Romner B, Bellner J, Kongstad P, Sjöholm H
Department of Neurosurgery, University Hospital of Lund, Sweden.
J Neurosurg. 1996 Jul;85(1):90-7. doi: 10.3171/jns.1996.85.1.0090.
Sixty-seven patients (45 males and 22 females) aged 2 to 70 years (mean 36 years) who had suffered closed head injury were investigated with daily transcranial Doppler (TCD) recordings. A total of 470 TCD recordings (mean 7) were made during Days 1 to 14 after admission. Blood flow velocities were determined in the middle cerebral artery (MCA) and the extracranial internal carotid artery (ICA). Twenty-seven (40%) of the 67 patients demonstrated traumatic subarachnoid hemorrhage (tSAH) on the first computerized tomography (CT) scan after the injury. Flow velocities exceeded 100 cm/second in 22 patients. Eleven (41%) of the 27 patients who showed tSAH on the first CT scan developed velocities greater than 100 cm/second, as compared to 11 (28%) of 40 patients without tSAH on CT. Two patients in whom a thick layer of tSAH was revealed on the first CT scan had MCA flow velocities exceeding 200 cm/second for several days. Measurements of cerebral blood flow (CBF) with single-photon emission CT (SPECT) were performed in six tSAH patients who showed TCD flow velocities exceeding 120 cm/second (uni- or bilaterally) to determine whether the increase in velocity reflected vasospasm or hyperemia. The SPECT studies verified ischemia in five patients but revealed general hyperemia in one. The bilateral increase in MCA flow velocities in the latter case was due to high-volume flow through the MCA secondary to elevated CBF rather than arterial narrowing. In one patient with a thick layer of subarachnoid blood on a CT scan obtained at admission, MCA flow velocities exceeded 220 cm/second bilaterally on Day 8 after the head injury. A SPECT measurement obtained on the same day reflected bilateral ischemia. In this patient flow velocities decreased, with a corresponding normalization of CBF, after 5 days of intravenous nimodipine administration. The MCA/ICA ratio correlated well with the distribution of CBF in the six patients studied using SPECT. This report suggests that vasospasm is an important secondary posttraumatic insult in patients suffering severe head injury and, in some cases, is probably treatable by administration of intravenous calcium channel blockers.
对67例年龄在2至70岁（平均36岁）的闭合性颅脑损伤患者进行了研究，通过每日经颅多普勒（TCD）记录进行观察。这些患者中，男性45例，女性22例。入院后第1至14天共进行了470次TCD记录（平均每人7次）。测定了大脑中动脉（MCA）和颅外颈内动脉（ICA）的血流速度。67例患者中有27例（40%）在受伤后的首次计算机断层扫描（CT）中显示有创伤性蛛网膜下腔出血（tSAH）。22例患者的血流速度超过100厘米/秒。在首次CT扫描显示有tSAH的27例患者中，有11例（41%）血流速度超过100厘米/秒，而在CT上无tSAH的40例患者中有11例（28%）血流速度超过100厘米/秒。首次CT扫描显示有厚层tSAH的2例患者，其MCA血流速度连续数天超过200厘米/秒。对6例TCD血流速度超过120厘米/秒（单侧或双侧）的tSAH患者进行了单光子发射计算机断层扫描（SPECT）脑血流量（CBF）测定，以确定血流速度增加是反映血管痉挛还是充血。SPECT研究证实5例患者存在缺血，但1例显示为全身性充血。在后一种情况下，MCA血流速度双侧增加是由于CBF升高导致通过MCA的血流量增加，而非动脉狭窄。1例入院时CT扫描显示有厚层蛛网膜下腔出血的患者，颅脑损伤后第8天MCA血流速度双侧超过220厘米/秒。同一天进行的SPECT测量显示双侧缺血。该患者静脉注射尼莫地平5天后，血流速度下降，CBF相应恢复正常。在使用SPECT研究的6例患者中，MCA/ICA比值与CBF分布相关性良好。本报告表明，血管痉挛是重度颅脑损伤患者重要的继发性创伤后损伤，在某些情况下，静脉注射钙通道阻滞剂可能有效。
