DISCUSSIONS
|
The changes of brain monoamine transmitters in the event of cerebral injury and
the secondary brain injury have drawn much attention. Studies demonstrate that
exhaustion of the monoamine transmitters in the brain after cerebral infarction
may reduce the volume of infarction, indicating the involvement of the monoamine
transmitters in the pathogenesis and development of cerebral infarction[4]
. In another study, it was found that found that NE content was elevated in the
serum and cerebrospinal fluid in most patients with acute cerebral blood
deficiency, and NE was therefore believed to participate in the pathophysiology
of injury to the blood-brain barrier following brain injury[5]
. In this present study, we found that the changes of NE in rat brain at various
time points of cerebral hemorrhage followed the pattern that 30 min after
cerebral hemorrhage, NE level was remarkably elevated in the peripheral tissues
of the hematoma, hypothalamus and brainstem, peaked at 24 h, while during
absorption period of the hematoma (48-72 h after hemorrhage), gradual decrease
of NE took place. Although NE in the hypothalamus at 72 h was remarkable lower
than its level at 24 h, it remained higher than that of the preoperative level,
while NE in the peripheral tissues of the hematoma was lower than the
preoperative level.At the same time ,the neurobehavioral score varied
synchronously together with NE.
Recent studies have identified energy metabolic disturbance and cessation of NE
intake by the synaptosome as the major factors for extracellular NE transmitter
retention[6] . At the same time, lowered
activities of aerobic enzymes, such as monoamine oxidase (MAO), occurs with
reduced decomposition of monoamine into homovanillic acid (HVA) and 5-ketoindole
acetic acid. In addition, due to excitement of the sympatho-adrenomedullary
system after brain injury that triggers massive NE release into the blood
stream, and the opening of the blood-brain barrier at the early stage of brain
injury, NE in the blood may gain direct access into the cerebrum leading to
increased NE content in the brain[7] . While in
the later period, NE is exhausted as a result of function loss of the nerve
endings for NE intake and storage, and decreased activity of β-hydroxylase,
which is especially obvious in the peripheral tissues of the hematoma.
Large amount of NE accumulated around the brain tissue, on the one hand promotes
Ca2+ overload in the neural cells to cause delayed death of the cells[8]
, and on the other, leads to excessive neural cell excitement to accelerate
energy consumption and lower the activities of many enzymes (such as Na-KATP
enzyme) necessary for maintaining normal brain metabolism, resulting in abnormal
ion distribution in the neural cells, which ultimately induce and exacerbates
secondary injuries of the brain cells[9] .
Experiments indicate that NE may even act on α and β receptors in the vascular
to cause intense contraction and spasm of the cerebral vessels, followed by
disturbance of cerebrovascular contractions and brain microcirculation disorder,
thus aggravating brain ischemia, edema and necrosis; in the meantime, large
amount of NE may directly injure the endothelial cells of the brain vessels,
leading to the leakage of the blood-brain barrier and aggravating cerebral edema[10]
. NE may stimulate the brain cells to secrete brain natriuretic peptide to
result in hyponatremia[11] , which is very likely
an important mechanism contributing to remarkable increase of water content in
the brain tissue and aggravating edema of the peripheral tissues of thehematoma.
It is therefore clear that large amount of NE ,accumulated in the brain tissue
in the course of cerebral hemorrhage ,may hamper functional recovery of the
brain. Prompt applicationofβ-receptor agonists during the early stage of
cerebral hemorrhage may be helpful for the management of brain injury.
ACKNOWLEDGEMENTS
|
This study was supported by Chongqing Municipal Health Bureau ,China. No.
00-1007
|
REFERENCES
 |
- 1. Xu ZQ,Jiang XJ,Chen ME,et al. Alterations neuropeptide Y
activity in brain tissue of rats during cerebral hemorrhage and its
significance.ZhongguoLinchuang Kangfu 2003;7(19):2664-5 (China)
- 2. Longa EZ,Weinstein PR,Carson S,et al. Reversible middle
cerebral artery occulusion without craniectomy in rats. Stroke
1989;20:84-91.
- 3. Luo LR,Liang YF,Yao YX. The relationship between plasma
level of monoamine neurohumor and attention deficit disorder with
hypractivity and autistc disorder.Zhongguo Linchuang Kangfu
2002;6(19):2868-9 (China)
- 4. Nellgard B, Mackensen GB, Sarraf-Yazdi,et al.
Pre-ischemic depletion of brain norepinephrine decreases infarct size in
normothermic rats exposed to transient focal cerebral ischemia. Neurosci
Lett 1999; 275(3):167-70..
- 5. Mautes AE, Muller M, Cortbus F,et al. Alterations of
norepinephrine levels in plasma and CSF of patients after traumatic
brain injury in relation to disruption of the blood-brain barrier. Acta
Neurochir (Wien) 2001;143(1):51-7.
- 6. Akiyama Y , Ito A, Koshimura K, et al. Effects of
transient forebrain ischemia and reperfusion on function of dopaminergic
neurons and dopamine reuptakes in vivo in rat striatum. Brain Res
1991;561(1):120-7.
- 7. Dunn-Meynell AA, Hassanain M, Lovin BE. Norepinephrine
and traumatic brain injury: a possible role in post-trauma edema. Brain
Res 1998;800(2):245-52.
- 8. Noh J, Kim EY,Kang JS,et al. Neurotoxic and
neuroprotective actions of catecholamines in cortical neurons. Exp
Neurol 1999;159(1):217-24.
- 9. Kroppenstedt SN, Sakowitz OW, Thomale UW,et al. Influence
of norepinephrine and dopamine on cortical perfusion, EEG activity,
extracellular glutamate, and brain edema in rats after controlled
cortical impact injury. J Neurotrauma 2002 ;19(11):1421-32.
- 10. Zhou AM,Zhang YH,Zhang LC,et al.The study of
correlation between the nitrous oxide and nitrous oxide syntheses and
brain infarction area. Zhongguo Linchuang Kangfu 2002;6(5):667-8 (China)
- 11. Tomida M, Muraki M, Uemara K,et al. Plasma
concentration of brain natriuretic peptide in patients with subarachniod
hemorrhage. Stroke 1998;29(8):1584-1587.