From the Departments of Neurosurgery (J.I., Y.K., Y.H.), Medical Technology (K.S.), and Cardiology (E.W.), Fujita Health University Hospital, Toyoake, Japan.
Stroke. 2013 Dec;44(12):3550-2. doi: 10.1161/STROKEAHA.113.003099. Epub 2013 Sep 24.
Insular injuries are known to cause autonomic derangements. Patients with ruptured middle cerebral artery aneurysms frequently develop temporal hematomas (THs) in addition to subarachnoid hemorrhages, and those with TH may sustain autonomic derangements more frequently than those without TH. Hemispheric lateralization in autonomic derangements has been reported in patients with insular ischemic stroke, and this study was conducted to clarify whether such lateralization was also observed in patients with TH resulting from middle cerebral artery aneurysm rupture.
A retrospective analysis on the medical records of 79 patients with ruptured middle cerebral artery aneurysms was performed on the basis of lateralization and presence of TH. They were quadrichotomized as left TH+ (LTH+; n=17), right TH+ (n=25), left TH- (n=15), and right TH- (n=22). Comparisons, mainly between LTH+ and right TH+, were made on demographic variables, autonomic/cardiac parameters, plasma catecholamine and glucose levels, and outcomes.
There were no significant differences in demographic or cardiac parameters between the 2 groups. Systolic blood pressures were lower in LTH+ (139±34 versus 174±47 mm Hg; P=0.05). The LTH+ group also tended to be more bradycardiac (80±19 versus 101±22 bpm; P=0.13). The LTH+ group exhibited significantly lower plasma norepinephrine (1008±975 versus 2549±2133 pg/mL; P=0.03) and glucose levels (9.3±1.8 versus 12.2±4.5 mmol/L; P=0.04). However, in-hospital mortality did not differ significantly (41% versus 44%; P=1.00).
Lateralization of autonomic derangements observed might not have had a significant effect on the outcomes. Nevertheless, autonomic derangements associated with insular injury should be considered in the management of subarachnoid hemorrhage patients with TH.
众所周知，脑岛损伤可导致自主神经功能紊乱。破裂的大脑中动脉动脉瘤患者除蛛网膜下腔出血外，常伴有颞叶血肿（TH），且伴有 TH 的患者比不伴有 TH 的患者更常发生自主神经功能紊乱。有研究报道，在脑岛缺血性卒中患者中存在自主神经功能紊乱的偏侧化，本研究旨在明确这种偏侧化是否也存在于大脑中动脉动脉瘤破裂所致 TH 的患者中。
对 79 例破裂的大脑中动脉动脉瘤患者的病历进行回顾性分析，根据偏侧化和 TH 的存在进行四分类：左 TH+（LTH+；n=17）、右 TH+（n=25）、左 TH-（n=15）和右 TH-（n=22）。主要对 LTH+与右 TH+两组间的人口统计学变量、自主/心脏参数、血浆儿茶酚胺和血糖水平及结局进行比较。
两组间的人口统计学或心脏参数无显著差异。LTH+组的收缩压较低（139±34 与 174±47mmHg；P=0.05）。LTH+组也更倾向于心动过缓（80±19 与 101±22bpm；P=0.13）。LTH+组的血浆去甲肾上腺素水平明显较低（1008±975 与 2549±2133pg/mL；P=0.03）和血糖水平较低（9.3±1.8 与 12.2±4.5mmol/L；P=0.04）。然而，住院死亡率无显著差异（41%与 44%；P=1.00）。
观察到的自主神经功能紊乱的偏侧化可能对结局没有显著影响。然而，在管理伴有 TH 的蛛网膜下腔出血患者时，应考虑与脑岛损伤相关的自主神经功能紊乱。
