Stroke:动脉瘤性蛛网膜下腔出血后白质微观结构异常与认知功能障碍

2018-08-13 xing.T MedSci原创

由此可见,aSAH患者在亚急性期会出现暂时性白质异常,其与发作后3个月的认知障碍相关。

动脉瘤性蛛网膜下腔出血(aSAH)可能对白质微观结构产生不利影响,这可能反过来解释经常在aSAH后发生的认知障碍。近日,卒中领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在调查了(1)aSAH患者的白质微观结构是否与未破裂的颅内动脉瘤患者相比有所改变;(2)这些异常是否与发作后3个月的认知障碍有关。 

49例aSAH患者和22例未破裂颅内动脉瘤患者接受了3T脑磁共振成像检查,包括高分辨率弥散张量成像序列。在发作后2周和6个月对aSAH患者进行扫描。白质微观结构改变是通过分数各向异性和平均扩散率(MD)来量化。在发作后3个月来评估患者认知。

发作后2周,aSAH患者的白质MD明显高于未破裂的颅内动脉瘤患者(平均差异±SEM为0.3±0.01×10-3mm2/s;P≤0.01),其反映出微观结构异常。6个月后,MD已恢复到与未破裂颅内动脉瘤组相似。没有发现分数各向异性的组间差异(-0.01±0.01; P=0.16)。2周后较高的MD与3个月后的认知障碍相关(MD每增加一个SD的比值比为2.6; 95%CI为1.1-6.7)。MD与认知障碍之间的关联独立于aSAH相关脑损伤的常规成像标志(即脑梗塞、脑积水、蛛网膜下腔血液总量、总脑容量或白质高信号严重程度)。

由此可见,aSAH患者在亚急性期会出现暂时性白质异常,其与发作后3个月的认知障碍相关。

原始出处:

Yael D. Reijmer,et al. Microstructural White Matter Abnormalities and Cognitive Impairment After Aneurysmal Subarachnoid Hemorrhage.Stroke. 2018. https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021622

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