的成人第四脑室出血（ＩＶＨ）５２例临床治疗资料。其中２８例有第四脑室出血并第四脑室扩张，尽管采取积极的综合治疗，所有患者均死亡。另２４例第四脑室出血非扩张者，有１０例死亡，１４例生存，质量良好。第四脑室出血扩张患者的死亡率明显高于非扩张组患者。两组ＧＣＳ评分存在较大差异。多因素分析提示，第四脑室出血扩张是预测预后的一项最有意义的指标，其次是ＧＣＳ评分，居第三位的是弥漫性脑室出血。     

Cerebral angiography and neuropsychological measurement: The twain may meet

In a sample of 31 cerebral revascularization candidates, severity and dissemination of atherosclerosis on the cerebral angiogram were correlated with two of three global indicators of neurobehavioral impairment. Additionally, the angiographic rating was correlated with age and with an index of medical risk factors, but not with duration of the longest symptomatic episode. It seems likely that several variables, particularly collateral circulation, help to determine whether a given pattern of stenoses results in neuropsychological dysfunction and what type of behavioral deficit occurs. In many cases, the configuration of neuropsychological test scores may not directly mirror the pattern of cerebrovascular stenoses.     

浅低温脑保护降温方法及其作用机制研究进展

背景 低温特别是浅低温对脑缺血缺氧性损伤具有保护作用,其降温方法近年来有了较为深入的研究,并取得了较大进展.目的 分析总结各种浅低温降温法及其作用机制.内容 浅低温降温法主要有全身浅低温降温法和局部浅低温降温法,即选择性头部浅低温降温法,每种降温法又分为无创浅低温降温法和有创浅低温降温法.浅低温分为缺血前浅低温、缺血期...     

右美托咪定预处理减轻脑缺血-再灌注后的脑局部炎症反应

目的利用大鼠大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)模型观察右美托咪定预处理减轻脑炎症反应的机制。方法雄性SD大鼠42只,体重220~250g,随机分为七组,每组6只:假手术组(S组):大鼠不做任何干预,只分离一侧颈动脉;MCAO组(M组):阻断一侧颈内动脉血流,缺血90min;D10组:MCAO前30min腹腔注射右美托咪定10μg/kg;D50组:MCAO前30min腹腔注射右美托咪定50μg/kg;D100组:MCAO前30 min腹腔注射右美托咪定100μg/kg;DY组:腹腔注射右美托咪定50μg/kg前10min给予育亨宾5mg/kg;Y组:MCAO前40min腹腔注射育亨宾5mg/kg。MCAO后24h采用TTC染色法测定脑梗死面积,神经功能评分法评定脑损伤程度。采用TUNEL染色法评估大脑皮层细胞凋亡情况,采用Western blot法检测AMPK和磷酸化AMPK(pAMPK)蛋白含量,并计算pAMPK/AMPK值;采用ELISA法检测脑组织中肿瘤坏死因子α(TNF-α)和白细胞介素1β(IL-1β)含量。缺血-再灌注后第1、2、5天评估运动功能。结果与S组比较,M组神经功能评分、脑组织中TNF-α和IL-1β含量明显升高,梗死面积、凋亡细胞数明显增加,运动功能评分明显降低(P0.01)。与M组比较,D10、D50和D100组神经功能评分、脑组织中TNF-α和IL-1β含量明显降低,梗死面积、凋亡细胞数明显减少,pAMPK/AMPK值、运动功能评分明显升高(P0.05);D50和D100组上述指标改变较D10组更为明显(P0.05)。与D50组比较,DY和Y组和YpAMPK/AMPK值明显降低(P0.01)。结论 MCAO后右美托咪定预处理可以通过激活AMPK减轻脑缺血后炎症反应,保护脑组织,改善脑功能,并且高剂量右美托咪定较低剂量的效应更为明显。采用α2肾上腺素能受体拮抗药育亨宾可阻断右美托咪定的这些效应。     

A technique of clipping giant intracranial aneurysms with the preservation of the parent artery

Several methods are currently available for the treatment of giant intracranial aneurysms. In this report, we emphasize the technique of temporary trapping of the aneurysm followed by aspiration and collapse, and subsequent clipping. This method permits the preservation of the parent vessel and avoids the need for creating a microvascular bypass. Two cases are presented to illustrate this technique; in one case the patient had a giant middle cerebral artery aneurysm, and in the other a giant carotid-ophthalmic artery aneurysm. Both aneurysms were successfully clipped with preservation of the major vessels and a good result. On the basis of the configurations of their necks, giant aneurysms can be classified into three groups. The different methods of treating these aneurysms are reviewed with respect to this classification.     

Management of cerebral vasospasm

Cerebral vasospasm is delayed narrowing of the large arteries of the circle of Willis occurring 4 to 14 days after aneurysmal subarachnoid hemorrhage (SAH). It is but one cause of delayed deterioration after SAH but, in general, is the most important potentially treatable cause of morbidity and mortality after SAH. Development of vasospasm is best predicted by the volume, location, persistence and density of subarachnoid clot early after SAH. Diagnosis is made by catheter angiography or, with less accuracy, by computed tomographic angiography, transcranial Doppler ultrasound or other methods. Treatment remains problematic because it is expensive, time-consuming, associated with substantial risk and largely ineffective. Treatment includes optimization of factors that affect cerebral blood flow and metabolism, systemic administration of nimodipine, hemodynamic therapy and pharmacologic and mechanical angioplasty.     

Relationship between blood viscosity and cerebral ischemia after surgical treatment of ruptured intracranial aneurysms

To determine the role of blood viscosity after surgical treatment of ruptured intracranial aneurysms, the relationship between blood viscosity and clinical condition was examined in 17 patients. A total of 213 blood samples were analyzed. An inverse correlation was found between blood viscosity and level of consciousness; in addition, blood viscosity was higher when focal neurologic deficit was observed. Hematocrit was similarly related to clinical condition, although the correlations observed were less strong. Postoperative plasma viscosity was higher in patients with focal neurologic deficit. Regular blood viscosity measurements are of value in patients at risk for developing cerebral ischemia.     

羟丁酸钠对新生大鼠缺血缺氧性脑损害的干预作用

目的 观察羟丁酸钠对新生大鼠缺血缺氧性脑损害的干预作用。方法 新生7dSD大鼠随机分为假手术组(S组)、生理盐水对照组(C组)、羟丁酸钠组(γ组),7组又分为γ_1、γ_2、γ_3组。各组20只。采用Rice法制作新生大鼠缺血缺氧性脑损害模型。C组缺血缺氧后即刻腹腔注射生理盐水,每日3次;γ_1、γ_2、γ_3组分别注射羟丁酸钠50、100和200 mg/kg,用法同C组。观察大鼠缺血缺氧后28d内存活率、脑部形态学改变、左/右大脑半球重量比值、左大脑半球含水量和学习记忆能力(Y-迷宫法)。结果 (1)C组动物存活率(60％)明显低于其余各组(P<0.05)。(2)学习记忆能力测试表明:C组达标率(41.7％)明显低于其他各组(P<0.05);γ_1组与γ_2、γ_3和S组相比,学习记忆能力较差;(3)C组和γ_1组左/右大脑半球湿重之比值明显小于γ_2、γ_3和S组(P<0.01或P<0.05);各组左侧大脑半球含水量差异无显著性(P<0.05);C组左侧大脑半球液化坏死后空洞发生率明显高于其他各组(P<0.05)。结论 羟丁酸钠对新生大鼠具有抗缺血缺氧性脑损害的作用。     

近红外光谱仪在颈动脉内膜剥脱术中的应用

颈动脉内膜剥脱术(carotid endarterectomy,CEA)是预防有症状或者无症状严重颈动脉狭窄患者脑卒中的一项有效治疗手段,但是术中阻断颈动脉缺血期可能会引起围手术期脑卒中的发生,应用术中神经监测技术可以及时发现术中脑缺血,从而采取相应的治疗措施。近红外光谱(near-infrared spectroscopy,NIRS)可以通过监测局部脑氧饱和度(regional cerebral oxygen saturation,rSO 2)的变化从而反映颅内灌注,判断缺血的发生,由于其操作简单、无创,可以进行术中连续监测而广泛应用于CEA。文章结合近年国内外最新研究,分析CEA术中各种神经监测技术的实用性及准确性,围绕CEA术中各种神经监测技术、NIRS与其他监测技术之间的相关性、NIRS在预测术中缺血及术后过度灌注方面发挥的作用展开介绍,多方面探索NIRS在临床中的作用,使其在临床工作中发挥更大的功效。     

低温对猪脑复苏和脑保护结局的影响及其机制

目的：通过对比低温的脑保护作用和脑复苏作用来探讨低温脑复苏机制。方法：将乳猪分为三组：（Ａ）常温组（３７℃，１２例）、（Ｂ）脑缺血前低温组（３２℃，１３例）、（Ｃ）脑缺血后低温组（３２℃，１４例）；室颤１０分钟进行心肺复苏（ＣＰＲ）；ＣＰＲ后２小时、５小时取脑组织测定乳酸、天门冬氨酸、谷氨酸、丙二醛含量并做电镜观察。结果：Ｂ、Ｃ两组各值均低于Ａ组（Ｐ＜０．０５），Ｂ、Ｃ两组间无差异；电镜示Ａ组脑呈进行性不可逆性损害，Ｂ、Ｃ为轻度可逆性损伤。结论：低温具有预防和阻断脑再灌注损害的双重作用。低温脑复苏机制与低温脑保护机制相似，低温可抑制脑乳酸的产生、降低脑自由基、兴奋性氨基酸含量。     

猫脑缺血时脑不同部位脑血流与氨基酸的变化

目的 比较缺血时猫脑不同部位脑血流、氮基酸的变化并研究两者之间的关系。方法 利用激光多普勒血流计，持续监测猫脑不同部位（颞叶、枕叶）在脑缺血时脑皮层表面的血流变化；利用微透析技术，测定相同位置细胞间隙中的氨基酸变化。结果 在阻断猫大脑中动脉（MCA）后，颞叶和枕叶部位的脑血流迅速下降，分别为正常值的21．44％和23．61％，并在2h内缓慢下降；微透析液中谷氨酸浓度迅速增加，可达到正常值的80余倍。结论 缺血时猫颞叶和枕叶的脑血流与谷氨酸浓度变化相同，差异无统计学意义。     

颅内动脉瘤术中阻断动脉后脑缺血发生的相关因素分析

目的探讨颅内动脉瘤手术中可能导致动脉阻断后脑缺血发生的相关因素。方法１９９４年１０月至１９９７年３月间对２７例颅内动脉瘤进行颅内外动脉的永久和（或）暂时性阻断,阻断前后用激光多普勒血流测定仪（ＬＤＦ）对被阻断动脉供应区脑组织的局部脑血流实施连续监测。将患者性别、年龄、动脉瘤大小、术前动脉瘤分级、阻断前的ＬＤＦ值、阻断后ＬＤＦ最大下降幅度、阻断解除后ＬＤＦ恢复的程度、动脉被阻断的持续时间、阻断次数、被阻断的程度诸变量进行单因素分析,探讨动脉阻断后可能导致缺血性损伤的原因。结果阻断后ＬＤＦ最大下降幅度、动脉被阻断的持续时间、阻断次数、被阻断的程度与动脉阻断后脑缺血的发生有显著相关。结论ＬＤＦ测定技术能及时了解动脉阻断后局部残存脑血流量的变化趋势及血管的侧支循环能力;动脉阻断后脑组织局部残存血流量若大于正常时的５０％时,动脉阻断持续时间小于２０分钟,暂时性阻断动脉是安全的,不会引起局部脑缺血的发生     

Implementation of cerebral autoregulation into computational fluid dynamics studies of cardiopulmonary bypass

Peri‐ or postoperative neurological complications are among the main risks for patients undergoing extracorporeal circulatory support (ECC). Two of the main reasons are an increased risk for strokes and altered flow conditions leading to cerebral hypoperfusion. This is strongly affected by cerebral autoregulation, which is the body's intrinsic ability to provide sufficient cerebral blood flow (CBF) despite changes in cerebral perfusion pressure (CPP). This complex mechanism has been mainly neglected in numerical studies, which have often been applied for analysis of ECC. In this study, a mathematical model is presented to implement cerebral autoregulation into computational fluid dynamics (CFD) studies. CFD simulations of cardiopulmonary bypass (CPB) were performed in a 3D model of the cardiovascular system, with flow variations between 4.5–6 L/min. Cerebral outlets were modeled using an equation to calculate CBF based on CPP. Assuming full regulation, CBF was kept constant for CPP between 80 and 120 mm Hg. A deviation in CBF of 20% occurred for CPP between 55–80 mm Hg and 120–145 mm Hg, respectively. The level of regulation was varied to take possible impairment of cerebral autoregulation into account. Furthermore, chronic hypertension was modeled by increasing the baseline CPP. Results indicate that even for full autoregulation, CBF is decreased during CPB. It is even lower for impaired autoregulation and hypertensive patients, demonstrating the strong impact of autoregulation on CBF. It is therefore imperative to include this mechanism into CFD studies. The presented model can help to improve CPB support conditions based on patient‐specific autoregulation parameters.     

硫喷妥钠血药浓度对颅内压和脑代谢影响的实验研究

本实验观察和研究了１１只家兔不同硫喷妥钠血药浓度对颅内压和脑代谢的影响。结果表明，在硫喷妥钠血药浓度较低时（≤３６．５ｍｍｏｌ／Ｌ），颅内压降低幅度大于脑灌注压的下降幅度，有利于脑组织的血液灌注；硫喷妥钠血药浓度较高时（≥４８．５９ｍｍｏｌ／Ｌ），虽有较强降低颅内压和脑组织氧耗率的作用，但其降低脑灌压，血压的作用亦较明显，不利于脑组织及其他脏器的血液灌注。     

Overall results in 304 consecutive patients with acute spontaneous subarachnoid hemorrhage

The results obtained in 304 consecutive patients with spontaneous subarachnoid hemorrhage are described, the majority of whom (86%) were admitted while in acute condition. Only 46% of the patients in this series were in good condition at admission. The initial management was standardized for all patients, but the protocol of "delayed surgery" was applied to patients with subarachnoid hemorrhage from aneurysmal rupture. Two hundred and twenty-two patients (73%) had intracranial aneurysms. Of these, 20 (9%) were moribund and died shortly after admission; nine (4%) underwent emergency surgery due to the coexistence of a life-threatening cerebral hematoma; seven (3%) were operated upon within 3 days of admission; 78 (35%) died after rebleeding or after steady deterioration of the patient's condition due to vasospasm while awaiting surgery. Of the remaining 108 patients ready for delayed surgery, 12 (11%) (operation refused, elderly patients in poor general condition, spontaneous thrombosis of the aneurysm) were treated conservatively, and 96 (89%), who were in various clinical conditions, were actually operated on. Of these 96 patients, 79 (82%) exhibited excellent or good results, 5 (5%) were disabled, and 12 (12%) died. In the authors' experience, the overall management of intracranial aneurysms in unselected patients according to the protocol of delayed surgery results in significant loss of patients awaiting surgery, and good surgical results in the survivors.     

Hemolysate-induced release of prostaglandinlike substances from the canine cerebral arteries

The release of prostaglandinlike substances from canine pial arteries that was induced by exposure of the pial arteries to red blood cell hemolysate was estimated by using a superfusion technique for prostaglandin bioassay. The assay organs used were strips of rat stomach for prostaglandin E2- or prostaglandin F2 alpha-like substances, strips of dog coronary artery for prostaglandin I2-like substance, and strips of dog ileum for prostaglandin F2 alpha-like substance. The substances released from the canine pial arteries induced contractions in rat stomach strips and relaxations in canine coronary arterial strips, whereas they did not induce any response in canine ileal strips. The equivalent prostaglandin E2 doses for the contractions of the rat stomach strips and the equivalent prostaglandin I2 doses for the relaxations of the canine coronary arterial strips were 125.2 +/- 19.4 (n = 8) and 59.5 +/- 16.4 (n = 6) pmol/g wet wt +/- SEM, respectively.     

268例颈动脉内膜切除术临床麻醉总结

目的 总结颈动脉内膜切除术(carotid endarterectomy,CEA)的临床麻醉经验. 方法 回顾分析2012年4月～2015年2月268例CEA患者的临床麻醉管理. 结果 257例患者采用全身麻醉,11例采用颈丛神经阻滞.颈动脉阻断时间(22.3±5.4) min,全身麻醉患者苏醒时间(5.3±1.5) min.术后发生3例脑梗死、1例脑出血、1例心力衰竭. 结论 麻醉期间需要维持足够的脑血流量,降低心肌氧耗,提供快速、平稳的苏醒过程.     

脑动静脉氧差监测对预测外伤后脑梗塞的临床价值

目的：监测患侧脑动静脉氧差（cerebral arteriovnous oxygen difference,AVDO2)，探讨其与外伤后延迟性脑梗死（DCI）的相关性。方法：随机选择Glasgow昏迷评分（GCS）≤8人的脑外伤患者68例分别于入院时或手术前后，3小时、6小时、12小时采集颈动静脉血标本，测定其AVDO2，同时监测颅内压（intracerebral pressure,ICP)及MR、CT检查。结果：以AVDO2＝6VOL％为分界，≤6VOL％为A组，＞6VOL％为B组。ICP的变化与AVDO2呈负相关，外伤后延迟性脑梗死发生A组为27／37例，发生率72．97％，B组为10／27例，发生率37．04％。MR在影像学上较CT早发现脑梗死。结论：AVDO2监测对预测外伤后脑梗死极有临床价值。     

伴脑动脉狭窄的症状性腔隙性脑梗死患者脑血管造影分析

目的分析伴脑供血动脉狭窄的症状性腔隙性脑梗死患者的全脑血管造影结果。方法选择经CT或MRI确诊的51例症状性腔隙性脑梗死患者,全部接受全脑血管造影检查,均存在脑供血动脉狭窄,观察统计病变血管的狭窄程度及闭塞血管的侧支代偿情况。结果全部患者均成功接受全脑血管造影,无严重并发症发生,狭窄程度：9例（17.65%）≤50%,12例（23.53%）50%～70%,14例（27.45%）71%～99%,16例（31.37%）闭塞。51例中,40例（78.43%）存在梗死相关病变血管。16例闭塞病例中,12例有侧支循环形成。结论对伴脑供血动脉狭窄的症状性腔隙性脑梗死患者行全脑血管造影具有较高的阳性率,梗死主要由前循环系统血管病变引起,观察血管病变程度及侧支代偿建立情况对疾病下一步治疗具有重要指导作用。