Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, T...Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, TLR4 is expressed in various cell types in the central nervous system, and is unique in that it can signal through both the myeloid differentiation primary-response protein 88-dependent and the toll receptor associated activator of interferon-dependent cascades to coordinate the maximal inflammatory response. TLR4 can be activated by many endogenous ligands having damage-associated molecular patterns including heme and fibrinogen at the rupture of an intracranial aneurysm, and the resultant inflammatory reaction and thereby tissue damages may furthermore activate TLR4. It is widely accepted that the excreted products of TLR4 signaling alter neuronal functions. Previous studies have focused on the pathway through nuclear factor（NF）-κΒ signaling among TLR4 signaling pathways as to the development of early brain injury（EBI） such as neuronal apoptosis and blood-brain barrier disruption, and cerebral vasospasm. However, many findings suggest that both pathways via NF-κΒ and mitogen-activated protein kinases may be involved in EBI and cerebral vasospasm development. To overcome EBI and cerebral vasospasm is important to improve outcomes after SAH, because both EBI and vasopasm are responsible for delayed brain injuries or delayed cerebral ischemia, the most important preventable cause of poor outcomes after SAH. Increasing evidence has shown that TLR4 signaling plays an important role in SAH-induced brain injuries. Better understanding of the roles of TLR4 signaling in SAH will facilitate development of new treatments.展开更多
A 70-year-old female with poorly controlled diabetes developed sudden visual loss, ptosis and complete ophthalmoplegia of the right eye. Funduscopic examination showed the pale retina and the cherry red spot in the ri...A 70-year-old female with poorly controlled diabetes developed sudden visual loss, ptosis and complete ophthalmoplegia of the right eye. Funduscopic examination showed the pale retina and the cherry red spot in the right eye. Fluorescein angiography and indocyanine green angiography demonstrated the absence of retinal arterial filling and choroidal perfusion in the right eye even 20 minutes after injecting the dye. The patient was diagnosed with right ophthalmic artery occlusion. Computed tomography (CT) showed diffuse mucosal thickening in the right ethmoidal sinus. Based on the clinical findings and endoscopic biopsy result, mucormycosis was confirmed. Amphotericin B (40 mg/day) and ceftriaxone (2 g/day) were intravenously administered. Despite the improvement of the right ethmoidal sinusitis and the right proptosis, the patient deteriorated into a comatose state after 19 days of systemic amphotericin B therapy. Although the previous CT showed no cerebral aneurysm, a repeated CT showed newly developed posterior communicating artery aneurysm and the subarachnoid hemorrhage. Despite the amphotericin B treatment and the improvement of the sinusitis, mucormycosis could cause sudden cerebral aneurysm rupture and subarachnoid hemorrhage resulting in coma.展开更多
<strong>Objective:</strong> To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. <strong>Methods:</strong> Seventy...<strong>Objective:</strong> To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. <strong>Methods:</strong> Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups.<strong> Results:</strong> There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (<em>P</em> > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. <strong>Conclusion:</strong> Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.展开更多
The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We ...The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.展开更多
Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. CVS ...Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th–7th postictal days. Several therapeutic modalities have been employed to prevent or reverse CVS. The aim of this review is to summate all the available drug treatment modalities for vasospasm.展开更多
Background: Aneurysmal subarachnoid hemorrhage (aSAH) is an acute neurosurgical emergency with a significant fatality rate. In addition to acute brain injury, a considerable part of patients suffering from aSAH develo...Background: Aneurysmal subarachnoid hemorrhage (aSAH) is an acute neurosurgical emergency with a significant fatality rate. In addition to acute brain injury, a considerable part of patients suffering from aSAH develops secondary brain damage such as cerebral vasospasm (CVS). CVS exacerbates the mortality. Therefore, it is urgently needed to find a biomarker, which could predict secondary brain and lead to operation by physicians more promptly. S100B, produced and released by astrocytes, has proven to be an important biomarker for brain injury.Methods: In this present study, 51 patients with aSAH were included. Five CSF samples from each patient were obtained via lumbar puncture and were detected using electrochemiluminescence immunoassay (ECLIA).Results: It indicated that S100B had a higher concentration in CSF of patients treated by surgical clipping after aSAH than that treated with endovascular coiling. In addition, the mean CSF S100B level in patients without CVS was much lower compared with patients with CVS. And, the expression of S100B increased along with the Fisher Grade at the same day after aSAH attacked and decreased as time went on. Moreover, the CSF S100B level of different time points and the mean CSF S100B level can predict the risk of CVS.Conclusions: These data suggest that CSF S100B can be served as a predictor of CVS, which triggers an immediate management by clinicians to prevent secondary exacerbation.展开更多
目的探讨化瘀解痉方联合尼莫地平治疗动脉瘤性蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)后脑血管痉挛患者的疗效及对其血管内皮功能的影响。方法选取2022年1月-2023年1月期间保定市第一中心医院收治的SAH后脑血管痉挛患者90例,按随...目的探讨化瘀解痉方联合尼莫地平治疗动脉瘤性蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)后脑血管痉挛患者的疗效及对其血管内皮功能的影响。方法选取2022年1月-2023年1月期间保定市第一中心医院收治的SAH后脑血管痉挛患者90例,按随机数字表法分为对照组和观察组,每组各45例。对照组给予尼莫地平治疗,观察组在对照组基础上联合化瘀解痉方治疗,均连续治疗15 d。观察两组患者治疗前后神经功能缺损评分(National institute of health stroke scale,NIHSS)、Hunt-Hess分级评分、意识障碍程度评分(Glasgow coma scale,GCS)、血管内皮功能指标[内皮素-1(Endothelin-1,ET-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)]、脑血流指标[大脑中动脉平均流速(Mean flow velocity of middle cerebral artery,MCA-Vm)、颈内动脉颅外段平均流速(Mean extracranial velocity of internal carotid artery,VICA-Vm)、脑血管痉挛(Cerebral vasospasm,CAS)指数]改善情况,临床总有效率及不良反应情况。结果治疗后两组患者NIHSS、Hunt-Hess评分均较治疗前降低,GCS评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组NIHSS、Hunt-Hess评分均明显低于对照组,GCS评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ET-1、VEGF水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组ET-1、VEGF水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者MCA-Vm、VICA-Vm及CAS指数均较治疗前降低,差异有统计学意义(P<0.05);且观察组MCA-Vm、VICA-Vm及CAS指数均明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组临床总有效率91.11%(41/45)明显高于对照组73.33%(33/45),差异有统计学意义(P<0.05)。治疗期间,两组患者均未发生不良反应,也未出现死亡病例。结论化瘀解痉方联合尼莫地平能够改善SAH后脑血管痉挛患者的血管内皮功能,增加脑血流灌注,减轻神经功能损伤,控制病情发展,疗效显著,安全性高。展开更多
目的探讨宁神止痉汤对颅内动脉瘤破裂所致蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)介入术后脑血管痉挛患者脑损伤、自由基、脑血流及神经功能的影响。方法选取治疗的aSAH患者80例,随机分为对照组与研究组,每组40例,患...目的探讨宁神止痉汤对颅内动脉瘤破裂所致蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)介入术后脑血管痉挛患者脑损伤、自由基、脑血流及神经功能的影响。方法选取治疗的aSAH患者80例,随机分为对照组与研究组,每组40例,患者给予尼莫地平等药物常规治疗,研究组在对照组治疗基础上给予宁神止痉汤口服治疗,治疗时间14 d,观察患者治疗前后血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、星形胶质源性蛋白(astroglia-derived protein,S100β)、超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、内皮素-1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO)变化,大脑中动脉平均血流速度(median cerebral artery velocity,Vm)、脑血管痉挛指数(linde-gard)、血管自我调节功能指标脉冲指数(impulse index of vascular self-regulation function,PI)变化,采用格拉斯哥(Glasgow coma scale,GCS)和美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分对患者神经功能状况进行评价。结果两组患者治疗前血清NSE及S100β水平比较差异无统计学意义(P>0.05),治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05);两组患者治疗前血清SOD、MDA、ET-1、NO水平比较差异无统计学意义(P>0.05),MDA、ET-1治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05),SOD、NO治疗后较治疗前升高(P<0.05),且研究组升高程度大于对照组(P<0.05),比较差异有统计学意义(P<0.05);两组患者治疗前大脑中动脉Vm、linde-gard、PI比较差异无统计学意义(P>0.05),治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05);两组患者治疗前血清GCS及NIHSS评分比较差异无统计学意义(P>0.05),NIHSS治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05),GCS治疗后较治疗前升高(P<0.05),且研究组升高程度大于对照组(P<0.05)。结论aSAH介入术后脑血管痉挛患者采用宁神止痉汤治疗,可有助于减轻脑损伤,降低自由基,改善脑血流,促进神经功能的恢复。展开更多
基金supported by a Grant-in-Aid for Scientific Research from Mie Medical Research Foundation to Dr.Suzuki
文摘Neuroinflammation is a well-recognized consequence of subarachnoid hemorrhage（SAH）, and Toll-like receptor（TLR） 4 may be an important therapeutic target for post-SAH neuroinflammation. Of the TLR family members, TLR4 is expressed in various cell types in the central nervous system, and is unique in that it can signal through both the myeloid differentiation primary-response protein 88-dependent and the toll receptor associated activator of interferon-dependent cascades to coordinate the maximal inflammatory response. TLR4 can be activated by many endogenous ligands having damage-associated molecular patterns including heme and fibrinogen at the rupture of an intracranial aneurysm, and the resultant inflammatory reaction and thereby tissue damages may furthermore activate TLR4. It is widely accepted that the excreted products of TLR4 signaling alter neuronal functions. Previous studies have focused on the pathway through nuclear factor（NF）-κΒ signaling among TLR4 signaling pathways as to the development of early brain injury（EBI） such as neuronal apoptosis and blood-brain barrier disruption, and cerebral vasospasm. However, many findings suggest that both pathways via NF-κΒ and mitogen-activated protein kinases may be involved in EBI and cerebral vasospasm development. To overcome EBI and cerebral vasospasm is important to improve outcomes after SAH, because both EBI and vasopasm are responsible for delayed brain injuries or delayed cerebral ischemia, the most important preventable cause of poor outcomes after SAH. Increasing evidence has shown that TLR4 signaling plays an important role in SAH-induced brain injuries. Better understanding of the roles of TLR4 signaling in SAH will facilitate development of new treatments.
文摘A 70-year-old female with poorly controlled diabetes developed sudden visual loss, ptosis and complete ophthalmoplegia of the right eye. Funduscopic examination showed the pale retina and the cherry red spot in the right eye. Fluorescein angiography and indocyanine green angiography demonstrated the absence of retinal arterial filling and choroidal perfusion in the right eye even 20 minutes after injecting the dye. The patient was diagnosed with right ophthalmic artery occlusion. Computed tomography (CT) showed diffuse mucosal thickening in the right ethmoidal sinus. Based on the clinical findings and endoscopic biopsy result, mucormycosis was confirmed. Amphotericin B (40 mg/day) and ceftriaxone (2 g/day) were intravenously administered. Despite the improvement of the right ethmoidal sinusitis and the right proptosis, the patient deteriorated into a comatose state after 19 days of systemic amphotericin B therapy. Although the previous CT showed no cerebral aneurysm, a repeated CT showed newly developed posterior communicating artery aneurysm and the subarachnoid hemorrhage. Despite the amphotericin B treatment and the improvement of the sinusitis, mucormycosis could cause sudden cerebral aneurysm rupture and subarachnoid hemorrhage resulting in coma.
文摘<strong>Objective:</strong> To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. <strong>Methods:</strong> Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups.<strong> Results:</strong> There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (<em>P</em> > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. <strong>Conclusion:</strong> Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.
文摘The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.
文摘Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th–7th postictal days. Several therapeutic modalities have been employed to prevent or reverse CVS. The aim of this review is to summate all the available drug treatment modalities for vasospasm.
文摘Background: Aneurysmal subarachnoid hemorrhage (aSAH) is an acute neurosurgical emergency with a significant fatality rate. In addition to acute brain injury, a considerable part of patients suffering from aSAH develops secondary brain damage such as cerebral vasospasm (CVS). CVS exacerbates the mortality. Therefore, it is urgently needed to find a biomarker, which could predict secondary brain and lead to operation by physicians more promptly. S100B, produced and released by astrocytes, has proven to be an important biomarker for brain injury.Methods: In this present study, 51 patients with aSAH were included. Five CSF samples from each patient were obtained via lumbar puncture and were detected using electrochemiluminescence immunoassay (ECLIA).Results: It indicated that S100B had a higher concentration in CSF of patients treated by surgical clipping after aSAH than that treated with endovascular coiling. In addition, the mean CSF S100B level in patients without CVS was much lower compared with patients with CVS. And, the expression of S100B increased along with the Fisher Grade at the same day after aSAH attacked and decreased as time went on. Moreover, the CSF S100B level of different time points and the mean CSF S100B level can predict the risk of CVS.Conclusions: These data suggest that CSF S100B can be served as a predictor of CVS, which triggers an immediate management by clinicians to prevent secondary exacerbation.
文摘目的探讨化瘀解痉方联合尼莫地平治疗动脉瘤性蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)后脑血管痉挛患者的疗效及对其血管内皮功能的影响。方法选取2022年1月-2023年1月期间保定市第一中心医院收治的SAH后脑血管痉挛患者90例,按随机数字表法分为对照组和观察组,每组各45例。对照组给予尼莫地平治疗,观察组在对照组基础上联合化瘀解痉方治疗,均连续治疗15 d。观察两组患者治疗前后神经功能缺损评分(National institute of health stroke scale,NIHSS)、Hunt-Hess分级评分、意识障碍程度评分(Glasgow coma scale,GCS)、血管内皮功能指标[内皮素-1(Endothelin-1,ET-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)]、脑血流指标[大脑中动脉平均流速(Mean flow velocity of middle cerebral artery,MCA-Vm)、颈内动脉颅外段平均流速(Mean extracranial velocity of internal carotid artery,VICA-Vm)、脑血管痉挛(Cerebral vasospasm,CAS)指数]改善情况,临床总有效率及不良反应情况。结果治疗后两组患者NIHSS、Hunt-Hess评分均较治疗前降低,GCS评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组NIHSS、Hunt-Hess评分均明显低于对照组,GCS评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ET-1、VEGF水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组ET-1、VEGF水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者MCA-Vm、VICA-Vm及CAS指数均较治疗前降低,差异有统计学意义(P<0.05);且观察组MCA-Vm、VICA-Vm及CAS指数均明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组临床总有效率91.11%(41/45)明显高于对照组73.33%(33/45),差异有统计学意义(P<0.05)。治疗期间,两组患者均未发生不良反应,也未出现死亡病例。结论化瘀解痉方联合尼莫地平能够改善SAH后脑血管痉挛患者的血管内皮功能,增加脑血流灌注,减轻神经功能损伤,控制病情发展,疗效显著,安全性高。
文摘目的探讨宁神止痉汤对颅内动脉瘤破裂所致蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)介入术后脑血管痉挛患者脑损伤、自由基、脑血流及神经功能的影响。方法选取治疗的aSAH患者80例,随机分为对照组与研究组,每组40例,患者给予尼莫地平等药物常规治疗,研究组在对照组治疗基础上给予宁神止痉汤口服治疗,治疗时间14 d,观察患者治疗前后血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、星形胶质源性蛋白(astroglia-derived protein,S100β)、超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、内皮素-1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO)变化,大脑中动脉平均血流速度(median cerebral artery velocity,Vm)、脑血管痉挛指数(linde-gard)、血管自我调节功能指标脉冲指数(impulse index of vascular self-regulation function,PI)变化,采用格拉斯哥(Glasgow coma scale,GCS)和美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分对患者神经功能状况进行评价。结果两组患者治疗前血清NSE及S100β水平比较差异无统计学意义(P>0.05),治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05);两组患者治疗前血清SOD、MDA、ET-1、NO水平比较差异无统计学意义(P>0.05),MDA、ET-1治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05),SOD、NO治疗后较治疗前升高(P<0.05),且研究组升高程度大于对照组(P<0.05),比较差异有统计学意义(P<0.05);两组患者治疗前大脑中动脉Vm、linde-gard、PI比较差异无统计学意义(P>0.05),治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05);两组患者治疗前血清GCS及NIHSS评分比较差异无统计学意义(P>0.05),NIHSS治疗后较治疗前下降(P<0.05),且研究组下降程度大于对照组(P<0.05),GCS治疗后较治疗前升高(P<0.05),且研究组升高程度大于对照组(P<0.05)。结论aSAH介入术后脑血管痉挛患者采用宁神止痉汤治疗,可有助于减轻脑损伤,降低自由基,改善脑血流,促进神经功能的恢复。
