Suzuki Hidenori
Department of Neurosurgery, Mie University Graduate School of Medicine.
No Shinkei Geka. 2024 Sep;52(5):890-898. doi: 10.11477/mf.1436204996.
Aneurysmal subarachnoid hemorrhage(SAH) causes brain injury and systemic complications, including cardiopulmonary dysfunction, which mutually affect each other. Post-SAH brain injury includes early brain injury(EBI) and delayed cerebral ischemia(DCI). EBI is a non-iatrogenic pathology occurring within 72 h of clinical SAH, primarily induced by increased intracranial pressure, subsequent transient global cerebral ischemia, and extravasated blood components. DCI typically develops between days 4 and 14 after clinical SAH because of erythrolysis(free hemoglobin) and EBI-mediated reactions. EBI and DCI share many pathologies, including large-artery spasm, microvascular spasm, microthrombosis, blood-brain barrier disruption, neuroinflammation, disturbance of venous outflow, and neuroelectric disturbances such as spreading depolarization and epileptic discharge. However, EBI and DCI differ not only in the timing of onset but also in their distribution, with EBI mainly occurring throughout the brain, while DCI occurs locally. Many substances, such as glutamic acid, cytokines, and matricellular proteins, mediate EBI and DCI pathologies. Further elucidation of EBI and DCI pathologies is essential for developing novel treatment strategies.
动脉瘤性蛛网膜下腔出血（SAH）可导致脑损伤和全身并发症，包括心肺功能障碍，这些并发症之间相互影响。SAH后的脑损伤包括早期脑损伤（EBI）和迟发性脑缺血（DCI）。EBI是临床SAH后72小时内发生的一种非医源性病理状态，主要由颅内压升高、随后的短暂性全脑缺血以及外渗的血液成分引起。DCI通常在临床SAH后的第4天至第14天之间发生，原因是红细胞溶解（游离血红蛋白）和EBI介导的反应。EBI和DCI有许多共同的病理状态，包括大动脉痉挛、微血管痉挛、微血栓形成、血脑屏障破坏、神经炎症、静脉流出障碍以及神经电紊乱，如扩散性去极化和癫痫放电。然而，EBI和DCI不仅在发病时间上不同，而且在分布上也不同，EBI主要发生在全脑，而DCI则局部发生。许多物质，如谷氨酸、细胞因子和基质细胞蛋白，介导EBI和DCI的病理过程。进一步阐明EBI和DCI的病理状态对于开发新的治疗策略至关重要。
