Mechanism and treatment principle for cerebral vessel spasm caused by concussion

To discuss the mechanism of cerebra l vessel spasm caused by concussion and the effect of Nimodipine on concussion. Methods: A total of 224 patients who were treated from March 1 995 to October 1999 were divided into two groups randomly, ie, Nimodipine group (113 cases) and control group (111 cases). Middle cerebral artery (MCA), basila r artery (BA) and the average peak forward velocity of cerebral blood flow were observed by color three dimensional transcranial Doppler (3D TCD) within 24 ho urs after admission and at the end of 3 6 days of treatment. Cerebral blood flo w changes, characteristics and treatment effect were analyzed and determined by clinical main symptom disappearance rate. Results: In concussion, cerebral blood flow was divided into 3 phases: cerebral blood flow low infusion dilation phase, cerebral blood vessel s pasm phase and cerebral blood flow recovery phase. In the Nimodipine group, clin ical main symptom disappearance rate was higher than that in the control group i n the cerebral spasm and recovery phases with a significant difference (P< 0.01 ). Conclusions: Cerebral vessel spasm, hypoxia and ischemia lesion are the main pathological changes. Whether cerebral dysfunction is reversible o r not is mainly determined by spasm time of cerebral blood vessel. Nimodipine ha s a good effect on releasing spasm and diminishing the cerebral blood flow veloc ity. It not only improves curative effect on concussion, but also reduces and pr events concussion sequelae. Hence, concussion patients who have cerebral spasm c onfirmed by 3D TCD should be given Nimodipine routinely and early.

Multiple factor analysis of symptomatic intracranial arterial stenosis

Objective: To discuss the correlation among intracranial arterial stenosis and its risk factors. Methods: A total of 486 patients with transient ischemic attack(TIA) or ischemic cerebral infarction were examined using color doppler flow imaging(CDFI) and transcranial doppler ultrosonography(TCD). According to the degrees of extracranial arterial stenosis, patients with mild-to-moderate extracranial stenosis were classified into group A(435 cases) while those with constant severe stenosis or occlusion were classified into group B(51 cases). The differences between the two groups of risk factors were compared, and the multi-factor logistic regression analysis of risk factors associated with moderately severe intracranial arterial stenosis was performed. Results:(1) The risk factors that were significantly associated with intracranial arterial stenosis included age(P = 0.034) and gender(P = 0.044).(2) Intracranial artery stenosis was observed in both anterior and posterior cerebral arteries in patients with hypertension, diabetes, and coronary heart disease respectively(P < 0.05).(3) Compared with group A, patients in group B were older(P = 0.000), with a higher proportion of men(P = 0.037), and the intracranial arterial stenosis degrees were significantly higher(P = 0.013).(4) Multi-factor logistic regression analysis showed that diabetes is a risk factor for moderately severe intracranial arterial stenosis(P < 0.05), and hyperlipidemia is a protective factor(P = 0.012). Conclusions: Age, gender, hypertension, diabetes, coronary heart disease, and smoking are risk factors for the distribution of intracranial arterial stenosis. The degrees of intracranial arterial stenosis are related with extracranial arterial stenosis. Diabetes is a risk factor for moderately severe intracranial arterial stenosis while hyperlipidemia is a protective factor.