腦蛛網膜下腔出血

SubarachnoidHemorrhage

CausesMicrocirculationDeficit：

anin-vivomicroscopystudy

ChenNishan/

1OutlineIntroduction;Researchpurposes;Materialandmethod;ResultandDiscussion;Evaluationandoutlook;Conclusion.2ReferencesCahillWJ,CalvertJH,ZHangJH,etal.Mechanismsofearlybraininjuryaftersubarachnoidhemorrhage[J].JCerebBloodFlowMetab,2006,26(11):1341-1353E.Ko?niewska,R.Michaliketal.Mechanismsofvasculardysfunctionaftersubarachnoidhemorrhage[J].J.PhysiologyandPharmacology,2006,57,11,145.160WestermAierT,Jaussa,EriskatJ,etal.Time-courseofcerebralperfusionandtissueoxygenationinthefirst6hafterexperimentalsubarachnoidhemorrhageinrats[J].JCerebBloodFlowMetab,2009,29(4):771-779BenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlow

Metab.2012,32(3):447-455IshikawaMami;KusakaGen;YamaguchiNoriyuki.Plateletandleukocyteadhesioninthemicrovasculartureatthecerebralsurfaceimmediatelyaftersubarachnoidhemorrhage,J.Neurosurgery,2009,64(3):546-553DanielZ,MuhammadF.etal.Delayedischemiaaftersubarachnoidhemorrhage:resultofvasospasmaloneorabroader[J],J.VascMed200712:2433IntroductionSubarachnoidHemorrhage(SAH):Asubtypeofstrokewithaparticularlyhighmorbidityandmortality.EarlyBrainInjury(EBI):Occurswithin72haftertheinitialbleed;Noeffectivetreatmentisavailable;Mechanismshaverecentlystartedtobeunderstood.4CAHILLWJ,CALVERTJH,ZHANGJH,etal.Mechanismsofearlybraininjuryaftersubarachnoidhemorrhage[J].JCerebBloodFlowMetab,2006,26(11):1341-13535E.KO?NIEWSKA,R.MICHALIKetal.MECHANISMSOFVASCULARDYSFUNCTIONAFTERSUBARACHNOIDHEMORRHAGE[J]J.PHYSIOLOGYANDPHARMACOLOGY2006,57,Suppl11,145.1606WESTERMAIERT,JAUSSA,ERISKATJ,etal.Time-courseofcerebralperfusionandtissueoxygenationinthefirst6hafterexperimentalsubarachnoidhemorrhageinrats[J].JCerebBloodFlowMetab,2009,29(4):771-7797ResearchpurposesCPPindependentInvestigateinvivoAlterationsonmicrocirculation?Whether/When/Where/What/HowRelationshipwithmicrothrombiEarlyperfusiondeficits

CBFreduction8MaterialandMethod

CWpmodel;Cranialwindow;Intravitalfluorescencemicroscopy.

9MicrovascularConstriction:Numerousconstrictedarterioleswereobserved,incontracttovenules;Distributionofseveritychangedovertime.Result-1BenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlowMetab.2012,32(3):447-45510Result1MicrovascularConstriction:Numerousconstrictedarterioleswereobserved,incontracttovenules;Distributionofseveritychangedovertime.Thesmallestarteriolesaremostseverelyaffectedbymicrovasospasm.BenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlowMetab.2012,32(3):447-45511Result-1Microthrombi:Arteriolarconstrictionsoccurfirstandthentriggermicrothrombosis;Theseverityofconstrictionwaspositivelycorrelatedwiththefrequencyofmicro-thrombiBenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlowMetab.2012,32(3):447-45512SummaryLong-lastinghemodynamicalterationsatthemicrocirculatorylevelmaybeanimportantmechanismforthedevelopmentofearlyposthemorrhagicischemia.13P-selectinandApocyninP-selectin

Platelet-Leukocyte

rollingandadhesionEndothelial–LeukocyteadhesionPlatelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet

P-selectinEndothelial

P-selectinLeukocyte

PSGL-1NAD(P)Hoxidase

Apocynin14Result-2Platelet-leukocyte-endothelialcellinteractionswereobservedmainlyinthepostcapillaryvenulesimmediatelyafterSAH.TreatmentwithP-selectin-blockingantibodybeforeSAHreducedrollingandadherentplateletsalmosttobaselinelevels.Treatmentwithapocynin

beforeSAHreducedplateletadhesionbyonehalf.IshikawaMami;KusakaGen;YamaguchiNoriyuki.Plateletandleukocyteadhesioninthemicrovasculartureatthecerebralsurfaceimmediatelyaftersubarachnoidhemorrhage,J.Neurosurgery,200915DiscussionP-selectin

Platelet-Leukocyte

rollingandadhesionEndothelial–LeukocyteadhesionPlatelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet

P-selectin;Endothelial

P-selectinLeukocyte

PSGL-1NAD(P)Hoxidase

ApocyninApocynin16SummaryP-selectinandNAD(P)HoxidaseparticipateintheearlymicrovascularresponsestoSAH.17EvaluationAdvantages:ProvideMorphologicalevidence;Helpverifymechanisms;Invivo;Dynamicchangesatearlytime;Microcirculation;Retainedduramater;Limitations:superficialstructuresonly;decompressioncraniectomy;detailedmolecularmechanisms;18OutlookThedistincteventsoccurinmicro-arteriolesandmicro-venules?whichpathwaysplayadominantrole?Otherpotentialrolesintheinductionofmicrocirculationdeficit?Combinewithmolecularbiologystudy?