Todua F I, Gachechiladze D G, Beraia M V, Berulava D V
Angiol Sosud Khir. 2005;11(2):39-43.
The aim of the work was to assess extra- and intracranial venous hemodynamics in patients with circulatory disorder-induced encephalopathy (DE). Altogether 114 DE patients were examined. There were 46 women and 68 men aged 43 to 78 years (mean age 59.6+/-12.5 years). As dependent on the clinical manifestations the patients were distributed into groups: stage 1 DE was present in 36 patients, stage 2 DE in 47>> and stage 3 DE was identified in 31 patients. 82.78% of the examined had arterial hypertension (AH), the mean standing of which accounted for 9.7+/-7.2 years. The control group accrued 36 practically normal persons aged 36 to 62 years (mean age 47.6+/-11.3 years). All the patients were provided standard neurologic examination, magnetic resonance tomography (MRT) of the brain with venography of the brachiocephalic veins and venous sinuses of the brain, Color Doppler Imaging of the extracranial vessels, and transcranial Doppler. The patients complained primarily of headache, dizziness, instability and staggering on walking, memory and work fitness decrease, and irritability. Atherosclerotic plaques which were primarily homogeneous (types IV and V according to the classification by Geroulakos et al., 1993) were identified in the carotid arteries in 76 (62%) patients. In 48 (42%) patients, stenoses were bilateral. Hemodynamically significant (>50%) stenoses were present in 42 (34%) persons. In most cases, the patients showed dilatation of the jugular veins and a mean reduction of the flow intensity to 14+/-8.1 cm/s as compared to the control group (20.6+/-11.3 cm/s). The tendency toward flow intensity lowering associated with its phasic nature disorder was particularly well-defined in patients with stage 3 DE and a long-term history of AH. On examination of the parameters of cerebral venous circulation the patients with stage 1 DE tended to the rise of the linear flow velocity (LFV) in the basal veins of Rozenthal and in the direct sinus. However, no significant changes in the PI parameters were recorded. In the patient group with stages 2 and 3 DE, there was an appreciable rise of the LFV in the deep veins in the presence of a remarkable PI lowering (the flow velocity in the vein of Rozenthal 21.8+/-7.2 cm/s in stage 2 DE, and 24.4+/-7.2 cm/s in stage 1 DE). In 87 (79%) cases, MRT revealed the signs of diffuse ischemic lesion of the brain. Fifty-five (48%) patients were diagnosed to have leukoarayos whereas in 48 (42%) cases, there were identified multiple lacunar infarctions, primarily of the deep cerebral segments. Ten (8%) patients demonstrated type 1 Arnold-Chiari abnormalities -- hypoplasia of the large cerebral cistern and 4 patients had porto-cerebellar atrophy (megacysterna magna). Analysis of the MRV revealed, in the majority of cases (in 67 or 59%), developmental abnormality of the drainage system of the brain. Thus, 42 (37%) patients were diagnosed to have hypoplasia of one of the transverse sinuses (of the right one in 23 cases and of the left one in 19 cases); 17 (15%) persons had aplasia of the transverse sinus. Eight patients showed hypoplasia of the sigmoid sinuses (of the right one in 5 cases and of the left one in 3 cases). In all the cases of developmental abnormalities of the venous sinuses, there was a compensatory dilatation of the contralateral sinus and in some cases, there were visualized the upper and lower sinuses, the identification of which in health is difficult. So, atherosclerosis of AH-induced lesion of the brachiocephalic arteries interferes with the action of the physiological "arteriovenous pump" thereby provoking venous congestion. Progression of the process is associated with depletion of the compensatory adaptive potentialities of the collateral venous outflow which (especially in concomitant developmental abnormality in the region of the posterior cranial fossa and venous sinuses) favours aggravation of venous circulatory distress, the rise of the CSF pulse pressure and the emergence of benign intracranial hypertension and hydrocephalus followed by cerebral atrophy.
这项工作的目的是评估循环障碍性脑病（DE）患者的颅外和颅内静脉血流动力学。共检查了114例DE患者。其中有46名女性和68名男性，年龄在43至78岁之间（平均年龄59.6±12.5岁）。根据临床表现，患者被分为几组：36例患者处于DE 1期，47例处于DE 2期，31例处于DE 3期。82.78%的受检者患有动脉高血压（AH），其平均患病时间为9.7±7.2年。对照组纳入了36名年龄在36至62岁之间（平均年龄47.6±11.3岁）的基本正常的人。所有患者均接受了标准的神经系统检查、脑部磁共振断层扫描（MRT）及头臂静脉和脑静脉窦的静脉造影、颅外血管彩色多普勒成像以及经颅多普勒检查。患者主要抱怨头痛、头晕、行走不稳和蹒跚、记忆力和工作能力下降以及易怒。在76例（62%）患者的颈动脉中发现了动脉粥样硬化斑块，主要为均匀性斑块（根据Geroulakos等人1993年的分类为IV型和V型）。48例（42%）患者的狭窄为双侧性。42例（34%）患者存在血流动力学显著（>50%）的狭窄。在大多数情况下，患者表现出颈静脉扩张，与对照组（20.6±11.3 cm/s）相比，血流强度平均降低至14±8.1 cm/s。在3期DE且有长期AH病史的患者中，与血流强度降低相关的血流相位性紊乱趋势尤为明显。在检查脑静脉循环参数时，1期DE患者的罗森塔尔基底静脉和直窦的线性流速（LFV）有升高趋势。然而，PI参数未记录到显著变化。在2期和3期DE患者组中，深静脉的LFV明显升高，同时PI显著降低（2期DE患者罗森塔尔静脉的流速为21.8±7.2 cm/s，1期DE患者为24.4±7.2 cm/s）。在87例（79%）病例中，MRT显示出脑弥漫性缺血性病变的迹象。55例（48%）患者被诊断为脑白质疏松，48例（42%）病例中发现多发性腔隙性梗死，主要位于大脑深部节段。10例（8%）患者表现为1型阿诺德 - 基亚里畸形——大脑大池发育不全，4例患者有小脑延髓池萎缩（巨大枕大池）。对磁共振静脉造影（MRV）的分析显示，在大多数病例（67例或59%）中，脑引流系统存在发育异常。因此，42例（37%）患者被诊断为一侧横窦发育不全（右侧23例，左侧19例）；17例（15%）患者横窦缺如。8例患者乙状窦发育不全（右侧5例，左侧3例）。在所有静脉窦发育异常的病例中，对侧窦均有代偿性扩张，在某些情况下，还可看到上、下窦，而在健康状态下很难识别这些窦。所以，AH引起的头臂动脉病变的动脉粥样硬化干扰了生理性“动静脉泵”的作用，从而引发静脉充血。该过程的进展与侧支静脉流出的代偿适应潜力耗尽有关，这（尤其是在后颅窝和静脉窦区域伴有发育异常时）有利于静脉循环窘迫的加重、脑脊液脉压的升高以及良性颅内高压和脑积水的出现，随后导致脑萎缩。
