Department of Neurosurgery, University of Florida, Gainesville, USA.
Department of Neurosurgery, University of Florida, Gainesville, USA.
Clin Neurol Neurosurg. 2022 Jul;218:107273. doi: 10.1016/j.clineuro.2022.107273. Epub 2022 May 6.
Delayed cerebral ischemia (DCI) contributes to extensive morbidity and mortality for patients with aneurysmal subarachnoid hemorrhage (SAH). Recent contributions to the basic and translational investigation of DCI have shed light on emerging concepts that may aid in the development of novel therapeutics. A clear association between cerebral vasospasm (CV) and DCI exists, but it is also known that DCI can affect brain parenchyma remote from sites of vasospasm. In this review, we highlight the most recent contributions to the understanding of the underlying pathophysiology of DCI including the emerging role of the glymphatic system. Furthermore, we discuss treatments for DCI, including both pharmacologic therapies and endovascular treatment of vasospasm. There continues to be a disconnect between interventions and targeted treatment against pathophysiology. This review is intended to serve as a catalyst for further research and discovery that can aid in improved treatment options for DCI.
迟发性脑缺血（DCI）是导致颅内动脉瘤性蛛网膜下腔出血（SAH）患者高发病率和高死亡率的主要原因。最近对 DCI 的基础和转化研究的贡献揭示了一些新的概念，这些概念可能有助于开发新的治疗方法。虽然脑血管痉挛（CV）和 DCI 之间存在明确的关联，但众所周知，DCI 也会影响到远离血管痉挛部位的脑实质。在这篇综述中，我们重点介绍了对 DCI 潜在病理生理学的最新理解，包括胶状淋巴系统的新作用。此外，我们还讨论了 DCI 的治疗方法，包括药物治疗和血管痉挛的血管内治疗。干预措施和针对病理生理学的靶向治疗之间仍然存在脱节。这篇综述旨在作为进一步研究和发现的催化剂，以帮助改善 DCI 的治疗选择。
