Dilraj A, Botha J H, Rambiritch V, Miller R, van Dellen J R
Department of Pharmacology, University of Durban-Westville, South Africa.
Neurosurgery. 1992 Jul;31(1):42-50; discussion 50-1. doi: 10.1227/00006123-199207000-00007.
Despite intensive investigation into the cause of cerebral vasospasm (focal ischemic deficit) after subarachnoid hemorrhage, the morbidity and mortality associated with this condition remain high. Various studies have shown levels of catecholamine in plasma and cerebrospinal fluid (CSF) to be increased in subarachnoid hemorrhage, and it is possible that these vasoactive substances play an important role in the subsequent vasospasm. In an attempt to elucidate this possibility, the study presented here was undertaken to investigate the relationship between catecholamine levels in plasma and CSF and focal ischemic deficit (FID); the rupture of aneurysms on blood vessels supplying the hypothalamus as compared with the rupture of aneurysms on blood vessels supplying other areas of the brain; and the clinical outcome of the patients. Concentrations of adrenaline and noradrenaline in plasma and CSF samples obtained from 21 patients who had suffered aneurysmal subarachnoid hemorrhage were determined by a radioenzymatic technique. Significantly higher levels of adrenaline were found at the time of surgery in the CSF of patients with FID. A similar trend, though not statistically significant, was also observed for plasma. Patients with a rupture of aneurysms on blood vessels supplying the hypothalamus showed a tendency towards higher catecholamine levels in plasma and CSF. Subjects with a bad clinical outcome (i.e., those who were severely disabled or had died) had significantly higher levels of catecholamine in plasma than did those with a good clinical outcome (i.e., those with moderate or no disability). Further detailed analysis of the interrelationships showed that, within the group of patients with FID, those with rupture of aneurysms on blood vessels supplying the hypothalamus had significantly higher catecholamine levels in plasma than did those with rupture of aneurysms on other cerebral vessels. Furthermore, in the group of patients with rupture of aneurysms on blood vessels supplying the hypothalamus, those with a bad clinical outcome had significantly higher catecholamine levels in plasma than did those with a good clinical outcome. These findings lend support to the possibility that damage to the hypothalamus and subsequent elevations in catecholamine levels may be associated with FID and poor clinical outcome.
尽管对蛛网膜下腔出血后脑血管痉挛（局灶性缺血性缺陷）的病因进行了深入研究，但与这种情况相关的发病率和死亡率仍然很高。各种研究表明，蛛网膜下腔出血时血浆和脑脊液（CSF）中的儿茶酚胺水平会升高，并且这些血管活性物质可能在随后的血管痉挛中起重要作用。为了阐明这种可能性，进行了本研究以调查血浆和脑脊液中的儿茶酚胺水平与局灶性缺血性缺陷（FID）之间的关系；供应下丘脑的血管上的动脉瘤破裂与供应大脑其他区域的血管上的动脉瘤破裂相比；以及患者的临床结局。通过放射酶法测定了从21例动脉瘤性蛛网膜下腔出血患者获得的血浆和脑脊液样本中肾上腺素和去甲肾上腺素的浓度。在手术时，FID患者的脑脊液中发现肾上腺素水平明显更高。血浆中也观察到类似趋势，尽管无统计学意义。供应下丘脑的血管上有动脉瘤破裂的患者，其血浆和脑脊液中的儿茶酚胺水平有升高趋势。临床结局差（即严重残疾或死亡的患者）的血浆中儿茶酚胺水平明显高于临床结局好（即中度残疾或无残疾的患者）。对相互关系的进一步详细分析表明，在FID患者组中，供应下丘脑的血管上有动脉瘤破裂的患者血浆中的儿茶酚胺水平明显高于其他脑血管上有动脉瘤破裂的患者。此外，在供应下丘脑的血管上有动脉瘤破裂的患者组中，临床结局差的患者血浆中的儿茶酚胺水平明显高于临床结局好的患者。这些发现支持了下丘脑损伤及随后儿茶酚胺水平升高可能与FID和不良临床结局相关的可能性。
