Grubb N R, Fox K A, Smith K, Best J, Blane A, Ebmeier K P, Glabus M F, O'Carroll R E
Cardiovascular Research, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
Stroke. 2000 Jul;31(7):1509-14. doi: 10.1161/01.str.31.7.1509.
More than 30% of out-of-hospital cardiac arrest (OHCA) survivors suffer significant memory impairment. The hippocampus may be vulnerable to hypoxic injury during cardiac arrest. The purpose of this study was to determine whether selective hippocampal injury is the substrate for this memory impairment.
Seventeen OHCA survivors and 12 patients with uncomplicated myocardial infarction were studied. OHCA survivors were divided into those with impaired and intact memory. Memory was assessed by use of the Rivermead Behavioural Memory Test and Doors and People Test. MRI was used to determine intracranial, whole-brain, amygdala-hippocampal complex, and temporal lobe volumes. Brain structure was also examined by statistical parametric mapping.
Left amygdala-hippocampal volume was reduced in memory-impaired OHCA victims compared with control subjects (mean 3. 93 cm(3) and 95% CI 3.50 to 4.36 cm(3) versus mean 4.65 cm(3) and 95% CI 4.37 to 4.93 cm(3); P=0.002). Left temporal lobe and whole-brain volumes were also reduced. There were no differences in amygdala-hippocampal volume indexed against ipsilateral temporal lobe volume. Significant correlations were observed between total brain volume and Rivermead Behavioural Memory Test (r=0.56, P<0.05) and Doors and People Test (r=0.67, P<0.01) scores in OHCA survivors. Both recall and recognition were compromised in memory-impaired subjects. Statistical parametric mapping did not detect focal brain abnormalities in these subjects. Global cerebral atrophy was confirmed by qualitative assessment.
Memory impairment in OHCA survivors is associated with global cerebral atrophy, not selective hippocampal damage. Rehabilitation protocols need to account for the global nature of the brain injury.
超过30%的院外心脏骤停（OHCA）幸存者存在明显的记忆障碍。心脏骤停期间海马体可能易受缺氧损伤。本研究的目的是确定选择性海马体损伤是否是这种记忆障碍的基础。
对17名OHCA幸存者和12名无并发症心肌梗死患者进行了研究。OHCA幸存者被分为记忆受损和记忆完好两组。通过使用里弗米德行为记忆测试和门与人物测试来评估记忆。MRI用于确定颅内、全脑、杏仁核 - 海马复合体和颞叶体积。还通过统计参数映射检查脑结构。
与对照组相比，记忆受损的OHCA患者左侧杏仁核 - 海马体积减小（平均3.93 cm³，95%可信区间3.50至4.36 cm³，而对照组平均为4.65 cm³，95%可信区间4.37至4.93 cm³；P = 0.002）。左侧颞叶和全脑体积也减小。以同侧颞叶体积为指标的杏仁核 - 海马体积无差异。在OHCA幸存者中，观察到全脑体积与里弗米德行为记忆测试（r = 0.56，P < 0.05）和门与人物测试（r = 0.67，P < 0.01）得分之间存在显著相关性。记忆受损受试者的回忆和识别能力均受损。统计参数映射未检测到这些受试者的局灶性脑异常。通过定性评估证实存在全球脑萎缩。
OHCA幸存者的记忆障碍与全球脑萎缩有关，而非选择性海马体损伤。康复方案需要考虑脑损伤的全球性。
