Fujioka M, Okuchi K, Sakaki T, Hiramatsu K, Miyamoto S, Iwasaki S
Department of Neurosurgery, Nara Medical University, Japan.
Stroke. 1994 Oct;25(10):2091-5. doi: 10.1161/01.str.25.10.2091.
Very few reports are available on serial changes in human brain after cardiac arrest. The primary objective of this study is to investigate sequential neuroradiological changes in patients remaining in a persistent vegetative state following resuscitation after cardiac arrest.
We repeatedly studied eight vegetative patients resuscitated from unexpected out-of-hospital cardiac arrest using computed tomographic (CT) scanning and high-field magnetic resonance (MR) imaging at 1.5 T.
In seven of the eight patients, CT scans obtained between days 2 and 6 features symmetrical low-density lesions in the bilateral caudate, lenticular, and/or thalamic nuclei. These ischemic lesions were persistently of low density on serial CT scans. In these seven patients, MR images demonstrated what were thought to be hemoglobin degradation products derived from minor hemorrhages localized in the bilateral basal ganglia, thalami, and/or substantia nigra. Diffuse brain edema in the acute stage and diffuse brain atrophy in the chronic stage were consistent neuroradiological findings. No abnormal enhanced lesions were demonstrated by CT scans.
The most characteristic findings on high-field MR images were symmetrical lesions in the bilateral basal ganglia, thalami, and/or substantia nigra with specific changes suggestive of minor hemorrhages that were not evident on CT scans. We speculate that these minor hemorrhages result from diapedesis of red blood cells in these regions during the reperfusion period through the endothelium disrupted by ischemia-reperfusion insult.
关于心脏骤停后人类大脑的系列变化的报道非常少。本研究的主要目的是调查心脏骤停复苏后仍处于持续性植物状态的患者的系列神经放射学变化。
我们对8例从院外意外心脏骤停复苏成功的植物状态患者，使用计算机断层扫描（CT）和1.5T高场磁共振（MR）成像进行了反复研究。
在8例患者中的7例中，在第2天至第6天之间进行的CT扫描显示双侧尾状核、豆状核和/或丘脑有对称的低密度病变。这些缺血性病变在系列CT扫描中持续呈低密度。在这7例患者中，MR图像显示双侧基底节、丘脑和/或黑质内有小出血灶，推测为血红蛋白降解产物。急性期弥漫性脑水肿和慢性期弥漫性脑萎缩是一致的神经放射学表现。CT扫描未显示异常强化病变。
高场MR图像上最具特征性的表现是双侧基底节、丘脑和/或黑质的对称病变，伴有提示小出血的特定变化，而这些在CT扫描上并不明显。我们推测这些小出血是由于再灌注期红细胞通过因缺血-再灌注损伤而破坏的内皮细胞渗出到这些区域所致。
