动脉瘤性蛛网膜下腔出血后迟发性脑缺血:叙述性回顾。

IF 1.6 4区 医学 Q4 NEUROSCIENCES
Arquivos de neuro-psiquiatria Pub Date : 2025-06-01 Epub Date: 2025-06-25 DOI:10.1055/s-0045-1809885
Ingrid Pereira Marques, Carolina Rouanet Cavalcanti de Albuquerque, Natalia Vasconcellos de Oliveira Souza, João Brainer Clares de Andrade, Gisele Sampaio Silva, Pedro Kurtz
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引用次数: 0

摘要

动脉瘤性蛛网膜下腔出血(aSAH)是一种死亡率和发病率较高的疾病,通常影响工作年龄人群,导致较高的社会经济负担。在初次出血存活的患者中,大约30%会经历延迟性脑缺血(DCI),这是导致预后不良的重要因素。然而,如果及时开始适当的治疗,它是可能可逆的。通过改进的Fisher量表(mFisher)评估的初始计算机断层扫描(CT)上的血量以及患者入院时的神经系统状态是DCI的最强预测因子。早期预防至关重要,通常包括给予尼莫地平肠内治疗和维持血容量,而其他治疗方案的支持证据有限。诊断仍然是一个挑战,主要是因为它依赖于临床检查。这在昏迷或镇静的高级别aSAH患者中更为明显。在这种情况下,可能需要额外的方法,如经颅多普勒(TCD)、连续脑电图(cEEG)或灌注CT (CTP)。治疗以预防脑梗死和不良临床结局为目的,以血流动力学优化、高血压诱导、心输出量增加和血管内治疗为基础。然而,关于DCI管理的随机数据仍然很少,这突出了迫切需要进行更多的研究和更好地了解这种SAH并发症。解决这一差距可能导致更有效的预防策略和治疗,这对改善这些患者的预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a narrative review.

Aneurismal subarachnoid hemorrhage (aSAH) is a condition with elevated mortality and morbidity, which usually affects a working-age population, leading to a high socioeconomic burden. Among those who survive the initial bleeding, approximately 30% will experience delayed cerebral ischemia (DCI), which is a significant factor in poor outcomes. However, it is potentially reversible if appropriate treatment is promptly initiated. The amount of blood present on the initial computed tomography (CT) scan, assessed through the modified Fisher scale (mFisher), and the patient's neurological status upon admission, are the strongest predictors of DCI. Early prevention is essential and typically involves administration of enteral nimodipine and the maintenance of euvolemia, while other treatment options have limited supporting evidence. Diagnosing remains a challenge, primarily due to its reliance on clinical examinations. This is more pronounced in high-grade aSAH patients who are unconscious or sedated. In such cases, additional methods may be necessary, such as transcranial Doppler (TCD), continuous electroencephalography (cEEG), or CT with perfusion (CTP). Treatment aims to prevent cerebral infarction and poor clinical outcomes, and it is based on hemodynamic optimization, hypertension induction, cardiac output augmentation, and endovascular therapy. Nevertheless, randomized data on DCI management remains scarce, highlighting the urgent need for more studies and a better understanding of this SAH complication. Addressing this gap may lead to more effective preventive strategies and treatments, which is crucial for improving the prognosis of these patients.

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来源期刊
Arquivos de neuro-psiquiatria
Arquivos de neuro-psiquiatria 医学-精神病学
CiteScore
2.10
自引率
7.10%
发文量
262
审稿时长
4-8 weeks
期刊介绍: Arquivos de Neuro-Psiquiatria is the official journal of the Brazilian Academy of Neurology. The mission of the journal is to provide neurologists, specialists and researchers in Neurology and related fields with open access to original articles (clinical and translational research), editorials, reviews, historical papers, neuroimages and letters about published manuscripts. It also publishes the consensus and guidelines on Neurology, as well as educational and scientific material from the different scientific departments of the Brazilian Academy of Neurology. The ultimate goals of the journal are to contribute to advance knowledge in the areas of Neurology and Neuroscience, and to provide valuable material for training and continuing education for neurologists and other health professionals working in the area. These goals might contribute to improving care for patients with neurological diseases. We aim to be the best Neuroscience journal in Latin America within the peer review system.
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