Brain edema after carotid surgery
Brain edema after carotid surgery
复制标题
颈动脉手术后脑水肿
DOI：
10.1212/wnl.46.1.175
复制
发表时间：
1996
期刊：
影响因子：
9.9
通讯作者：
T. P. O'Donnell
中科院分区：
文献类型：
--
作者：
J. Breen;L. R. Caplan;L. Dewitt;Michael Belkin;W. C. Mackey;T. P. O'Donnell
文章摘要--术后高灌注症候群描述的是手术后再灌流的脑血流突然增加并失去自我调节功能。报告描述了一系列的发现，包括严重头痛、一过性脑缺血、癫痫发作和脑出血。高血压是颈动脉手术后常见的疾病，常在其病理生理过程中发挥作用。我们现在报告5例颈动脉手术后严重的白质水肿，这一发现以前没有包括在高灌注症候群中。颈动脉手术后5至8天和出院后，每个患者都出现高血压、头痛、偏瘫、癫痫、失语或因颈动脉手术同侧严重的白质水肿而被忽视。一位病人在水肿区有少量出血。4名患者为重度高血压，1名患者为中度高血压。所有患者术后均行超声或血管造影术，颈动脉通畅。经颅多普勒显示手术同侧血流速度增加2例，双侧1例。在接受抗高血压药物和抗惊厥药物治疗的五名患者中，有四名患者的计算机断层扫描异常和神经体征在3周内消失。第五例患者死于继发于大量水肿性腹股沟突出。伴有局灶性神经体征的脑水肿应被列为术后高灌注症候群的一个严重但可能可逆的组成部分。神经病学1996；46：175-181
Article abstract-The postoperative hyperperfusion syndrome describes an abrupt increase in blood flow with loss of autoregulation in surgically reperfused brain. Reports described a spectrum of findings, including severe headache, transient ischemia, seizures, and intracerebral hemorrhage. Hypertension is common after carotid artery surgery and often plays a role in the pathophysiology. We now report five patients with severe white matter edema after carotid surgery, a finding not previously included in the hyperperfusion syndrome. Five to 8 days after carotid surgery and after hospital discharge, each patient developed hypertension, headache, hemiparesis, seizures, and aphasia or neglect due to severe white matter edema ipsilateral to the carotid surgery. One patient had a small hemorrhage within the edematous area. Hypertension was severe in four patients and moderate in one. The carotid artery was patent by ultrasound or angiography in each patient after surgery. Transcranial Doppler showed increased velocities ipsilateral to surgery in two patients and bilaterally in one. Computed tomographic abnormalities and neurologic signs resolved within 3 weeks in four of the five patients treated with antihypertensives and anticonvulsants. The fifth patient died from herniation secondary to massive edema. Brain edema with focal neurologic signs should be included as a serious but potentially reversible component of the postoperative hyperperfusion syndrome. NEUROLOGY 1996;46: 175-181