Experimental and clinical studies on the damage of the brain parenchyma in the disturbance of the cerebrospinal fluid hydrodynamics.

在临床研究和实验研究的基础上，探讨脑脊液动力学紊乱对脑实质损伤的影响及脑积水症状的发生机制。在兔和狗大池注射高岭土制备脑积水模型的实验研究中，脑积水急性和亚急性期脑室周围白质中游离水含量增加，发现水含量减少。在这些阶段，皮层灰质中自由水和结合水的含量没有变化。自由水与结合水的比值恢复到控制值附近。急性和亚急性期脑室周围白质能量代谢紊乱，慢性期恢复到接近正常状态。在临床研究中，幕上结构的脑血流量在脑积水的所有阶段都减少。小脑的血流动力学也受到干扰，这是一种远程影响。脑脊液分流术后脑血流动力学及小脑结构均有恢复。实验和临床研究结果提示，脑室周围白质游离水含量的增加可引起脑能代谢和脑小脑血流的紊乱。由于这些形态和功能紊乱，可能出现脑积水的临床症状和体征。

The influence of the disturbance of cerebrospinal fluid dynamics on the damage of the brain parenchyma and the mechanism of hydrocephalic symptoms were studied on the basis of the clinical findings and the experimental investigations. In experimental studies using hydrocephalic models produced by injection of kaolin into the cisterna magna of rabbits and dogs, content of the free water increased and that of the found water decreased in the periventricular white matter at the acute and subacute stages of hydrocephalus. At these stages content of both free and bound water did not change in the cortical gray matter. The ratio of the free to bound water content recovered near the control values. The energy metabolism was deranged in the periventricular white matter at both acute and subacute stages and recovered near the normal state at the chronic stage. In clinical studies the cerebral blood flow of the supratentorial structures decreased in all stages of hydrocephalus. There was also a disturbance of hemodynamics of the cerebellum as a remote effect. There was a recovery of hemodynamics of the cerebrum as well as the cerebellar structures after cerebrospinal fluid shunting. It is suggested from the result of experimental and clinical studies that increase in free water content in the periventricular white matter may produce disturbance of the cerebral energy metabolism and the cerebro-cerebellar blood flow. As a result of these morphological and functional disturbances the clinical symptoms and signs of hydrocephalus may occur.