Nemati M N, Dietz H
Neurochirurgische Klinik der Medizinischen Hochschule Hannover, Bonn.
Schweiz Arch Neurol Psychiatr (1985). 1995;146(6):256-63.
It is well known that cerebral blood flow (CBF) is altered corresponding to the severity of the subarachnoid hemorrhage (SAH) in different extents. The extent of CBF reduction and its regional accentuation is regarded as a pathophysiological correlation of clinical conditions. Therefore, we agree that CBF of patients in grade IV+V (Hunt and Hess) are clearly lower than in grade I+II. There are quite different results in grade III. Disturbance of consciousness and/or neurological deficits, as described in the definition of grade III, can be a consequence of different kinds of CBF changes. 45 Xe-CT studies were performed on 19 patients (mean age 44 +/- 14 years) after SAH. 8 patients were of grade I+II, 7 of grade III, and 4 patients of grade IV+V. The studies were performed preoperatively, at a time of clinical change, and before discharge. The evaluation of flow-maps was done by measuring 15 regions per hemisphere. Mean CBF data were evaluated in each area. To show the CBF differences between both hemispheres within each group of patients, a difference index (%) was calculated. The results demonstrated a mean CBF reduction in nearly all regions from grade I+II to grade III up to grade IV+V. The mean CBF reduction between grade I+II and grade III was 10% for gray and 20% for white matter (p < 0.05). On the other hand the difference index of gray matter in grade III with 17% is significantly higher than in grade I+II. For the white matter there was no significant side difference. Our findings demonstrate a visually evaluable pattern of CBF corresponding to grade I+II, grade III, and grade I+V. Intention of this study was to show a correlation between clinical conditions of patients after SAH and the CBF changes by the use of Xe-CT method.
众所周知，脑血流量（CBF）会根据蛛网膜下腔出血（SAH）的严重程度在不同程度上发生改变。CBF降低的程度及其区域强化被视为临床状况的病理生理相关性。因此，我们认同IV+V级（Hunt和Hess分级）患者的CBF明显低于I+II级患者。III级患者的结果差异较大。如III级定义中所述，意识障碍和/或神经功能缺损可能是不同类型CBF变化的结果。对19例SAH患者（平均年龄44±14岁）进行了45 Xe-CT研究。8例为I+II级，7例为III级，4例为IV+V级。研究在术前、临床变化时和出院前进行。通过测量每个半球的15个区域来评估血流图。对每个区域的平均CBF数据进行评估。为了显示每组患者两个半球之间的CBF差异，计算了差异指数（%）。结果表明，从I+II级到III级再到IV+V级，几乎所有区域的平均CBF都有所降低。I+II级和III级之间灰质的平均CBF降低了10%，白质降低了20%（p<0.05）。另一方面，III级灰质的差异指数为17%，明显高于I+II级。白质没有明显的侧别差异。我们的研究结果显示了与I+II级、III级和IV+V级相对应的CBF视觉可评估模式。本研究的目的是通过Xe-CT方法显示SAH后患者的临床状况与CBF变化之间的相关性。
