Strong Anthony J, Anderson Peter J, Watts Helena R, Virley David J, Lloyd Andrew, Irving Elaine A, Nagafuji Toshiaki, Ninomiya Mitsuyoshi, Nakamura Hajime, Dunn Andrew K, Graf Rudolf
King's College London, Department of Clinical Neurosciences (Neurosurgery), UK.
Brain. 2007 Apr;130(Pt 4):995-1008. doi: 10.1093/brain/awl392.
In the light of accumulating evidence for the occurrence of spontaneous cortical spreading depression and peri-infarct depolarizations in the human brain injured by trauma or aneurysmal subarachnoid haemorrhage, we used DC electrode recording and laser speckle imaging to study the relationship between depolarization events and perfusion in the ischaemic, gyrencephalic brain. In 14 adult male cats anaesthetized with chloralose, one cerebral hemisphere was exposed and the middle cerebral artery occluded. Surface cortical perfusion in core and penumbral territories was imaged semiquantitatively at intervals of 13 s for 4 h. Cortical surface DC potential was recorded. Time interval between changes in DC potential and in perfusion was examined, and this comparison was repeated using microelectrodes for DC potential in five similar experiments in a second laboratory. Mean pre-occlusion perfusion was 11707 +/- 4581 units (equivalent to CBF (cerebral blood flow) approximately 40.5 +/- SD 14.4 ml/100 g/min), and fell on occlusion to 5318 +/- 2916 (CBF approximately 17.1 +/- 8.3), 5291 +/- 3407 (CBF approximately 17.0 +/- 10.1), and 6711 +/- 3271 (CBF approximately 22.2 +/- 9.6), quickly recovering to 8704 +/- 4581 (CBF approximately 29.5 +/- 14.4), 9741 +/- 4499 (CBF approximately 33.3 +/- 14.1) and 10 314 +/- 3762 (CBF approximately 35.4 +/- 11.4) on the core, intermediate and outer penumbral gyri, respectively. Mean perfusion later fell secondarily on core and intermediate gyri but, overall, was preserved on the outer (upper level of perfusion) gyrus during the period of observation. Pattern and severity of transient changes in perfusion associated with depolarization events varied with gyral location; falls in perfusion were sometimes profound and irreversible, and followed rather than preceded depolarization. In this model of occlusive stroke, reductions in perfusion linked to peri-infarct depolarization events contribute to secondary deterioration in penumbral areas. The findings suggest that such events play a central rather than a subsidiary role in cerebral infarction in the gyrencephalic brain.
鉴于有越来越多的证据表明,在因创伤或动脉瘤性蛛网膜下腔出血而受损的人脑中会发生自发性皮质扩散性抑制和梗死周围去极化,我们使用直流电极记录和激光散斑成像技术来研究缺血性脑回脑去极化事件与灌注之间的关系。在14只用氯醛糖麻醉的成年雄性猫中,暴露一个大脑半球并闭塞大脑中动脉。在4小时内每隔13秒对核心区和半暗带区的表面皮质灌注进行半定量成像。记录皮质表面直流电位。检查直流电位变化与灌注变化之间的时间间隔,并在第二个实验室的五个类似实验中使用微电极记录直流电位重复此比较。闭塞前的平均灌注为11707±4581单位(相当于脑血流量(CBF)约40.5±标准差14.4毫升/100克/分钟),闭塞时降至5318±2916(CBF约17.1±8.3)、5291±3407(CBF约17.0±10.1)和6711±3271(CBF约22.2±9.6),然后在核心、中间和外侧半暗带脑回分别迅速恢复到8704±4581(CBF约29.5±14.4)、9741±4499(CBF约33.3±14.1)和10314±3762(CBF约35.4±11.4)。平均灌注随后在核心和中间脑回继发下降,但总体而言,在观察期内外侧(灌注较高水平)脑回的灌注得以保留。与去极化事件相关的灌注瞬时变化的模式和严重程度因脑回位置而异;灌注下降有时很严重且不可逆,并且发生在去极化之后而非之前。在这个闭塞性中风模型中,与梗死周围去极化事件相关的灌注减少导致半暗带区域的继发性恶化。研究结果表明,这些事件在脑回脑的脑梗死中起核心而非次要作用。
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