Carlson Andrew P, Yonas Howard
Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131-0001, USA.
Neurol Res. 2009 Jul;31(6):593-604. doi: 10.1179/174313209X455754.
Vasospasm following aneurysmal subarachnoid hemorrhage is ascribed to be the cause of morbidity and mortality in 10-30% of patients. Vascular narrowing following SAH defined by angiography (along with non-invasive vascular imaging such as CT angiography) is, however, present in most patients. We seek to describe the need for understanding the clinically relevant syndrome of delayed ischemic neurological deficit (DIND) and to describe various perfusion techniques which in addition to vascular imaging studies, are needed to fully understand when delayed neurological deficits are due to due vasospasm induced ischemia.
The literature regarding various perfusion techniques as they relate to vasospasm and DIND was reviewed.
There are many techniques which offer some data regarding cerebral blood flow in the setting of DIND. Truly quantitative techniques such as positron emission tomography and xenon CT offer powerful tools to identify areas at increased risk for infarction. Xenon CT is a practical technique which may be performed at the bedside and may be used to assess cerebral blood flow response to a changing variable.
Perfusion techniques offer clinical data which may be applied to the care of an individual patient so that treatment may be tailored to that patient's physiological needs. This allows the clinician to pursue a rational strategy for diagnosis and treatment of a patient with a delayed neurological deficit following aneurysmal SAH.
动脉瘤性蛛网膜下腔出血后的血管痉挛被认为是10% - 30%患者发病和死亡的原因。然而，血管造影（以及CT血管造影等非侵入性血管成像）所定义的蛛网膜下腔出血后的血管狭窄在大多数患者中都存在。我们试图描述理解延迟性缺血性神经功能缺损（DIND）这一临床相关综合征的必要性，并描述除血管成像研究外，为全面理解延迟性神经功能缺损何时是由血管痉挛诱导的缺血所致而需要的各种灌注技术。
回顾了有关各种灌注技术与血管痉挛和DIND关系的文献。
有许多技术可提供一些关于DIND情况下脑血流量的数据。真正的定量技术，如正电子发射断层扫描和氙CT，为识别梗死风险增加的区域提供了有力工具。氙CT是一种实用技术，可在床边进行，可用于评估脑血流量对变化变量的反应。
灌注技术提供的临床数据可应用于个体患者的护理，以便根据患者的生理需求进行治疗。这使临床医生能够为动脉瘤性蛛网膜下腔出血后出现延迟性神经功能缺损的患者制定合理的诊断和治疗策略。
