Stolz Erwin, Gerriets Tibo, Babacan Sait Seymen, Jauss Marek, Kraus Jörg, Kaps Manfred
Department of Neurology, Justus-Liebig University, Giessen, Germany.
Stroke. 2002 Feb;33(2):479-85. doi: 10.1161/hs0202.102371.
Cerebral venous pressure is governed by intracranial pressure, cerebral perfusion pressure, and venous outflow resistance. Therefore, changes in venous flow velocities are to be expected because of changes in intracranial pressure and brain tissue dislocation in patients with ischemic stroke and space-occupying brain edema.
In 21 prospectively recruited patients with middle cerebral artery stroke and postischemic edema, flow velocities in the basal veins, the vein of Galen, the straight sinus, and the P2 segment of the posterior cerebral artery were recorded every 0.9+/-0.5 days during the first 5 days after symptom onset with the use of transcranial color-coded duplex sonography. The midline shift of the third ventricle was determined by B-mode imaging.
We observed an initial increase of flow velocity in the basal vein ipsilateral to the lesion, followed by a significant decrease within 5 days after symptom onset and with increasing midline shift in patients with brain herniation. In the straight sinus, flow velocity showed a biphasic U-shaped response to increasing dislocation of the third ventricle, with an initial decrease followed by an increase in the course of mass movement (midline shift 1 to 1.5 cm). A steep increase of flow velocity in the vein of Galen took place with a midline shift >1.5 cm. In the survivors these changes could not be observed. Flow velocity in the P2 segment of the posterior cerebral artery followed a typical course in neither the fatal cases nor the survivors.
Monitoring of flow velocities in the basal cerebral veins and in the straight sinus can provide additional pathophysiological information in patients with space-occupying brain edema after acute stroke.
脑静脉压力受颅内压、脑灌注压和静脉流出阻力的影响。因此，在缺血性卒中和占位性脑水肿患者中，由于颅内压变化和脑组织移位，预计静脉血流速度会发生改变。
对21例前瞻性招募的大脑中动脉卒中并缺血后水肿患者，在症状发作后的前5天，每隔0.9±0.5天使用经颅彩色编码双功超声记录基底静脉、大脑大静脉、直窦和大脑后动脉P2段的血流速度。通过B型成像确定第三脑室的中线移位。
我们观察到，病变同侧基底静脉的血流速度最初增加，随后在症状发作后5天内显著降低，且在发生脑疝的患者中随着中线移位增加而降低。在直窦中，血流速度对第三脑室移位增加呈现双相U形反应，在肿块移位过程中（中线移位1至1.5 cm），最初降低，随后增加。当中线移位>1.5 cm时，大脑大静脉的血流速度急剧增加。在幸存者中未观察到这些变化。大脑后动脉P2段的血流速度在致命病例和幸存者中均未呈现典型变化过程。
监测大脑基底静脉和直窦的血流速度可为急性卒中后占位性脑水肿患者提供额外的病理生理学信息。
