Department of Neurology, University of Erlangen, Erlangen, Germany.
Cerebrovasc Dis. 2011;32(5):420-5. doi: 10.1159/000330652. Epub 2011 Oct 8.
Cerebral vasospasm (VSP) is a common complication after subarachnoid hemorrhage (SAH), but has rarely been reported after intracerebral hemorrhage (ICH) without subarachnoidal bleeding. The underlying pathophysiological mechanism is mainly mediated by circulating heme products within the cerebrospinal fluid, and thus patients with ICH and ventricular involvement (IVH) may also be in danger of developing VSP. The incidence and role of VSP in IVH, however, have not been systematically studied.
We prospectively enrolled 115 patients with ICH with or without IVH into the study between April 2009 and April 2010. All patients received serial extracranial and transcranial Doppler sonography (TCD) at baseline, on days 3-5 and 7-9 to detect and monitor VSP. In addition, CT scans taken on admission, after 24 h and before discharge were evaluated for the occurrence of delayed cerebral ischemia.
Three out of 53 patients (5.7%) with IVH showed a significant elevation of flow velocities over the examined timeframe. One of these patients developed severe VSP resulting in secondary ischemic infarction. None of the ICH patients without IVH showed significantly elevated flow velocities or secondary infarction.
Cerebral VSP with secondary infarction may occur in patients with spontaneous IVH, though far less frequently than in SAH; thus, systematic screening of all patients with IVH may not be warranted. However, serial TCD should be considered in patients with secondary clinical worsening or extensive IVH.
蛛网膜下腔出血（SAH）后常发生脑血管痉挛（VSP），但颅内出血（ICH）无蛛网膜下腔出血时很少发生。其潜在的病理生理机制主要是通过脑脊液中的循环血红素产物介导的，因此，伴有脑室内出血（IVH）的 ICH 患者也可能有发生 VSP 的危险。然而，VSP 在 IVH 中的发生率和作用尚未得到系统研究。
我们前瞻性纳入了 2009 年 4 月至 2010 年 4 月间的 115 例伴有或不伴有 IVH 的 ICH 患者。所有患者均在基线时、第 3-5 天及第 7-9 天接受经颅和颅外多普勒超声（TCD）连续检查，以发现和监测 VSP。此外，对入院时、24 小时后和出院前的 CT 扫描进行评估，以发现迟发性脑缺血的发生。
53 例伴有 IVH 的患者中，有 3 例（5.7%）在研究期间出现流速明显升高。其中 1 例患者出现严重的 VSP ，导致继发性缺血性梗死。无 IVH 的 ICH 患者无明显流速升高或继发性梗死。
尽管自发性 IVH 患者发生继发性 VSP 和继发性梗死的情况比 SAH 患者少见得多，但仍可能发生；因此，对所有 IVH 患者进行系统筛查可能是不必要的。然而，对于有继发性临床恶化或广泛 IVH 的患者，应考虑进行连续 TCD 检查。
