Khiabani Elmira, Kalisvaart Anna C J, Wilkinson Cassandra M, Hurd Peter L, Buck Brian H, Colbourne Frederick
Department of Psychology, Faculty of Science, University of Alberta, P217 Biological Sciences Bldg, Edmonton, AB, Canada.
Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.
Transl Stroke Res. 2024 Dec 11. doi: 10.1007/s12975-024-01316-y.
Intracerebral hemorrhage (ICH) along with aggravating factors, such as edema, can raise intracranial pressure (ICP) to pathological levels. Diversion of some cerebrospinal fluid (CSF) and venous blood out of the cranium can limit ICP rises while maintaining cerebral perfusion pressure. Brain tissue itself is widely considered immutable in volume but prone to distortion (e.g., midline shift). However, distal brain regions shrink acutely following ICH in rodents. Tissue contraction arises from cell shrinkage and increased packing density. This "tissue compliance" is hypothesized to be an additional mechanism to limit ICP rises. Here, we examined whether and by how much parenchyma volume reduction occurs in ICH patients. We conducted a retrospective analysis on computed tomography (CT) scans of 96 ICH patients (average age 63.8 years old, 55% male) with an average hematoma volume of 32.4 and 35.3 mL at the first and second scan (separated by ~ 23 h), respectively. Hematoma growth (any absolute increase) occurred in 44% of patients, with a minimal but significant growth of the hematoma of 2.9 mL on average across all patients (p = 0.028). As hypothesized, the contralateral hemisphere volume was significantly reduced by 12.7 mL (p < 0.0001) between scans. This was unrelated to midline shift (R = 0.012, p = 0.21), which averaged 2.3 mm. These findings suggest that distal parenchymal shrinkage may be a major compliance mechanism after ICH; the implications for ICP and brain function merit further study.
脑出血（ICH）连同诸如水肿等加重因素，可将颅内压（ICP）升高至病理水平。将一些脑脊液（CSF）和静脉血引出颅腔可限制ICP升高，同时维持脑灌注压。脑组织本身在体积上被广泛认为是不变的，但容易发生变形（例如中线移位）。然而，啮齿动物脑出血后远端脑区会急性萎缩。组织收缩源于细胞萎缩和堆积密度增加。这种“组织顺应性”被认为是限制ICP升高的另一种机制。在此，我们研究了脑出血患者实质体积减少是否发生以及减少了多少。我们对96例脑出血患者（平均年龄63.8岁，55%为男性）的计算机断层扫描（CT）进行了回顾性分析，首次扫描和第二次扫描（间隔约23小时）时血肿平均体积分别为32.4和35.3 mL。44%的患者出现血肿增大（任何绝对增加），所有患者血肿平均最小但有显著增大2.9 mL（p = 0.028）。正如所假设的，两次扫描之间对侧半球体积显著减少了12.7 mL（p < 0.0001）。这与平均为2.3 mm的中线移位无关（R = 0.012，p = 0.21）。这些发现表明，远端实质萎缩可能是脑出血后主要的顺应性机制；其对ICP和脑功能的影响值得进一步研究。
