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61.
G. F. Hamann 《Der Radiologe》1997,37(11):843-852
Summary
This review focuses on the pathophysiological changes in acute cerebral ischemia, with special emphasis on disturbances of
the cerebral blood flow (CBF) and the associated penumbra concept. Alternatively, the model of peri-infarct depolarization
is demonstrated. Metabolic and molecular changes caused by cerebral ischemia and reperfusion are discussed, namely energy
failure, release of glutamate with an excitatoric burst, calcium influx in neurons, generation of free radicals, activation
of different proteases, disturbances of protein synthesis, induction of gene expression and apoptosis, loss of membrane integrity,
edema formation and microvascular disturbances. In summary, the pathophysiological changes after focal cerebral ischemia and
reperfusion are most adequately described by a network of interacting different mechanisms of tissue alterations. The simple
concept of a cascade of ischemic effects which would be easy to block seems to be less applicable. A time window of approximately
6 h for the acute stroke therapy is postulated on the base of the above mentioned pathophysiological changes. The recently
introduced treatment regimen with optimized basic treatment, recanalization using thrombolysis and neuroprotection by different
agents is presented. Different modes of a possible intervention are discussed. Modern concepts of stroke therapy including
stroke-unit care and thrombolysis with add-on neuroprotection seem to have potential for improving the outcome of acute stroke
patients.
相似文献
62.
Rashmi Kothari MD Kent Hall MD Thomas Brott MD Joseph Broderick MD 《Academic emergency medicine》1997,4(10):986-990
Objective : To develop an abbreviated and practical neurologic scale that could assist emergency medical services or triage personnel in identifying patients with stroke.
Methods : A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using χ2 were performed to rank items. Recursive partitioning was then performed to develop the decision rule for predicting the presence of stroke.
Results : Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-of-hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%.
Conclusion : Using the derivation data set, a proposed Out-of-hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed. 相似文献
Methods : A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using χ
Results : Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-of-hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%.
Conclusion : Using the derivation data set, a proposed Out-of-hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed. 相似文献
63.
G. E. Cold K. J. S. Christensen J. Nordentoft M. Engberg M. Bach Pedersen 《Acta anaesthesiologica Scandinavica》1988,32(4):310-315
In 10 patients subjected to craniotomy for supratentorial cerebral tumours in neurolept anaesthesia, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured twice peroperatively by a modification of the Kety & Schmidt technique, using 133Xe. The relative CO2 reactivity was assessed indirectly as the % change of the arteriovenous oxygen difference (AVDO2) per mm change in PaCO2. The patients were premedicated with diazepam 10-15 mg perorally. For induction, thiopentone 4-6 mg/kg, droperidol 0.2 mg/kg and fentanyl 5 micrograms/kg were used, and for maintenance N2O 67% and fentanyl 4 micrograms/kg/h. During the first flow measurement the median and range of CBF was 30 ml/100 g/min (range 17-45), of AVDO2 8.0 vol % (range 4.1-9.5), and of CMRO2 2.28 ml O2/100 g/min (range 1.57-2.84). During the second CBF study, AVDO2 increased to 9.3 vol % (range 3.4-11) (P less than 0.05), and CMRO2 increased to 2.51 ml O2/100 g/min (range 1.88-3.00) P less than 0.05, while CBF was unchanged. The CO2 reactivity was present in all studies, median 1.8%/mmHg (range 0.5-15.1). The correlation coefficients between jugular venous oxygen tension/saturation, respectively, and CBF were high at tensions/saturations exceeding 4.0 kPa and 55%, indicating that hyperperfusion is easily unveiled by venous samples from the jugular vein during this anaesthesia. 相似文献
64.
Dynamic aspects of expanding cava septi pellucidi et Vergae 总被引:2,自引:0,他引:2
Summary Two paediatric patients with expanding cysts of the cava Vergae et septi pellucidi are presented. In the first patient, consecutive CT scans showed agrowing cavum thought to be responsible for his dramatic increase in head circumference. In the other patient, the expanding cavum was discovered because a routine skull X-ray after minor head trauma revealed marked impressiones digitatae.Both patients were successfully treated with stereotactically placed internal shunts from the cysts via the lateral ventricle to the subarachnoid space. During this procedure, contrast medium was instilled, and the cysts were visualized on postoperative CT scans.Some dynamic aspects of such expanding cava are discussed. 相似文献
65.
F. F. Madsen 《Acta neurochirurgica》1990,106(3-4):164-169
Summary Changes in regional cerebral blood flow in anaesthetized pigs with an induced focal cerebral contusion were studied before and after two grades of hyperventilation. A reduction in arterial tension of CO2 with 0.70mmHg and a further reduction of 0.55mmHg did not change the CO2 reactivity. Reactivity in both injured and macroscopically normal regions was the same, revealing an average of 39.3% flow change per kPa change in CO2 tension. Regions with low flow after the contusion had an equally big reduction apparently leading to hypoxia because global metabolic rate was unchanged. 相似文献
66.
Hyperaemia prior to acute cerebral swelling in severe head injuries: The role of transcranial doppler monitoring 总被引:4,自引:0,他引:4
Z. Muttaqin M.D. T. Uozumi S. Kuwabara K. Arita K. Kurisu S. Ohba H. Kohno H. Ogasawara M. Ohtani T. Mikami 《Acta neurochirurgica》1993,123(1-2):76-81
Summary Acute cerebrovascular congestion after a closed head injury is significantly related to intracranial hypertension. As an indirect method of cerebral blood flow measurement, transcranial doppler sonography (TCD) provides a rapid and noninvasive assessment of cerebral haemodynamics, including hyperaemic conditions.TCD examinations was serially performed in 35 patients with severe head injury with intact cerebral circulation; i.e. the mean flow velocity (MFV) patterns of the middle cerebral artery (MCA) did not show signs of cerebral circulatory arrest such as systolic spike, to and fro, or no flow. The results showed that the MFV of the MCAs and ipsilateral extracranial internal carotid arteries (ICAs) in 9 of these patients increased sharply and pulsatility index (PI) decreased during 48–96 hours after the injury. This was soon followed by patterns of high intracranial resistance, consistent with elevated intracranial pressure (ICP) in monitored patients and acute brain swelling on repeated computed tomographic (CT) scans. The correlation between increased MFVs, decreased PIs, and cerebral haemodynamic changes leading to acute brain swelling is discussed.The number of patients who ended with severe disability, vegetative state, or death was 66% in this group of 9 patients, compared to only 34% for the 35 patients overall with severe head injury. Though the morbidity and mortality rates largely depend on the primary injury, the presence of acute cerebral swelling aggravate the grave course in these patients. And the ability of TCD to monitor the hyperaemic state prior to oedema should lead us to adjust the therapy in order to minimize the secondary insult related to intracranial hypertension. 相似文献
67.
J. Randolph Swartz Ira M. Lesser Kyle B. Boone Bruce L. Miller Ismael Mena 《International journal of geriatric psychiatry》1995,10(6):437-446
Global and regional cerebral blood flow (CBF) were evaluated with single photon emission computerized tomography (SPECT) utilizing both 133Xenon (133Xe) (47 subjects, 47–82 years old) and 99Tc-hexamethylpropyleneamine oxime (99Tc-HMPAO) (27 subjects, 47–80 years old). The 133Xe results showed: among total subjects, no age-related decline in global CBF, but a significant regional decline in the occipital lobe (p < 0.05); among men, significant age-related declines in global, frontal, temporal, occipital and right hemisphere CBF (all p < 0.05); among women, no age-related decline in global or regional CBF. The 99Tc-HMPAO results showed no age-related decline in either global or regional perfusion among total subjects, men or women. These results suggest that age-related global and regional (including frontal lobe) CBF declines do not occur in healthy control subjects after the age of 45 years. However, gender differences in age-related CBF changes warrant further study. 相似文献
68.
林尚泽 《中华耳鼻咽喉头颈外科杂志》1994,(4)
报道1例严重鼻衄伴高血压、动脉硬化患者,经常规方法止血无效,行患侧颌内动脉超选择性栓塞术。术后鼻出血停止,但出现脑梗塞、昏迷,经抢救无效,于术后第9天死亡。认为对有动脉硬化的患者,应不用或慎用超选择性动脉栓塞术。 相似文献
69.
电针对沙鼠急性脑缺血再灌注后神经原损伤的保护作用 总被引:9,自引:0,他引:9
本实验利用沙鼠急性脑缺血再灌注模型,研究电针对脑缺血及再灌注各期脑电活动的影响及组织病理学的改变。结果表明:缺血10mln,脑电幅度受到严重抑制,甚至变平坦,总功率大大下降,再灌注后总功率难以恢复,在120min时仅恢复到缺血前的27.39±11.31%,以后即不再进一步恢复,电针组动物缺血10min再灌注后,脑电的恢复明显比对照组快,120min时恢复至缺血前的71.45±16.46%(P<0.01),240min时继续恢复至缺血前的75.27±18.43%。同时电针能明显减轻缺血10min后再灌注24小时的神经原缺血性损伤。结果提示:电针对急性脑缺血引起的神经原损伤具有保护作用,并能促进脑功能的恢复。 相似文献
70.
Piotr Kozlowski Alastair M. Buchan Ursula I. Tuor Dong Xue Zhi-Gao Huang Karen E. Chaundy John K. Saunders 《Magnetic resonance in medicine》1997,37(3):346-354
31P, 1H and lactate spectroscopic imaging was used to evaluate the effects of hypothermia on focal cerebral ischemia produced by middle cerebral artery occlusion. The effects on high energy phosphate metabolism, pH, lactate and NAA were investigated in 24 spontaneously hypertensive rats subjected to either permanent or transient ischemia. Under either normothermic (37.5°C) or hypothermic (32°C) conditions, with permanent 6-h occlusion, there was little difference between groups in either the NMR measurements or the volume of infarction. In animals that underwent 3 h of ischemia followed by 12 h of reperfusion, the ischemic changes in lactate, pH, NAA, and high-energy phosphate returned toward control values, and there was a protective effect of hypothermia (infarct volume of 211 ± 26 and 40 ± 14 mm3 in normothermic and hypothermic groups, respectively). Thus, hypothermia did not ameliorate the changes in lactate, pH, NAA, or high energy phosphate levels occurring during ischemia, however, during reperfusion there was an improvement in both the recovery of these metabolites and pathological outcome in hypothermic compared with normothermic animals. 相似文献