Nakase H, Heimann A, Kempski O
Institute for Neurosurgical Pathophysiology, Johannes Gutenberg University Mainz, Germany.
J Cereb Blood Flow Metab. 1996 Jul;16(4):720-8. doi: 10.1097/00004647-199607000-00024.
The symptoms following sinus and vein occlusion observed in patients and experimental animals display a considerable variability that so far remains largely unexplained. In a rat cortical vein occlusion model using a photochemical thrombotic technique, we examined changes in the cerebral venous flow pattern by fluorescence angiography and regional cerebral blood flow (rCBF) and cerebral blood volume fraction (CBVF) by a modern laser Doppler "scanning" technique. Brain damage was assessed histologically. Fluorescence angiographic findings fell into two groups: group A, rats with an altered venous flow pattern after occlusion (n = 12), and group B, rats with interruption of blood flow and/or a growing venous thrombus (n = 5). In addition, sham-operated animals made up group C (n = 5). Extravasation of fluorescein, a massive decrease in rCBF, a short-lasting increase in CBVF, and regional brain damage were typical for group B. In addition, cortical CBF mapping revealed a transient hyperperfusion zone with hyperemia surrounding a hypoperfused ischemic core in group B. A circulation perturbation following venous occlusion appeared near those occluded cerebral veins without sufficient collateral flow. Furthermore, the venous thrombus continued to grow, accompanied by local critical ischemia and severe brain damage. Conversely, 71% of the animals (12 of 17) tolerated occlusion of a solitary vein without major flow disturbances or histological evidence of damage to the CNS (group A).
在患者和实验动物中观察到的鼻窦和静脉闭塞后的症状表现出相当大的变异性,迄今为止,这在很大程度上仍无法解释。在使用光化学血栓形成技术的大鼠皮质静脉闭塞模型中,我们通过荧光血管造影检查了脑静脉血流模式的变化,并通过现代激光多普勒“扫描”技术检查了局部脑血流量(rCBF)和脑血容量分数(CBVF)。通过组织学评估脑损伤。荧光血管造影结果分为两组:A组,闭塞后静脉血流模式改变的大鼠(n = 12),B组,血流中断和/或静脉血栓形成的大鼠(n = 5)。此外,假手术动物组成C组(n = 5)。B组的典型表现为荧光素外渗、rCBF大幅下降、CBVF短暂升高以及局部脑损伤。此外,皮质CBF图谱显示B组在灌注不足的缺血核心周围有一个伴有充血的短暂性高灌注区。静脉闭塞后的循环紊乱出现在那些没有足够侧支血流的闭塞脑静脉附近。此外,静脉血栓持续增大,伴有局部严重缺血和严重脑损伤。相反,71%的动物(17只中的12只)能够耐受单条静脉闭塞,而没有明显的血流紊乱或中枢神经系统损伤的组织学证据(A组)。