脑半球萎缩——人与动物实验数据的相关性。

L Ford, G M de Courten-Myers, T Mandybur, R E Myers
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引用次数: 7

摘要

我们报告了一名63岁白人男性的神经病理学发现,他有出生窒息、脑瘫、癫痫发作和轻度智力低下的病史,并结合了围产期窒息动物模型的类似脑病理学发现。人类病例表现为左脑半球半萎缩,伴广泛性脑失联,累及一侧所有脑叶,右半球单一镜下病灶皮质萎缩。在大量的实验性围产期窒息暴露中,只有偶然的动物,如所述的人类病例,如果早期检查,表现为单侧半球损伤,伴有软化和坏死,如果检查较晚,则表现为半球半萎缩的失忆。本文认为,围产期窒息在特定的病理生理条件下可能导致单侧脑损伤。我们的实验研究表明,围产期窒息可能导致单侧或不对称脑损伤的具体情况是明显的低氧血症伴血压大幅降低,但无循环衰竭。考虑到这些情况,脑损伤的不对称性可能反映了胎儿头部在重力场中相对于心脏的位置。由于窒息引起的脑血流自动调节紊乱,重力场可能会加重心脏上方最高脑区的缺血。因此,我们假设头部位置可能在确定低血压围产期窒息中受损的大脑区域中起关键作用。这种解释可能会影响低氧、低血压新生儿的重症监护,以尽量减少脑损伤的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cerebral hemiatrophy--correlation of human with animal experimental data.

We report the neuropathologic findings in a 63-year-old white male with a history of birth asphyxia, cerebral palsy, seizures and mild mental retardation in conjunction with similar brain pathologic findings in animal models of perinatal asphyxia. The human case showed a left cerebral hemispheric hemiatrophy associated with an extensive ulegyria involving all cerebral lobes on that side and a single microscopic focus of cortical atrophy in the right hemisphere. Among a large number of experimental perinatal asphyctic exposures only an occasional animal, like the human case described, showed unilateral hemispheric injury with softening and necrosis if examined early and ulegyria with hemispheric hemiatrophy if examined late. The present paper suggests that perinatal asphyxia under specific pathophysiologic conditions may cause unilateral brain injury. Our experimental studies suggest the specific condition of perinatal asphyxia potentially causing unilateral or asymmetrical brain damage is marked hypoxemia combined with substantial reductions in blood pressure but without circulatory collapse. Given these conditions, the asymmetry of the brain damage likely reflects fetal head position within the gravitational field relative to the heart. With disturbed cerebral blood flow autoregulation from asphyxia, the gravitational field likely accentuates the ischemia of those brain areas most elevated above the level of the heart. Thus, we postulate head position may play a pivotal role in defining brain regions that are damaged in hypotensive perinatal asphyxia. This interpretation may affect the intensive care of hypoxemic, hypotensive newborns aimed at minimizing the risk of brain damage.

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