Early brain injury, an evolving frontier in subarachnoid hemorrhage research.
Early brain injury, an evolving frontier in subarachnoid hemorrhage research.
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DOI：
10.1007/s12975-013-0257-2
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发表时间：
2013-08
影响因子：
6.9
通讯作者：
Zhang, John H.
中科院分区：
文献类型：
--
作者：
Fujii, Mutsumi;Yan, Junhao;Rolland, William B.;Soejima, Yoshiteru;Caner, Basak;Zhang, John H.
蛛网膜下腔出血（SAH），主要由动脉瘤破裂引起，是一种毁灭性的神经系统疾病，其发病率和死亡率高于50%。传统的活体研究主要集中在脑池内注血后大动脉的病理生理或形态学变化。这是由于广泛假设SAH后迟发性血管痉挛是迟发性脑缺血和不良结局的主要原因。然而，CONSCIOUS-1试验的结果表明，与血管造影性血管痉挛无关的其他一些病理生理因素也导致了不良的临床结局。术语早期脑损伤（EBI）是指蛛网膜下腔出血（SAH）后迟发性血管痉挛发作前的即刻脑损伤。在EBI期间，破裂的动脉瘤会引起许多生理紊乱，例如颅内压（ICP）升高、脑血流量（CBF）减少和全脑缺血。这些事件引发继发性损伤，如血脑屏障破坏，炎症和氧化级联反应，最终导致细胞死亡。鉴于血管痉挛的逆转似乎不能改善患者结局，可以认为EBI的治疗可能成功减轻一些破坏性继发性损伤并改善SAH患者的结局。在这篇综述中，我们提供了一个主要的进展，EBI后SAH研究的概述。
Subarachnoid hemorrhage (SAH), predominantly caused by a ruptured aneurysm, is a devastating neurological disease that has a morbidity and mortality rate higher than 50%. Most of the traditional in vivo research has focused on the pathophysiological or morphological changes of large-arteries after intracisternal blood injection. This was due to a widely held assumption that delayed vasospasm following SAH was the major cause of delayed cerebral ischemia and poor outcome. However, the results of the CONSCIOUS-1 trial implicated some other pathophysiological factors, independent of angiographic vasospasm, in contributing to the poor clinical outcome. The term early brain injury (EBI) has been coined and describes the immediate injury to the brain after SAH, before onset of delayed vasospasm. During the EBI period, a ruptured aneurysm brings on many physiological derangements such as increasing intracranial pressure (ICP), decreased cerebral blood flow (CBF), and global cerebral ischemia. These events initiate secondary injuries such as blood-brain barrier disruption, inflammation, and oxidative cascades that all ultimately lead to cell death. Given the fact that the reversal of vasospasm does not appear to improve patient outcome, it could be argued that the treatment of EBI may successfully attenuate some of the devastating secondary injuries and improve the outcome of patients with SAH. In this review, we provide an overview of the major advances in EBI after SAH research.
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影响因子：
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