RESUMO
The authors studied the time course of changes in the parameters of the cerebral thyronergic system (total and free triiodthyronine (T3) and thyroxin (T4), thyroxine-binding globulin (TBG), thyroid-stimulating hormone (TSH) by radioimmunoassay (Immunotech, Czechia; CIS, France), proinflammatory cytokine of TNF-alpha by enzyme immunoassay (Innogenetic, Belgium) in the blood and cerebrospinal fluid (CSF) in 59 patients (37 males and 22 females whose age ranged from 21 to 64 years) in acute subarachnoidal hemorrhage due to arterial aneurysmal rupture. On admission, the condition of 47 (79.7%) was rated as grades III-VI according to the Hunt-Hess scale, which was responsible for high mortality rates (33.89% in the assessment of outcomes according to the Glasgow outcome scale). The causes of death were ischemic and hemorrhagic insults, edema of the brain, cerebral stem wedging. Laboratory findings were analyzed in relation to the clinical condition of patients, outcomes, and the degree of secondary vasospasm assessed by Doppler transcranial study by the average blood flow velocity in the middle cerebral artery. They revealed a significant depression of thyroidal metabolism with developed the total low T3 syndrome just before surgical treatment in patients with deterioration in the early postoperative period. The significant correlations found by the authors between the decreased blood T3 and TSH levels and 1) the severity of neurological disorders; 2) the degree of vasospasm, and 3) the outcome of disease, as well as negative correlations of elevated TNF-alpha levels not only in the blood, but also in CSF with the content of CT3, CT4 and with the severity of neurological symptomatology are indicative of the development of isolated syndrome in the brain, which is characterized by specific thyroidal metabolic disorders, which the author propose to call the cerebral low T3 syndrome (by taking into account the presence of the autonomic systems of thyroidal homeostatic provision).
Assuntos
Encéfalo/metabolismo , Aneurisma Intracraniano/metabolismo , Hemorragia Subaracnóidea/metabolismo , Tri-Iodotironina/metabolismo , Adulto , Feminino , Humanos , Aneurisma Intracraniano/mortalidade , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/cirurgia , Taxa de Sobrevida , Síndrome , Tireotropina/sangue , Tireotropina/líquido cefalorraquidiano , Tiroxina/sangue , Tiroxina/líquido cefalorraquidiano , Tiroxina/metabolismo , Proteínas de Ligação a Tiroxina/líquido cefalorraquidiano , Proteínas de Ligação a Tiroxina/metabolismo , Tri-Iodotironina/sangue , Tri-Iodotironina/líquido cefalorraquidiano , Fator de Necrose Tumoral alfa/análiseRESUMO
Changes in intracranial pressure (ICP) and cerebral circulation were evaluated from Doppler transcranial ultrasound (DTU) in 29 patients with spontaneous aneurysmal hemorrhage in acute rupture. There is a tendency for the pulse wave amplitude (PWA) of ICP to increase concurrently with higher ICP values (r = 0.768, p < 0.01), the tendency being smoother in patients with severe diffuse spasm (r = 0.573, p < 0.01). There was also a linear correlation between the ICP values and the pulse index of blood flow velocity (r = 0.783, p < 0.01). Evidence is given for the possibility of indirect assessment of ICP from DTU data and for that of indirect evaluation of cerebral perfusion from ICP monitoring data. In the latter case, the authors used a ICP PWA ratio. The findings suggest that the decrease in PWA/ICP values by less than 0.2 during intracranial hypertension and severe diffuse arterial spasm corresponds to the reduction in cerebral blood filling beyond the critical values.