颅底肿瘤术后脑脊液中ET-1的动态变化与脑血管痉挛的相关性研究

目的探讨颅底肿瘤术后脑脊液中内皮素-1（ET-1）的动态变化规律及其与脑血管痉挛（CVS）的相关性。方法颅底肿瘤病人33例，在术后第3、5、7、10和14天用放免法测定脑脊液中ET-1的含量；手术前1天和术后第1、3、5、7、10和14天用经颅多普勒超声动态监测双侧颈内动脉、双侧大脑前动脉和中动脉的血流速度。结果术后发生CVS的患者第3天脑脊液中ET-1水平即升高，第7天达到高峰，而后逐渐下降；术后第5、7和10天，中、重度CVS组ET-1水平明显高于对照组（P〈0.05），术后第7和10天，重度CVS组ET-1水平高于轻、中度CVS组和无CVS组（P〈0.05）；术后脑脊液中ET-1的水平与大脑中动脉平均血流速度呈正相关（r=0.635，P〈0.01）。结论颅底肿瘤术后患者脑脊液中ET-1水平的升高参与了术后CVS的发生，且其变化与术后CVS呈正相关，提示其含量可预测颅底肿瘤病人术后CVS的严重程度和预后。     

Varicella with delayed hemiplegia

We report 4 children who developed acute hemiplegia 7 weeks to 4 months after varicella infection. In 2 patients, carotid angiography demonstrated segmental narrowing and occlusion of the middle cerebral artery. Their clinical and angiographic features were similar to those associated with contralateral hemiplegia after herpes zoster ophthalmicus, the pathogenesis of which comprises cerebral angiitis due to varicella zoster viral infection. We believe that our patients had the same pathogenesis. In a survey of infectious diseases in our region, the frequency of varicella with delayed hemiparesis was roughly 1:6,500 varicella patients.     

Serial magnetic resonance angiography in cerebral infarction after varicella infection

The case of a 1-year-8-month-old-boy with cerebral infarction after varicella infection is reported here. Brain magnetic resonance (MR) angiography revealed segmental narrowing of the left middle cerebral artery which became normal 8 months later. The MR angiography well demonstrated the time course of the vascular involvement in the present patient. In cerebral infarction after varicella infection, the proximal portion of the main cerebral arteries were frequently damaged therefore MR angiography is useful for diagnosis and therapeutic decision-making. Moreover, serial MR angiographic studies can clarify the natural course of vascular changes in varicella virus-related cerebral infarction.     

脑脊液释放试验后脑血流变化对正常压力性脑积水患者临床症状改善的预测作用

目的 探讨经颅多普勒超声(Transcranial Doppler,TCD)评价正常压力性脑积水(normal pressure hydrocephalus,NPH)患者脑脊液释放试验对脑血流速度的影响及脑脊液释放试验的效果。方法 收集2015年5月1日-2017年6月1日于上海长征医院神经内科治疗的NPH患者25例,在脑脊液释放试验前及脑脊液释放试验24 h后评估患者NPH分级量表评分、运动功能及应用TCD测试大脑中动脉和大脑前动脉的血流速度; 根据NPH分级量表评分进行分组,降低≥1分者为改善组,否则为未改善组,观察2组动脉血流速度情况。结果 与脑脊液释放试验前比较,改善组患者脑脊液释放试验24 h后行走时间、行走步数均明显减少,TCD示左右两侧大脑中动脉最大流速、平均流速、最小流速均明显降低; 非改善组则无上述改变。结论 脑脊液释放试验NPH分级量表评分的改善可能与大脑中动脉血流速度有关,而TCD可有效地评测NPH患者脑脊液释放试验的效果。     

Neuropeptide Y: vasoconstrictor effects and possible role in cerebral vasospasm after experimental subarachnoid hemorrhage

The possible role of neuropeptide Y (NPY) as a vasoconstrictor substance contributing to the development of cerebral vasospasm after experimental subarachnoid hemorrhage was studied. Autologous blood was injected into the cisterna magna of control rabbits and rabbits that had received bilateral superior cervical ganglionectomy 2 days before blood injection. The days after blood injection the concentration of NPY in cerebrospinal fluid (CSF) was 5971 ± 551pg/ml while CSF from control animals contained992 ± 162pg/ml of NPY. The effects of porcine NPY on norepinephrine-induced contraction of rabbit cerebral arteries were also studied in vitro. NPY (1.2 nM) caused a 3-fold potentiation of norepinephrine-induced contraction of cerebral arteries. CSF from control rabbits diluted by 50% with Krebs solution had no significant effect on norepinephrine-induced contraction of cerebral arteries when compared to responses in Krebs solution only; however, diluted CSF from denervated blood-injected rabbits potentiated norepinephrine-induced contraction by 2.6-fold. Antiserum containing NPY specific antibodies was used to immunoprecipitate the peptide from CSF taken from denervated blood-injected rabbits. CSF treated with this antiserum contained less than 40 pg/ml of NPY and had no effect on norepinephrine-induced contraction of cerebral arteries. These results show that the concentration of NPY in CSF of rabbits is elevated after experimetal subarachnoid hemorrhage. In addition, NPY in CSF can potentiate the vasoconstrictor effect of norepinephrine which may contribute to the development of cerebral vasospasm.     

Herpes zoster ophthalmicus and delayed contralateral hemiparesis caused by cerebral angiitis: Diagnosis and management approaches

Four patients with herpes zoster ophthalmicus and delayed contralateral hemiparesis are described, and their findings are compared with those in patients previously reported in the English language literature. The current patients evidenced multifocal ipsilateral cerebral angiitis by angiography and multifocal infarcts in the distribution of the ipsilateral middle cerebral artery by computed tomographic scanning. Cerebrospinal fluid showed mononuclear pleocytosis, positive oligoclonal bands, and an elevated immunoglobulin G index. Two patients were treated with corticosteroids and acyclovir, and 1 with corticosteroids alone, all without apparent response. Necrotizing angiitis ipsilateral to the herpes zoster ophthalmicus was demonstrated postmortem in 1 patient with multifocal cerebral infarction and progressive leukoencephalopathy. Neither herpes varicella zoster immunocytochemical reactivity nor viral inclusions were seen. The leukoencephalopathy associated with herpes varicella zoster either may be caused by cerebral angiitis or, as previously reported, may be a temporally remote manifestation of persistent herpes varicella zoster infection. The cerebral angiitis associated with herpes varicella zoster is histologically similar to granulomatous angiitis, and both may be related to herpes varicella zoster infection of the cerebral vasculature.     

腰池引流对破裂动脉瘤患者血浆和脑脊液ET浓度及脑血管痉挛的影响

目的探讨腰池持续引流对破裂动脉瘤患者血浆和脑脊液内皮素(ET)浓度及脑血管痉挛的影响。方法将经栓塞治疗后的破裂颅内动脉瘤患者354例分为引流组和对照组。引流组268例,栓塞后行腰池持续引流;对照组86例,每天腰穿放脑脊液一次。用放免法测定栓塞后不同时间血浆和脑脊液中ET浓度,用经颅彩色多普勒超声检测大脑中动脉血流速度。结果引流组血浆和脑脊液中ET浓度轻度增加,对照组ET浓度增加明显,两组差异显著(P<0.01)。引流组大脑中动脉平均血流流速轻度增加,对照组明显增加,两组差异显著(P<0.01)。血浆和脑脊液中ET浓度与脑动脉血流速度呈正相关(r=0.95,P<0.01)。结论蛛网膜下腔出血后脑血管痉挛与血浆和脑脊液中ET浓度异常增加有关,腰池持续引流能够有效地清除引起脑血管痉挛的因子。     

Cerebrovascular disease and neurocysticercosis

We report three cases of stroke secondary to neurocysticercosis. The first one is a 36 years old man with bilateral middle cerebral artery occlusions who had presented acute right hemiparesia and aphasia. MRI demonstrated several enhancing subarachnoid cysts surrounding the occluded vessels, a right parietal racemose cyst and a left temporal large infarction area. Angiographic study showed total occlusion of left middle cerebral artery and a subtotal occlusion of right middle cerebral artery. The second one is a 42 years old man with vasculitis of small cortical vessels who presented with headache, seizures and focal neurological deficit. CT scan demonstrated several calcifications and a left temporal infarction area. Cerebral angiographic study was normal. The third case was a woman, 53 years old, with a past history of six stroke events and an actual behavior disturbance and seizures. MRI demonstrated several cortical and subcortical infarction areas and cisternal cysts. Angiographic study showed diffuse arteritis of basilar and carotid arterial system. In all three cases CSF study showed linfomonocitic pleocytosis and positive ELISA for cysticercosis.     

Bilateral anterior opercular (Foix–Chavany–Marie) syndrome

The bilateral anterior opercular (Foix–Chavany–Marie) syndrome is a rare condition most commonly encountered after bilateral middle cerebral artery stroke. Clinically, the syndrome is characterised by a loss of voluntary control of the facio-pharyngeo-glosso-masticatory muscles, while reflex movements and limb strength are preserved. We report the clinical presentation of a patient with anterior biopercular syndrome due to a bilateral middle cerebral artery stroke.     

Accumulation of calpain and caspase-3 proteolytic fragments of brain-derived alphaII-spectrin in cerebral spinal fluid after middle cerebral artery occlusion in rats.

Preclinical studies have identified numerous neuroprotective drugs that attenuate brain damage and improve functional outcome after cerebral ischemia. Despite this success in animal models, neuroprotective therapies in the clinical setting have been unsuccessful. Identification of biochemical markers common to preclinical and clinical cerebral ischemia will provide a more sensitive and objective measure of injury severity and outcome to facilitate clinical management and treatment. However, there are currently no effective biomarkers available for assessment of stroke. Nonerythroid alphaII-spectrin is a cytoskeletal protein that is cleaved by calpain and caspase-3 proteases to signature alphaII-spectrin breakdown products (alphaII-SBDPs) after cerebral ischemia in rodents. This investigation examined accumulation of calpain- and caspase-3-cleaved alphaII-SBDPs in cerebrospinal fluid (CSF) of rodents subjected to 2 hours of transient focal cerebral ischemia produced by middle cerebral artery occlusion (MCAO) followed by reperfusion. After MCAO injury, full-length alphaII-spectrin protein was decreased in brain tissue and increased in CSF from 24 to 72 hours after injury. Whereas alphaII-SBDPs were undetectable in sham-injured control animals, calpain but not caspase-3 specific alphaII-SBDPs were significantly increased in CSF after injury. However, caspase-3 alphaII-SBDPS were observed in CSF of some injured animals. These results indicate that alphaII-SBDPs detected in CSF after injury, particularly those mediated by calpain, may be useful diagnostic indicators of cerebral infarction that can provide important information about specific neurochemical events that have occurred in the brain after acute stroke.     

An autopsy case of drug‐induced diffuse cerebral axonopathic leukoencephalopathy: The pathogenesis in relation to reversible posterior leukoencephalopathy syndrome

An autopsy case of diffuse axonopathic leukoencephalopathy induced by drug treatment is reported. A 70‐year‐old woman with multiple myeloma developed encephalopathy several days after completing a course of intravenous human immunoglobulin (IVIg) and granulocyte‐colony stimulating factor (G‐CSF), and died within I month. T2‐weighted MRI demonstrated multifocal high‐signal areas in the bilateral cerebral white matter, especially in the right frontal lobe. Neuropathologically, multifocal hydropic axonal swelling with a poor glial reaction was recognized diffusely in the bilateral deep cerebral white matter, being especially marked in the frontal lobe. The cortex, subcortical U‐fibers, corpus callosum, and anterior commissure were spared. The cerebellar white matter also showed similar changes, albeit less marked, but the brainstem was spared. Microscopically, the myeloma involvement of the CNS was limited to the dura, and the cerebral arteries showed slight atherosclerosis, but neither thrombi nor angitis. This case, although ultimately fatal, neurologically and neuroradiologically resembled reversible posterior leukoencephalopathy syndrome (RPLS) induced by IVIg and/or G‐CSF, and the nature and selective distribution of the neuropathological changes suggested that the pathogenesis involved vasospasm of the bilateral internal carotid artery and the main trunks of the cerebral arteries, due to unknown cause, inducing ischemia in the deep white matter, which is supplied by long nutrient arteries.     

蛛网膜下腔出血后脑血管痉挛与血管活性物质的关系

目的 探讨蛛网膜下腔出血后脑血管痉挛与血管活性物质的关系。方法 测定52例蛛网膜下腔出血患者血浆血栓素B_2(thromboxane B_2,TXB_2)、6-酮-前列环素F1α(6-keto-prostaglandin,6-Keto)及血浆和脑脊液中血管紧张素转化酶(angiotensin converting enzyme,ACE)活性,同时通过经颅多普勒超声检查法(transcranial Doppler nltrasonography,TCD)观察蛛网膜下腔出血后脑血管平均血流速度(Vm)的变化,并与正常对照组进行比较。结果 蛛网膜下腔出血患者血浆TXB_2水平高于对照组(P<0.01),6-Keto水平低于对照组(P<0.05或P<0.01);发病后血浆ACE活性无明显改变,但脑脊液中ACE活性高于对照组(P<0.01);大脑中动脉平均血流速度于蛛网膜下腔出血后第4～5d的变化最为显著(P<0.01)。结论 蛛网膜下腔出血后患者血浆TXB_2、6-Keto与脑脊液ACE水平均发生明显变化,结合TCD检测结果,推测蛛网膜下腔出血后脑血管痉挛与血管活性物质水平有关。     

Granulomatous angiitis following primary varicella zoster infection

Granulomatous angiitis is an uncommon but well recognized complication of varicella zoster infection. The classic presentation is of a delayed hemiparesis in an often immunocompromised patient following zoster ophthalmicus. This report outlines the case of a young woman who developed a large left middle cerebral artery territory infarct secondary to granulomatous angiitis during primary varicella zoster infection.     

Bilateral cerebral hemispheric infarction associated with sildenafil citrate (Viagra®) use

Sildenafil citrate (Viagra^®) is one of the frequently prescribed drugs for men with erectile dysfunction. We describe a 52-year-old man with bilateral middle cerebral artery (MCA) territory infarction after sildenafil use. He ingested 100 mg of sildenafil and about 1 h later, he complained of chest discomfort, palpitation and dizziness followed by mental obtundation, global aphasia and left hemiparesis. Brain magnetic resonance imaging documented acute bilateral hemispheric infarction, and cerebral angiography showed occluded bilateral MCA. Despite significant bilateral MCA stenosis and cerebral infarction, systemic hypotension persisted for a day. We presume that cerebral infarction was caused by cardioembolism with sildenafil use.     

L-精氨酸枕大池注射对蛛网膜下腔出血脑血管痉挛的影响

目的:研究L-精氨酸枕大池注射对兔蛛网膜下腔出血后脑血管痉挛的影响及作用机制。方法:采用双侧颈动脉结扎及枕大池二次注血法制造兔蛛网膜下腔出血模型。在蛛血后第4天,以比色法测定血清及脑脊液中NO及脑组织NOS的含量。光镜下测定基底动脉的动脉壁厚度和基底动脉的内径,以其比值作为脑血管痉挛的指标。治疗组分为300μmol及500μmol组,在蛛血后第4天,枕大池持续微泵滴注L-精氨酸,在滴注后再分别测定上述指标。结果:蛛血后第4天,基底动脉的动脉壁厚度和内径的比值明显升高,血清及脑脊液中NO及脑组织NOS的含量降低。在L-精氨酸滴注后,脑血管痉挛缓解。血清及脑脊液中NO及脑组织NOS的含量较对照明显升高。结论:L-精氨酸枕大池注射对兔蛛网膜下腔出血后的血管痉挛具有治疗作用。L-精氨酸可能是通过NO及NOS系统起作用。     

Decompressive hemicraniectomy in a 2-year-old girl with a left middle cerebral artery infarct

Introduction We report on the case of a 2-year 5-month-old girl with congenital heart disease who developed left middle cerebral artery occlusion and cerebral hemorrhagic infarction a day after ventricular septal defect patch closure.Results Cranial computed tomography scan revealed an acute hemorrhagic infarct over the left middle cerebral artery territory with midline shift to the right. Since medical treatment failed, decompressive hemicraniectomy with duraplasty was performed, successfully reversing herniation. Decompressive surgery allows extracranial expansion of the swollen brain and relieves CSF space compression. We believe this to be the youngest reported patient to undergo decompressive hemicraniectomy for middle cerebral artery territory infarction. Although the patient survived, her functional outcome was poor.Conclusion Decompressive hemicraniectomy can be lifesaving and should be considered as an alternative therapy for patients with brain swelling refractory to medical management.     

3D-CTA对破裂大脑中动脉瘤诊断及手术指导意义

目的探讨3D-CTA对破裂大脑中动脉瘤诊断和手术指导作用。方法我院神经外科从2010年1月-2011年12月经3D-CTA对收住自发性蛛网膜下腔出血病人检查证实的122例颅内动脉瘤,其中18例为大脑中动脉动脉瘤,进行了术前CTA手术模拟。17例行翼点入路开颅显微外科手术,动脉瘤夹闭手术,与术前CTA影像学资料进行了对比。结果术前经3D-CTA诊断不同部位大脑中动脉瘤术中所见完全一致。术中除1例大脑中动脉瘤M2段梭形动脉瘤行包裹术外,其余17例动脉瘤均成功行夹闭手术。术后16例病人恢复良好痊愈出院。1例术前破裂大脑中动脉瘤病人,Hunt-Hess分级V级,术后双侧脑疝死亡。1例病人入院做术前准备时,动脉瘤二次破裂出血,急诊手术,术后病人偏瘫生活不能自理。结论术前单独依靠CTA对不同部位大脑中动脉瘤进行诊断及模拟手术,对破裂大脑中动脉瘤成功手术夹闭具有较好应用价值。     

Regional cerebral blood flow changes after bilateral external carotid artery ligation in acute experimental infarction.

Regional cerebral blood flow (rCBF) was measured in baboons by intracarotid injection of 133Xe and a gamma camera after acute cerebral infarction was induced by occlusion of the middle cerebral artery (MCA). A steady state of rCBF was measured four hour after MCA occlusion and was followed by bilateral ligation of the external cartoid arteries (ECA). Subsequent rCBF measurements were obtained at 30, 60, and 120 minutes. After bilateral ECA ligation, flow in ischaemic and non-ischaemic areas was greatly enhanced and flow in the hyperaemic areas significantly reduced, presumably since they had provided collateral circulation to the ischaemic zone with a favourable redistribution.     

iFlow成像技术对中脑周围非动脉瘤性蛛网膜下腔出血后脑血管痉挛的评估

目的 探讨iFlow成像技术在中脑周围非动脉瘤性蛛网膜下腔出血（PNSAH）后脑血管痉挛评估中的价值。方法 收集经CT及两次血管造影明确诊断为PNSAH 60例为观察组,收集我院同期颅内动脉瘤单纯弹簧圈栓塞治疗后半年以上随访复查造影时未见复发60例为对照组。利用西门子公司iFlow软件测量首次造影和复查造影时双侧颈内动脉分叉部、双侧大脑中动脉分叉部、双侧椎动脉造影基底动脉末端相同部位的造影剂达峰时间（TTP）。结果 与对照组相比,观察组首次造影中双侧椎-基底动脉末端造影剂TTP明显增高（P<0.05）,观察组复查造影中双侧椎-基底动脉末端、右侧颈内分叉部、右侧大脑中分叉部造影剂TTP均明显增高（P<0.05）。与首次造影相比,观察组复查造影双侧椎-基底动脉末端造影剂TTP明显增高（P<0.05）。结论 PNSAH后存在血管痉挛,且以基底动脉最明显,应用iFlow技术评估脑血管痉挛的具有可行性。     

动物蛛网膜下腔出血后脑血管痉挛与内皮素、一氧化氮的关系

目的:研究兔症状性蛛网膜下腔出血(ＳＡＨ)后脑血管痉挛(ＣＶＳ)与内皮素(ＥＴ)和一氧化氮(ＮＯ)的关系。方法:采用兔ＳＡＨ模型,观察ＳＡＨ前后动物进食量、神经功能和局部脑血流量(ｒＣＢＦ)改变,测定血液和脑脊液中ＥＴ和ＮＯｘ－含量。结果:ＳＡＨ后动物进食量和ｒＣＢＦ下降、神经功能障碍,血液和脑脊液中ＥＴ含量增加,ＮＯｘ－含量下降(Ｐ＜０．０１)。结论:兔双侧颈动脉结扎后枕大池二次注血可制成可靠的症状性ＳＡＨ后ＣＶＳ模型。ＳＡＨ后ＥＴ和ＮＯ含量的改变与ＣＶＳ的发生密切相关,并进而导致临床症状的恶化。