Hayashi M, Kobayashi H, Kawano H, Yamamoto S, Maeda T
J Neurosurg. 1984 Jul;61(1):30-6. doi: 10.3171/jns.1984.61.1.0030.
Cerebral blood flow (CBF) was measured, the intracranial pressure (ICP) was continuously recorded, and the ventricular system size was evaluated on serial computerized tomography scans in 43 patients. These patients all had communicating hydrocephalus after subarachnoid hemorrhage (SAH) from rupture of an intracranial aneurysm. The studies were carried out both in the acute stage (within 7 days after SAH) and in the communicating hydrocephalus stage. In patients in the acute stage who had no ventricular dilatation, but who later developed communicating hydrocephalus, the mean CBF was reduced; lower CBF was associated with poorer clinical grades and a higher resting pressure range. Communicating hydrocephalus produced a significant decrease in CBF. The ICP tracing showed continuing plateau waves in conjunction with B-waves in patients in whom recordings were begun within 63 days after SAH. In general, patients with more dilated ventricular systems, with less frequent ICP irregularities, and with lower resting pressure ranges had a more marked decrease in CBF. A significant decrease in CBF was also found in patients with diffuse vasospasm in comparison to those without vasospasm. Patients with communicating hydrocephalus in whom ICP recordings were started more than 6 months after SAH showed no ICP irregularities. In these patients, a mean CBF of less than 25 ml/100 gm/min and a markedly low resting pressure range were observed. Shunting procedures were never effective in any of these patients. The results suggest that, in patients with communicating hydrocephalus, a mean CBF below this level may cause irreversible damage to the brain tissue in the terminal stage, and may inhibit the cerebral vasomotor reaction that participates in the development of ICP irregularities.
对43例患者测量了脑血流量（CBF），连续记录颅内压（ICP），并通过系列计算机断层扫描评估脑室系统大小。这些患者均因颅内动脉瘤破裂导致蛛网膜下腔出血（SAH）后发生交通性脑积水。研究在急性期（SAH后7天内）和交通性脑积水期进行。在急性期无脑室扩张但后来发展为交通性脑积水的患者中，平均CBF降低；较低的CBF与较差的临床分级和较高的静息压力范围相关。交通性脑积水使CBF显著降低。在SAH后63天内开始记录的患者中，ICP描记显示持续的平台波与B波同时出现。一般来说，脑室系统扩张更明显、ICP不规则性较少且静息压力范围较低的患者，CBF降低更为显著。与无血管痉挛的患者相比，弥漫性血管痉挛患者的CBF也显著降低。SAH后6个月以上开始记录ICP的交通性脑积水患者未出现ICP不规则性。在这些患者中，观察到平均CBF低于25 ml/100 gm/min且静息压力范围明显较低。分流手术对这些患者均无效。结果表明，在交通性脑积水患者中，低于该水平的平均CBF可能在终末期对脑组织造成不可逆损害，并可能抑制参与ICP不规则性发展的脑血管运动反应。
