Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Int J Stroke. 2014 Feb;9(2):183-7. doi: 10.1111/ijs.12021. Epub 2013 Mar 21.
The cause of perimesencephalic hemorrhage is unknown, but a venous source is suggested. If perimesencephalic hemorrhage is of venous origin, less elevation of the intracranial pressure and less perfusion deficits are expected than after aneurysmal subarachnoid hemorrhage.
We compared perfusion in the acute stage after perimesencephalic hemorrhage and aneurysmal subarachnoid hemorrhage.
We included 45 perimesencephalic hemorrhage patients and 45 aneurysmal subarachnoid hemorrhage patients, who were matched on clinical condition at admission and underwent computerized tomographic scanning <72 h after subarachnoid hemorrhage. Cerebral blood flow was assessed in 12 predefined regions of interest. Differences in cerebral blood flow values with corresponding 95% confidence intervals were calculated. Sub-group analyses were performed stratified on comparable amounts of blood and location of blood (posterior circulation aneurysms and additionally in infratentorial and supratentorial aneurysms).
Cerebral blood flow was higher in perimesencephalic hemorrhage patients (mean: 63·8) than in aneurysmal sub-arachnoid hemorrhage patients (mean: 55·9; difference of means: -7·9 [95% confidence interval: -10·7 to -5·2]) and also in the sub-group with comparable amounts of blood (mean cerebral blood flow: 56·4; difference of means: -7·4 [95% confidence interval: -10·4 to -4·3]). Cerebral blood flow was comparable with perimesencephalic hemorrhage patients for the sub-group with posterior circulation aneurysms (difference of means: -0·7 [95% confidence interval: -5·2 to 3·8]); however, differences diverged after stratifying posterior circulation aneurysms into supratentorial (difference of means -3·9 [95% confidence interval: -9·3 to 1·4]) and infratentorial aneurysms (difference of means 3·0 [95% confidence interval: -2·8 to 8·8]).
Perimesencephalic hemorrhage patients have a higher cerebral blood flow than aneurysmal subarachnoid hemorrhage patients. The findings of this study further support a venous origin of bleeding in perimesencephalic hemorrhage patients. Future studies should further elaborate on cerebral blood flow in posterior circulation aneurysms.
目前尚不清楚脑桥旁正中出血的病因，但提示可能与静脉源相关。如果脑桥旁正中出血是静脉源，预计颅内压升高和灌注不足的程度会低于蛛网膜下腔出血后的情况。
我们比较了脑桥旁正中出血和蛛网膜下腔出血后的急性期灌注情况。
我们纳入了 45 例脑桥旁正中出血患者和 45 例蛛网膜下腔出血患者，根据入院时的临床情况进行匹配，并在蛛网膜下腔出血后 <72 小时内行计算机断层扫描。评估了 12 个预设感兴趣区的脑血流。计算了脑血流值的差异及其对应的 95%置信区间。根据相当量的血液和血液位置（后循环动脉瘤，另外还包括小脑幕下和幕上动脉瘤）进行亚组分析。
脑桥旁正中出血患者的脑血流（平均：63.8）高于蛛网膜下腔出血患者（平均：55.9；平均差值：-7.9 [95%置信区间：-10.7 至 -5.2]），且在相当量血液的亚组中也是如此（平均脑血流：56.4；平均差值：-7.4 [95%置信区间：-10.4 至 -4.3]）。对于后循环动脉瘤亚组，脑桥旁正中出血患者的脑血流与脑桥旁正中出血患者相当（平均差值：-0.7 [95%置信区间：-5.2 至 3.8]）；然而，在后循环动脉瘤分层为幕上（平均差值：-3.9 [95%置信区间：-9.3 至 1.4]）和幕下动脉瘤（平均差值：3.0 [95%置信区间：-2.8 至 8.8]）后，差异出现分歧。
脑桥旁正中出血患者的脑血流高于蛛网膜下腔出血患者。本研究的结果进一步支持脑桥旁正中出血的静脉源出血。未来的研究应进一步阐明后循环动脉瘤的脑血流情况。
