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Woeppel KM, Krahe DD, Robbins EM, Vazquez AL, Cui XT. Electrically Controlled Vasodilator Delivery from PEDOT/Silica Nanoparticle Modulates Vessel Diameter in Mouse Brain. Adv Healthc Mater 2024; 13:e2301221. [PMID: 37916912 PMCID: PMC10842908 DOI: 10.1002/adhm.202301221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/16/2023] [Indexed: 11/03/2023]
Abstract
Vascular damage and reduced tissue perfusion are expected to majorly contribute to the loss of neurons or neural signals around implanted electrodes. However, there are limited methods of controlling the vascular dynamics in tissues surrounding these implants. This work utilizes conducting polymer poly(ethylenedioxythiophene) and sulfonated silica nanoparticle composite (PEDOT/SNP) to load and release a vasodilator, sodium nitroprusside, to controllably dilate the vasculature around carbon fiber electrodes (CFEs) implanted in the mouse cortex. The vasodilator release is triggered via electrical stimulation and the amount of release increases with increasing electrical pulses. The vascular dynamics are monitored in real-time using two-photon microscopy, with changes in vessel diameters quantified before, during, and after the release of the vasodilator into the tissues. This work observes significant increases in vessel diameters when the vasodilator is electrically triggered to release, and differential effects of the drug release on vessels of different sizes. In conclusion, the use of nanoparticle reservoirs in conducting polymer-based drug delivery platforms enables the controlled delivery of vasodilator into the implant environment, effectively altering the local vascular dynamics on demand. With further optimization, this technology could be a powerful tool to improve the neural electrode-tissue interface and study neurovascular coupling.
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Affiliation(s)
- Kevin M Woeppel
- Department of Bioengineering, University of Pittsburgh, United States
| | - Daniela D Krahe
- Department of Bioengineering, University of Pittsburgh, United States
| | - Elaine M Robbins
- Department of Bioengineering, University of Pittsburgh, United States
| | - Alberto L Vazquez
- Department of Bioengineering, University of Pittsburgh, United States
- Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, United States
- Department of Radiology, University of Pittsburgh, United States
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, United States
| | - Xinyan Tracy Cui
- Department of Bioengineering, University of Pittsburgh, United States
- Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, United States
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, United States
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2
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Pellesi L. The human NTG model of migraine in drug discovery and development. Expert Opin Drug Discov 2023; 18:1077-1085. [PMID: 37439036 DOI: 10.1080/17460441.2023.2236545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Various triggers can originate a migraine attack. In healthy volunteers and patients with migraine, the nitroglycerin (NTG) provocation model induces a headache that resembles migraine in pain characteristics and vascular manifestations. This headache is reversible and treatable in monitored conditions, providing an opportunity to test novel antimigraine medications in early clinical development. AREAS COVERED This perspective covers the main characteristics and applications of the human NTG model of migraine with effective and ineffective antimigraine therapies. EXPERT OPINION The NTG model represents a potential de-risking strategy to test novel hypotheses for antimigraine mechanisms in humans. Considering previous studies conducted with effective and ineffective antimigraine therapies, the sensitivity of the model was 71% while the specificity was 100%. The probability that following an analgesic effect, that compound would truly be efficacious in individuals with migraine was 100%. Following a negative result, the probability that such compound would truly be ineffective in patients with individuals was 33%. A clinical trial testing the analgesic properties of novel compounds after a sublingual and/or intravenous NTG challenge in migraine patients may support a subsequent phase 2 trial for the treatment of migraine.
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Affiliation(s)
- Lanfranco Pellesi
- Department of Clinical Pharmacology, H. Lundbeck A/S, Copenhagen, Denmark
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3
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Wiggers A, Ashina H, Hadjikhani N, Sagare A, Zlokovic BV, Lauritzen M, Ashina M. Brain barriers and their potential role in migraine pathophysiology. J Headache Pain 2022; 23:16. [PMID: 35081902 PMCID: PMC8903554 DOI: 10.1186/s10194-021-01365-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022] Open
Abstract
Migraine is a ubiquitous neurologic disease that afflicts people of all ages. Its molecular pathogenesis involves peptides that promote intracranial vasodilation and modulate nociceptive transmission upon release from sensory afferents of cells in the trigeminal ganglion and parasympathetic efferents of cells in the sphenopalatine ganglion. Experimental data have confirmed that intravenous infusion of these vasoactive peptides induce migraine attacks in people with migraine, but it remains a point of scientific contention whether their site of action lies outside or within the central nervous system. In this context, it has been hypothesized that transient dysfunction of brain barriers before or during migraine attacks might facilitate the passage of migraine-inducing peptides into the central nervous system. Here, we review evidence suggestive of brain barrier dysfunction in migraine pathogenesis and conclude with lessons learned in order to provide directions for future research efforts.
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Moir ME, Vermeulen TD, Smith SO, Woehrle E, Matushewski BJ, Zamir M, Shoemaker JK. Vasodilatation by carbon dioxide and sodium nitroglycerin reduces compliance of the cerebral arteries in humans. Exp Physiol 2021; 106:1679-1688. [PMID: 34117663 DOI: 10.1113/ep089533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Vascular compliance importantly contributes to the regulation of cerebral perfusion and complex mechanisms are known to influence compliance of a vascular bed: while vasodilatation mediates changes in vascular resistance, does it also affect compliance, particularly in the cerebral vasculature? What is the main finding and its importance? Cerebral vasodilatation, elicited by hypercapnia and sodium nitroglycerin administration, reduced cerebrovascular compliance by approximately 26% from baseline. This study provides new insight into mechanisms mediating cerebrovascular compliance. ABSTRACT Changes in vascular resistance and vascular compliance contribute to the regulation of cerebral perfusion. While changes in vascular resistance are known to be mediated by vasodilatation, the mechanisms contributing to changes in vascular compliance are complex. In particular, whether vasodilatation affects compliance of the vasculature within the cranium remains unknown. Therefore, the present study examined the impact of two vasodilatation pathways on cerebrovascular compliance in humans. Fifteen young, healthy adults (26 ± 5 years, seven females) completed two protocols: (i) sublingual sodium nitroglycerin (SNG; 0.4 mg) and (ii) hypercapnia (5-6% carbon dioxide gas mixture for 4 min). Blood pressure waveforms (finger photoplethysmography) and middle cerebral artery blood velocity waveforms (transcranial Doppler ultrasound) were input into a modified Windkessel model and an index of cerebrovascular compliance (Ci) was calculated. During the SNG protocol, Ci decreased 24 ± 17% from baseline ((5.0 ± 2.3) × 10-4 cm s-1 mmHg-1 ) to minute 10 ((3.6 ± 1.2) × 10-4 cm s-1 mmHg-1 ; P = 0.009). During the hypercapnia protocol, Ci decreased 28 ± 9% from baseline ((4.4 ± 1.9) × 10-4 cm s-1 mmHg-1 ) to minute 4 ((3.1 ± 1.4) × 10-4 cm s-1 mmHg-1 ; P < 0.001). Cerebral vasodilatory stimuli induced by nitric oxide and carbon dioxide mechanisms reduced compliance of the cerebral vascular bed by approximately 26% from supine baseline values.
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Affiliation(s)
- M Erin Moir
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Tyler D Vermeulen
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Sydney O Smith
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Emilie Woehrle
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Brad J Matushewski
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Mair Zamir
- Department of Applied Mathematics, University of Western Ontario, London, Ontario, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
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5
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Nitroglycerin Is Not Associated with Improved Cerebral Perfusion in Acute Ischemic Stroke. Can J Neurol Sci 2020; 48:349-357. [PMID: 32799944 DOI: 10.1017/cjn.2020.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study was conducted to test the hypothesis that nitroglycerin (NTG) increases cerebral perfusion focally and globally in acute ischemic stroke patients, using serial perfusion-weighted imaging (PWI) magnetic resonance imaging measurements. PATIENTS AND METHODS Thirty-five patients underwent PWI immediately before and 72 h after administration of a transdermal NTG patch or no treatment. Patients with baseline mean arterial pressure (MAP) > 100 mmHg (NTG group, n = 20) were treated with transdermal NTG (0.2 mg/h) for 72 h, without a nitrate-free interval. Patients with MAP ≤ 100 mmHg (untreated group, n = 15) were not treated. The primary outcome measure was absolute cerebral blood flow (CBF) in the hypoperfused region at 72 h. RESULTS The mean baseline absolute CBF in the hypoperfused region was similar in the NTG group (33.3 ± 10.2 ml/100 g/min) and untreated (32.7 ± 8.4 ml/100 g/min, p = 0.4) groups. The median (IQR) baseline infarct volume was 10.4 (2.5-49.3) ml in the NTG group and 32.6 (8.6-96.7) ml in the untreated group (p = 0.09). MAP change in the NTG group was 1.2 ± 12.6 and 8 ± 20.7 mmHg at 2 h and 72 h, respectively. Mean absolute CBF in the hypoperfused region at 72 h was similar in the NTG (29.9 ± 12 ml/100 g/min) and untreated groups (24.1 ± 10 ml/100 g/min, p = 0.8). The median infarct volume increased in untreated (11.8 (5.7-44.2) ml) than the NTG group (3.2 (0.5-16.5) ml; p = 0.033) on univariate analysis, however, there was no difference on regression analysis. CONCLUSION NTG was not associated with improvement in cerebral perfusion in acute ischemic stroke patients.
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Jarrett CL, Shields KL, Broxterman RM, Hydren JR, Park SH, Gifford JR, Richardson RS. Imaging transcranial Doppler ultrasound to measure middle cerebral artery blood flow: the importance of measuring vessel diameter. Am J Physiol Regul Integr Comp Physiol 2020; 319:R33-R42. [PMID: 32401627 DOI: 10.1152/ajpregu.00025.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cerebral blood flow (CBF) is commonly inferred from blood velocity measurements in the middle cerebral artery (MCA), using nonimaging, transcranial Doppler ultrasound (TCD). However, both blood velocity and vessel diameter are critical components required to accurately determine blood flow, and there is mounting evidence that the MCA is vasoactive. Therefore, the aim of this study was to employ imaging TCD (ITCD), utilizing color flow images and pulse wave velocity, as a novel approach to measure both MCA diameter and blood velocity to accurately quantify changes in MCA blood flow. ITCD was performed at rest in 13 healthy participants (7 men/6 women; 28 ± 5 yr) with pharmaceutically induced vasodilation [nitroglycerin (NTG), 0.8 mg] and without (CON). Measurements were taken for 2 min before and for 5 min following NTG or sham delivery (CON). There was more than a fivefold, significant, fall in MCA blood velocity in response to NTG (∆-4.95 ± 4.6 cm/s) compared to negligible fluctuation in CON (∆-0.88 ± 4.7 cm/s) (P < 0.001). MCA diameter increased significantly in response to NTG (∆0.09 ± 0.04 cm) compared with the basal variation in CON (∆0.00 ± 0.04 cm) (P = 0.018). Interestingly, the product of the NTG-induced fall in MCA blood velocity and increase in diameter was a significant increase in MCA blood flow following NTG (∆144 ± 159 ml/min) compared with CON (∆-5 ± 130 ml/min) (P = 0.005). These juxtaposed findings highlight the importance of measuring both MCA blood velocity and diameter when assessing CBF and document ITCD as a novel approach to achieve this goal.
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Affiliation(s)
- Catherine L Jarrett
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Katherine L Shields
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Ryan M Broxterman
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jay R Hydren
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Soung Hun Park
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Jayson R Gifford
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Russell S Richardson
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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7
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Ölmestig J, Marlet IR, Hansen RH, Rehman S, Krawcyk RS, Rostrup E, Lambertsen KL, Kruuse C. Tadalafil may improve cerebral perfusion in small-vessel occlusion stroke-a pilot study. Brain Commun 2020; 2:fcaa020. [PMID: 33033800 PMCID: PMC7530832 DOI: 10.1093/braincomms/fcaa020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/22/2019] [Accepted: 12/28/2019] [Indexed: 01/29/2023] Open
Abstract
New treatments for cerebral small-vessel disease are needed to reduce the risk of small-vessel occlusion stroke and vascular cognitive impairment. We investigated an approach targeted to the signalling molecule cyclic guanosine monophosphate, using the phosphodiesterase 5 inhibitor tadalafil, to explore if it improves cerebral blood flow and endothelial function in patients with cerebral small-vessel disease and stroke. In a randomized, double-blinded, placebo-controlled, cross-over pilot trial (NCT02801032), we included patients who had a previous (>6 months) small-vessel occlusion stroke. They received a single dose of either 20 mg tadalafil or placebo on 2 separate days at least 1 week apart. We measured the following: baseline MRI for lesion load, repeated measurements of blood flow velocity in the middle cerebral artery by transcranial Doppler, blood oxygen saturation in the cortical microvasculature by near-infrared spectroscopy, peripheral endothelial response by EndoPAT and endothelial-specific blood biomarkers. Twenty patients with cerebral small-vessel disease stroke (3 women, 17 men), mean age 67.1 ± 9.6, were included. The baseline mean values ± standard deviations were as follows: blood flow velocity in the middle cerebral artery, 57.4 ± 10.8 cm/s; blood oxygen saturation in the cortical microvasculature, 67.0 ± 8.2%; systolic blood pressure, 145.8 ± 19.5 mmHg; and diastolic blood pressure, 81.3 ± 9.1 mmHg. We found that tadalafil significantly increased blood oxygen saturation in the cortical microvasculature at 180 min post-administration with a mean difference of 1.57 ± 3.02%. However, we saw no significant differences in transcranial Doppler measurements over time. Tadalafil had no effects on peripheral endothelial function assessed by EndoPAT and endothelial biomarker results conflicted. Our findings suggest that tadalafil may improve vascular parameters in patients with cerebral small-vessel disease stroke, although the effect size was small. Increased oxygenation of cerebral microvasculature during tadalafil treatment indicated improved perfusion in the cerebral microvasculature, theoretically presenting an attractive new therapeutic target in cerebral small-vessel disease. Future studies of the effect of long-term tadalafil treatment on cerebrovascular reactivity and endothelial function are needed to evaluate general microvascular changes and effects in cerebral small-vessel disease and stroke.
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Affiliation(s)
- Joakim Ölmestig
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark
| | - Ida R Marlet
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark
| | - Rasmus H Hansen
- Department of Radiology, Herlev Gentofte Hospital, Herlev 2730, Denmark
| | - Shazia Rehman
- Department of Radiology, Herlev Gentofte Hospital, Herlev 2730, Denmark
| | - Rikke Steen Krawcyk
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark.,Department of Physiotherapy and Occupational Therapy, Herlev Gentofte Hospital, Herlev 2730, Denmark
| | - Egill Rostrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Capital Region Psychiatry, Glostrup 2600, Denmark
| | - Kate L Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense 5000, Denmark.,Department of Neurology, Odense University Hospital, Odense 5000, Denmark.,BRIDGE-Brain Research Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev 2730, Denmark.,Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
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8
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Chen Y, Ke Z, Xiao J, Lin M, Huang X, Yan C, Ye S, Tan X. Subcutaneous Injection of Nitroglycerin at the Radial Artery Puncture Site Reduces the Risk of Early Radial Artery Occlusion After Transradial Coronary Catheterization: A Randomized, Placebo-Controlled Clinical Trial. Circ Cardiovasc Interv 2019; 11:e006571. [PMID: 30002088 DOI: 10.1161/circinterventions.118.006571] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transradial coronary catheterization is widely used as a diagnostic or interventional procedure for coronary disease. However, it can lead to adverse complications, such as radial artery occlusion. We sought to determine whether preprocedural injection of nitroglycerin at the radial artery puncture site reduces radial artery occlusion. METHODS AND RESULTS A total of 188 patients undergoing transradial coronary catheterization were randomized in a single-blind fashion to receive subcutaneous injection of 0.5 mL 0.1% nitroglycerin or a placebo at the radial artery puncture site. The participants underwent ultrasound examinations of the radial artery before and at 24 hours after the procedure. Of the 188 patients enrolled, 182 completed the study, as the procedure failed in 2 participants in the nitroglycerin-treated group and 4 in the placebo group. Baseline demographic and clinical characteristics were similar between 2 groups. Comparing the radial artery diameters before and after the operation, there was a statistically significant increase in the nitroglycerin-treated group (2.48±0.45 versus 2.45±0.46 mm; P=0.003) but a decrease in the placebo control group (2.41±0.50 versus 2.46±0.49 mm; P<0.001). Importantly, the incidence of radial arterial occlusion was substantially lower in the nitroglycerin-treated group than in the placebo control group (5.4% versus 14.4%; P=0.04). There was not significant difference in other complications (forearm hematoma and radial artery pseudoaneurysm, respectively), and there was no incidence of cause hypotension or an intolerable headache. CONCLUSIONS Subcutaneous injection of nitroglycerin at the radial artery puncture site dilates the radial artery and reduces the incidence of early radial artery occlusion post-catheterization. CLINICAL TRIAL REGISTRATION URL: https://www.chictr.org.cn. Unique identifier: ChiCTR-IPR-15006559.
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Affiliation(s)
- Yequn Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, China (Y.C., Z.K., J.X., M.L., X.H., C.Y., X.T.)
| | - Zhiquan Ke
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, China (Y.C., Z.K., J.X., M.L., X.H., C.Y., X.T.)
| | - Jiaxin Xiao
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, China (Y.C., Z.K., J.X., M.L., X.H., C.Y., X.T.)
| | - Mengyue Lin
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, China (Y.C., Z.K., J.X., M.L., X.H., C.Y., X.T.)
| | - Xiru Huang
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, China (Y.C., Z.K., J.X., M.L., X.H., C.Y., X.T.)
| | - Chunyin Yan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, China (Y.C., Z.K., J.X., M.L., X.H., C.Y., X.T.)
| | - Shu Ye
- Cardiovascular Genetics Laboratory, Shantou University Medical College, China (S.Y.). .,Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, United Kingdom (S.Y.)
| | - Xuerui Tan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, China (Y.C., Z.K., J.X., M.L., X.H., C.Y., X.T.).
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9
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Nowaczewska M, Kamińska A, Kukulska-Pawluczuk B, Junik R, Pawlak-Osińska K. Effect of hyperglycemia on cerebral blood flow in patients with diabetes. Diabetes Res Clin Pract 2019; 153:1-5. [PMID: 31145928 DOI: 10.1016/j.diabres.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/22/2019] [Accepted: 05/20/2019] [Indexed: 01/19/2023]
Abstract
AIMS Diabetes interferes with cerebral blood flow (CBF) and it seems that the effect of acute hyperglycemia on CBF is different from the changes in CBF caused by chronic diabetes. The aim of the study was to check whether there are changes in CBF measured using transcranial Doppler (TCD) in patients with hyperglycemia before and after normalization of glycemia. METHODS The study involved 29 patients with diabetes and 27 healthy subjects (control group). The TCD test evaluated mean flow velocity (Vm), systolic velocity (Vs) and Gosling's pulsatility index (PI) in both middle cerebral arteries (MCAs). It was performed twice in patients with diabetes (during hyperglycemia and after normalization of glycemia) and once in the control group. RESULTS The baseline blood flow parameters were similar in both groups. After the normalization of glycemia in patients with diabetes, they showed lower values of Vm and Vs compared to the control group (p < 0.001). Also, the normalization of glycemia caused a decrease in Vm and Vs (p < 0.001) in patients with diabetes. There were no significant differences in PI. CONCLUSIONS In the patients with hyperglycemia, Vm and Vs in the MCA were higher than during normoglycemia, which was probably related to vasoconstriction and hypervolemia.
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Affiliation(s)
- Magdalena Nowaczewska
- Department of Neurology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland; Department of Pathophysiology of Hearing and Balance, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
| | - Anna Kamińska
- Department of Endocrinology and Diabetology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Beata Kukulska-Pawluczuk
- Department of Neurology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Katarzyna Pawlak-Osińska
- Department of Pathophysiology of Hearing and Balance, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
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10
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Demartini C, Greco R, Zanaboni AM, Sances G, De Icco R, Borsook D, Tassorelli C. Nitroglycerin as a comparative experimental model of migraine pain: From animal to human and back. Prog Neurobiol 2019; 177:15-32. [DOI: 10.1016/j.pneurobio.2019.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
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11
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Schytz HW, Amin FM, Selb J, Boas DA. Non-invasive methods for measuring vascular changes in neurovascular headaches. J Cereb Blood Flow Metab 2019; 39:633-649. [PMID: 28782410 PMCID: PMC6446419 DOI: 10.1177/0271678x17724138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Vascular changes during spontaneous headache attacks have been studied over the last 30 years. The interest in cerebral vessels in headache research was initially due to the hypothesis of cerebral vessels as the pain source. Here, we review the knowledge gained by measuring the cerebral vasculature during spontaneous primary headache attacks with the use of single photon emission tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRA) and transcranial Doppler (TCD). Furthermore, the use of near-infrared spectroscopy in headache research is reviewed. Existing TCD studies of migraine and other headache disorders do not provide solid evidence for cerebral blood flow velocity changes during spontaneous attacks of migraine headache. SPECT studies have clearly shown cortical vascular changes following migraine aura and the differences between migraine with aura compared to migraine without aura. PET studies have shown focal activation in brain structures related to headache, but whether the changes are specific to different primary headaches have yet to be demonstrated. MR angiography has shown precise changes in large cerebral vessels during spontaneous migraine without aura attacks. Future development in more precise imaging methods may further elucidate the pathophysiological mechanisms in primary headaches.
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Affiliation(s)
- Henrik W Schytz
- 1 Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Faisal M Amin
- 1 Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Juliette Selb
- 2 Department of Radiology, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - David A Boas
- 2 Department of Radiology, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
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12
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Miller JB, Calo S, Reed B, Thompson R, Nahab B, Wu E, Chaudhry K, Levy P. Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency. Am J Emerg Med 2018; 37:1073-1077. [PMID: 30172599 DOI: 10.1016/j.ajem.2018.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 11/27/2022] Open
Abstract
STUDY OBJECTIVE In the Emergency Department (ED) setting, clinicians commonly treat severely elevated blood pressure (BP) despite the absence of evidence supporting this practice. We sought to determine if this rapid reduction of severely elevated BP in the ED has negative cerebrovascular effects. METHODS This was a prospective quasi-experimental study occurring in an academic emergency department. The study was inclusive of patients with a systolic BP (SBP) > 180 mm Hg for whom the treating clinicians ordered intensive BP lowering with intravenous or short-acting oral agents. We excluded patients with clinical evidence of hypertensive emergency. We assessed cerebrovascular effects with measurements of middle cerebral artery flow velocities and any clinical neurological deterioration. RESULTS There were 39 patients, predominantly African American (90%) and male (67%) and with a mean age of 50 years. The mean pre-treatment SBP was 210 ± 26 mm Hg. The mean change in SBP was -38 mm Hg (95% CI -49 to -27) mm Hg. The average change in cerebral mean flow velocity was -5 (95% CI -7 to -2) cm/s, representing a -9% (95% CI -14% to -4%) change. Two patients (5.1%, 95% CI 0.52-16.9%) had an adverse neurological event. CONCLUSION While this small cohort did not find an overall substantial change in cerebral blood flow, it demonstrated adverse cerebrovascular effects from rapid BP reduction in the emergency setting.
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Affiliation(s)
- Joseph B Miller
- Department of Emergency Medicine, Henry Ford Hospital and Wayne State University, Detroit, MI, United States of America; Department of Internal Medicine, Henry Ford Hospital and Wayne State University, Detroit, MI, United States of America.
| | - Sean Calo
- Central Michigan University School of Medicine, Mount Pleasant, MI, United States of America
| | - Brian Reed
- Department of Emergency Medicine, Wayne State University, Detroit, MI, United States of America
| | - Richard Thompson
- Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Bashar Nahab
- Department of Radiology, Wayne State University, Detroit, MI, United States of America
| | - Evan Wu
- Department of Emergency Medicine, University of California Davis, Davis, CA, United States of America
| | - Kaleem Chaudhry
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - Phillip Levy
- Department of Emergency Medicine, Cardiovascular Research Institute, Wayne State University, Detroit, MI, United States of America; Department of Physiology, Wayne State University, Detroit, MI, United States of America
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Fan JL, Bourdillon N, Meyer P, Kayser B. Oral Nitrate Supplementation Differentially Modulates Cerebral Artery Blood Velocity and Prefrontal Tissue Oxygenation During 15 km Time-Trial Cycling in Normoxia but Not in Hypoxia. Front Physiol 2018; 9:869. [PMID: 30061839 PMCID: PMC6054990 DOI: 10.3389/fphys.2018.00869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Nitrate is a precursor of nitric oxide (NO), an important regulator of cerebral perfusion in normoxic and hypoxic conditions. Nitrate supplementation could be used to improve cerebral perfusion and oxygenation during exercise in hypoxia. The effects of dietary nitrate supplementation on cerebral haemodynamics during exercise in severe hypoxia (arterial O2 saturation < 70%) have not been explored. Methods: In twelve trained male cyclists, we measured blood pressure (BP), middle cerebral artery blood velocity (MCAv), cerebrovascular resistance (CVR) and prefrontal oxyhaemoglobin and deoxyhaemoglobin concentration (O2Hb and HHb, respectively) during 15 km cycling time trials (TT) in normoxia and severe hypoxia (11% inspired O2, peripheral O2 saturation ∼66%) following 3-day oral supplementation with placebo or sodium nitrate (0.1 mmol/kg/day) in a randomised, double-blinded manner. We tested the hypothesis that dietary nitrate supplementation increases MCAv and cerebral O2Hb during TT in severe hypoxia. Results: During TT in normoxia, nitrate supplementation lowered MCAv by ∼2.3 cm/s and increased cerebral O2Hb by ∼6.8 μM and HHb by ∼2.1 μM compared to normoxia placebo (p ≤ 0.01 for all), while BP tended to be lowered (p = 0.06). During TT in severe hypoxia, nitrate supplementation elevated MCAv (by ∼2.5 cm/s) and BP (by ∼5 mmHg) compared to hypoxia placebo (p < 0.01 for both), while it had no effect on cerebral O2Hb (p = 0.98), HHb (p = 0.07) or PETCO2 (p = 0.12). Dietary nitrate had no effect of CVR during TT in normoxia or hypoxia (p = 0.19). Conclusion: Our findings indicate that during normoxic TT, the modulatory effect of dietary nitrate on regional and global cerebral perfusion is heterogeneous. Meanwhile, the lack of major changes in cerebral perfusion with dietary nitrate during hypoxic TT alludes to an exhausted cerebrovascular reserve.
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Affiliation(s)
- Jui-Lin Fan
- Wellington Medical Technology Group, Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand.,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Nicolas Bourdillon
- Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
| | - Philippe Meyer
- Cardiology Service, Geneva University Hospital, Geneva, Switzerland
| | - Bengt Kayser
- Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
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14
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Schulz JM, Al-Khazraji BK, Shoemaker JK. Sodium nitroglycerin induces middle cerebral artery vasodilatation in young, healthy adults. Exp Physiol 2018; 103:1047-1055. [PMID: 29766604 PMCID: PMC6099468 DOI: 10.1113/ep087022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/08/2018] [Indexed: 01/03/2023]
Abstract
NEW FINDINGS What is the central question of this study? Nitric oxide causes dilatation in peripheral vessels; however, whether nitric oxide affects basal cerebral artery dilatation has not been explored. What is the main finding and its importance? This study demonstrated that vasodilatation occurs in the right middle cerebral artery in response to exogenous nitric oxide. However, blood velocity decreased and, therefore, overall cerebral blood flow remained unchanged. This study provides new insight into the role of nitric oxide in cerebral blood flow control. ABSTRACT Recent evidence indicates that basal cerebral conduit vessels dilate with hypercapnia, with a nitric oxide (NO) mechanism explaining one way in which parenchymal cerebral arterioles dilate. However, whether NO affects basal cerebral artery dilatation remains unknown. This study quantified the effect of an exogenous NO donor [sodium nitroglycerin (NTG); 0.4 mg sublingual spray] on the right middle cerebral artery (rMCA) cross-sectional area (CSA), blood velocity and overall blood flow. Measures of vessel CSA (7 T magnetic resonance imaging) and MCA blood velocity (transcranial Doppler ultrasound) were made at baseline (BL) and after exogenous NTG or placebo (PLO) administration in young, healthy individuals (n = 10, two males, age range 20-23 years). The CSA increased in the rMCA [BL, 5.2 ± 1.2 mm2 ; PLO, 5.4 ± 1.5 mm2 ; NTG, 6.6 ± 1.5 mm2 , P < 0.05; mean ± SD]. Concurrently, rMCA blood velocity decreased from BL during NTG compared with PLO (BL, 67 ± 10 cm s-1 ; PLO, 62 ± 10 cm s-1 ; NTG, 59 ± 9.3 cm s-1 , P < 0.05; mean ± SD]. However, total MCA blood flow did not change with NTG or PLO [BL, 221 ± 37.4 ml min-1 ; PLO, 218 ± 35.0 ml min-1 ; NTG, 213 ± 46.4 ml min-1 ). Therefore, exogenous NO mediates a dilatory response in the rMCA, but not in its downstream vascular bed.
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Affiliation(s)
- Jenna M Schulz
- School of Physical Therapy, Department of Health Sciences, Western University, London, ON, Canada
| | - Baraa K Al-Khazraji
- School of Kinesiology, Department of Health Sciences, Western University, London, ON, Canada
| | - J Kevin Shoemaker
- Department of Physiology and Pharmacology, Western University, London, ON, Canada.,School of Kinesiology, Department of Health Sciences, Western University, London, ON, Canada
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15
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Karlsson WK, Sørensen CG, Kruuse C. l-arginine and l-NMMA for assessing cerebral endothelial dysfunction in ischaemic cerebrovascular disease: A systematic review. Clin Exp Pharmacol Physiol 2017; 44:13-20. [PMID: 27704594 DOI: 10.1111/1440-1681.12679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/11/2016] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Abstract
Endothelial dysfunction (ED), in particular cerebral ED, may be an essential biomarker for ischaemic cerebrovascular disease. However, there is no consensus on methods to best estimate cerebral ED. In this systematic review, we evaluate the use of l-arginine and NG -monomethyl-l-arginine (l-NMMA) for assessment of cerebral ED. A systematic search of PubMed, EMBASE and the Cochrane Library was done. We included studies investigating cerebrovascular response to l-arginine or l-NMMA in human subjects with vascular risk factors or ischaemic cerebrovascular disease. Seven studies (315 subjects) were eligible according to inclusion and exclusion criteria. Studies investigated the effect of age (n=2), type 2 diabetes mellitus (DM) (n=1), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) (n=1), leukoaraiosis (n=1), and prior ischaemic stroke or transient ischaemic attack (TIA) (n=2) on cerebral ED. Most studies applied transcranial Doppler to quantify cerebral ED. Endothelium-dependent vasodilatation (EDV) induced by l-arginine was impaired in elderly and subjects with leukoaraiosis, but enhanced in CADASIL patients. Studies including subjects with prior ischaemic stroke or TIA reported both enhanced and impaired EDV to l-arginine. Responses to l-NMMA deviated between subjects with type 2 DM and the elderly. We found only few studies investigating cerebral endothelial responses to l-arginine and l-NMMA in subjects with vascular risk factors or ischaemic cerebrovascular disease. Inconsistencies in results were most likely due to variations in methods and included subject populations. In order to use cerebral ED as a prognostic marker, further studies are required to evaluate the association to cerebrovascular disease.
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Affiliation(s)
- William K Karlsson
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caspar G Sørensen
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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16
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Arngrim N, Schytz HW, Britze J, Vestergaard MB, Sander M, Olsen KS, Olesen J, Ashina M. Carbon monoxide inhalation induces headache in a human headache model. Cephalalgia 2017; 38:697-706. [DOI: 10.1177/0333102417708768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Carbon monoxide (CO) is an endogenously produced signalling molecule that has a role in nociceptive processing and cerebral vasodilatation. We hypothesized that inhalation of CO would induce headache and vasodilation of cephalic and extracephalic arteries. Methods In a randomized, double-blind, placebo-controlled crossover design, 12 healthy volunteers were allocated to inhalation of CO (carboxyhemoglobin 22%) or placebo on two separate days. Headache was scored on a verbal rating scale from 0–10. We recorded mean blood velocity in the middle cerebral artery (VMCA) by transcranial Doppler, diameter of the superficial temporal artery (STA) and radial artery (RA) by high-resolution ultrasonography and facial skin blood flow by laser speckle contrast imaging. Results Ten volunteers developed headache after CO compared to six after placebo. The area under the curve for headache (0–12 hours) was increased after CO compared with placebo ( p = 0.021). CO increased VMCA ( p = 0.002) and facial skin blood flow ( p = 0.012), but did not change the diameter of the STA ( p = 0.060) and RA ( p = 0.433). Conclusion In conclusion, the study demonstrated that CO caused mild prolonged headache but no arterial dilatation in healthy volunteers. We suggest this may be caused by a combination of hypoxic and direct cellular effects of CO.
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Affiliation(s)
- Nanna Arngrim
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Henrik Winther Schytz
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Josefine Britze
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Mark Bitsch Vestergaard
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Mikael Sander
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karsten Skovgaard Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Jes Olesen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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17
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Lemkuil BP, Gierl BT, Patel PM, Pearn ML, Nguyen LC, Minokadeh A, Drummond JC. The Effect of Clevidipine on Cerebral Blood Flow Velocity and Carbon Dioxide Reactivity in Human Volunteers. J Neurosurg Anesthesiol 2016; 28:337-40. [PMID: 26447497 DOI: 10.1097/ana.0000000000000236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clevidipine is a short acting, esterase metabolized, calcium channel antagonist administered as a continuous infusion for control of hypertension. Its profile allows for rapid titration and may be uniquely suited to achieving tight hemodynamic targets in neurosurgical and neurocritical care patients. The present study was designed to investigate the effect of clevidipine infusion on cerebral blood flow and cerebral CO2 responsiveness as measured by cerebral blood flow velocity (CBFV) using transcranial Doppler. MATERIALS AND METHODS CBFV was continuously recorded in 5 healthy subjects during the following conditions: baseline 1 (BL1); baseline with hyperventilation (HV1); baseline 2 (BL2); clevidipine infusion to achieve 15% mean arterial pressure (MAP) reduction (C15); clevidipine infusion to achieve 30% MAP reduction (C30); clevidipine infusion to 30% MAP reduction with hyperventilation (HV2). RESULTS The mean CBFV during intermediate (C15) or maximum (C30) dose clevidipine infusion was unchanged compared with baseline (BL2) (F2,8=0.66; P=0.54). Cerebral CO2 reactivity, expressed as %[INCREMENT]CBFV/[INCREMENT]mm Hg CO2, was not significantly different in the presence of maximal-dose clevidipine (HV2) as compared with baseline (HV1) (1.6±0.4 vs. 1.6±0.3%[INCREMENT]CBFV/[INCREMENT]mm Hg CO2, P=0.73). CONCLUSIONS Clevidipine infusion did not significantly increase CBFV nor was cerebral CO2 reactivity reduced during maximal-dose clevidipine infusion. Further systematic investigation of clevidipine in patients with central nervous system pathology seems justified.
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Affiliation(s)
- Brian P Lemkuil
- *Department of Anesthesiology, University of California †Veterans Affairs Medical Center, San Diego, CA ‡Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
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18
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Russell D, Dahl A, Nyberg-Hansen R, Rootwelt K. Reproducibility of Simultaneous TCD and rCBF Measurements. Cephalalgia 2016. [DOI: 10.1177/0333102491011s1125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Russell
- Departments of Neurology and Clinical Biochemistry, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Arve Dahl
- Departments of Neurology and Clinical Biochemistry, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Rolf Nyberg-Hansen
- Departments of Neurology and Clinical Biochemistry, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Kjell Rootwelt
- Departments of Neurology and Clinical Biochemistry, Rikshospitalet, University of Oslo, Oslo, Norway
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19
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Petersen KA, Birk S, Lassen LH, Kruuse C, Jonassen O, Lesko L, Olesen J. The CGRP-Antagonist, BIBN4096BS Does not Affect Cerebral or Systemic Haemodynamics in Healthy Volunteers. Cephalalgia 2016; 25:139-47. [PMID: 15658951 DOI: 10.1111/j.1468-2982.2004.00830.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BIBN4096BS is a CGRP-antagonist effective in the treatment of migraine. Blocking the receptor of a strong vasodilator involves a theoretical risk of causing cerebral vasoconstriction, a probability not previously investigated with BIBN4096BS. Seven healthy volunteers completed this double-blinded placebo-controlled crossover study. The volunteers received randomly 10 min infusions of either placebo, 2.5 mg or 10 mg of BIBN4096BS on 3 separate days. Transcranial Doppler was used to measure the middle cerebral artery blood flow velocity (VMCA); global and regional cerebral blood flow (rCBFMCA) was measured by 133-Xenon inhalation SPECT. The diameter of the temporal and radial artery was measured by highresolution ultrasound. Systemic haemodynamics and partial pressure of CO2 (PetCO2), and adverse events were monitored regularly. BIBN4096BS had no influence on global or regional cerebral blood flow, or on the blood flow velocity in the middle cerebral artery. There was no effect on systemic haemodynamics and adverse events were minor. We conclude that there is no effect of CGRP-receptor blockade on the cerebral or systemic circulation in humans. Circulating CGRP is therefore not likely to exert a vasodilatory activity in the resting state and the use of BIBN4096BS for acute migraine seems to be without risk of cerebral vasoactivity. These data suggest that BIBN4096BS is the first specific antimigraine drug without vasoactive effect.
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Affiliation(s)
- K A Petersen
- Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup University Hospital, DK-2600 Glostrup, Denmark.
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20
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Tvedskov JF, Thomsen LL, Thomsen LL, Iversen HK, Williams P, Gibson A, Jenkins K, Peck R, Olesen J. The Effect of Propranolol on Glyceryltrinitrate-Induced Headache and Arterial Response. Cephalalgia 2016; 24:1076-87. [PMID: 15566422 DOI: 10.1111/j.1468-2982.2004.00796.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Prophylactic drug trials in migraine are long-lasting and expensive and require long-term toxicology information. A human migraine model would therefore be helpful in testing new drugs. Immediate headache and delayed migraine after glyceryltrinitrate (GTN) has been well characterized. We have recently shown that sodium valproate has prophylactic effect in the GTN model. Here we report our experience with propranolol in this model. Nineteen subjects with migraine without aura and 16 sex- and aged-matched healthy subjects were included in a two-centre randomized double-blind cross-over study. Fourteen migraine subjects and 14 healthy subjects completed the study and results from comparison of the 28 subjects are reported. Randomly propranolol 160 mg or placebo were each given daily for 14 days to both migraine and healthy subjects. A 20-min intravenous infusion of GTN 0.25 mg/kg per min was administered on a study day at the end of both pretreatment periods. Headache was registered for 12 h after GTN infusions. Its intensity was scored on a numerical verbal rating scale from 0 to 10. Fulfilment of International Headache Society (HIS) criteria was recorded for 24 h. Radial and superficial temporal artery diameters and blood velocity of both middle cerebral arteries were measured. All migraine subjects developed headache after GTN. No reduction of overall peak headache was found after propranolol (median 5, range 0-7) compared with placebo (median 5, range 0-10) ( P = 0.441). Eight of the 14 completing migraine subject developed IHS 1.1 migraine after GTN, two subjects on both days, three subjects only after placebo, and three subjects only after propranolol. No reduction of GTN-induced migraine was found after propranolol compared with placebo (5 vs. 5, P = 1.000). All healthy subjects developed headache after GTN. No reduction of overall peak headache was found after propranolol (median 2, range 1-5) compared with placebo (median 1, range 1-7) ( P = 0.315). Two subjects fulfilled IHS criteria 1.1 for migraine without aura after propranolol but not after placebo. The fulfilment was short lasting and did not require rescue medication. Headache after GTN was more pronounced in migraine subjects than in healthy subjects both with ( P = 0.003) and without pretreatment with propranolol ( P = 0.017). We found that 2 weeks of propranolol constricted the radial artery in healthy subjects but not in migraine subjects. GTN-induced vasodilatation abolished this difference. Mean maximum blood flow velocity in the middle cerebral artery was higher in healthy subjects than in migraine patients ( P = 0.003-0.033) and unaffected by propranolol. We observed no effect of propranolol on GTN-induced headache and migraine. This could indicate that GTN induces migraine at a deeper level of the pathophysiological cascade of migraine than the prophylactic effect of propranolol. Propranolol does not constrict cerebral arteries, which therefore cannot be part of its mechanism of action in migraine.
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Affiliation(s)
- J F Tvedskov
- Danish Headache Centre, University of Copenhagen and Department of Neurology, Glostrup University Hospital, Glostrup, Denmark.
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21
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Hansen JM, Sitarz J, Birk S, Rahmann AM, Oturai PS, Fahrenkrug J, Olesen J, Ashina M. Vasoactive Intestinal Polypeptide Evokes Only a Minimal Headache in Healthy Volunteers. Cephalalgia 2016; 26:992-1003. [PMID: 16886936 DOI: 10.1111/j.1468-2982.2006.01149.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The role of the parasympathetic nervous system in the pathogenesis of migraine is disputed. The headache-eliciting effect of the parasympathetic neurotransmitter, vasoactive intestinal polypeptide (VIP), and its effect on cerebral arteries and brain haemodynamics has not been systematically studied in man. We hypothesized that infusion of VIP might induce headache in healthy subjects and cause changes in cerebral haemodynamics. VIP (8 pmol/kg per min) or placebo (0.9± saline) was infused for 25 min into 12 healthy young volunteers in a crossover, double-blind design. Headache was scored on a verbal rating scale from 0 to 10, regional cerebral blood flow (rCBF) was measured with single-photon emission computed tomography and 133Xe inhalation and mean flow velocity in the middle cerebral artery (VmeanMCA) was measured with transcranial Doppler ultrasonography. The headache was very mild with a maximum score of 2 and described as a pressing or throbbing sensation. Five participants developed headache during VIP and one during placebo. During the infusion, a significant drop in VmeanMCA was seen for VIP compared with placebo ( P < 0.001), but the effect quickly waned and no difference was found when comparing the time between 30 and 120 min. In addition, no significant difference in the diameter of the MCA could be found during the infusion. No significant differences in rCBF ( P = 0.10) were found between VIP and placebo. A marked dilation of the superficial temporal artery was seen ( P = 0.04) after VIP in the first 30 min but no difference was found when comparing the time between 30 and 120 min. We found no difference in mean arterial blood pressure between VIP and placebo days but the heart rate increased significantly on a VIP day compared with a placebo day (AUC0–30min, P < 0.001). Plasma VIP was significantly higher on a VIP day compared with placebo (AUC0–80min, P < 0.001). These results show that VIP causes a decrease in VmeanMCA without affecting rCBF. In spite of a marked vasodilator effect in the extracranial vessels and increased plasma VIP, healthy subjects developed only a very mild headache.
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Affiliation(s)
- J M Hansen
- Danish Headache Centre and Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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22
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Babikian V, Pochay VE, Sloan MA, Burdette D. The Effects of Dolichoectasia on Transcranial Doppler Measurements. J Neuroimaging 2016. [DOI: 10.1111/jon19922119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tfelt-Hansen P. The qualitative problem of major quotation errors, as illustrated by 10 different examples in the headache literature. Headache 2015; 55:419-26. [PMID: 25760466 DOI: 10.1111/head.12529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2014] [Indexed: 11/30/2022]
Abstract
There are two types of errors when references are used in the scientific literature: citation errors and quotation errors, and these errors have in reviews mainly been evaluated quantitatively. Quotation errors are the major problem, and 1 review reported 6% major quotation errors. The objective of this listing of quotation errors is to illustrate by qualitative analysis of different types of 10 major quotation errors how and possibly why authors misquote references. The author selected for review the first 10 different consecutive major quotation errors encountered from his reading of the headache literature. The characteristics of the 10 quotation errors ranged considerably. Thus, in a review of migraine therapy in a very prestigious medical journal, the superiority of a new treatment (sumatriptan) vs an old treatment (aspirin plus metoclopramide) was claimed despite no significant difference for the primary efficacy measure in the trial. One author, in a scientific debate, referred to the lack of dilation of the middle meningeal artery in spontaneous migraine despite the fact that only 1 migraine attack was studied. The possibility for creative major quotation errors in the medical literature is most likely infinite. Qualitative evaluations, as the present, of major quotation errors will hopefully result in more general awareness of quotation problems in the medical literature. Even if the final responsibility for correct use of quotations is with the authors, the referees, the experts with the knowledge needed to spot quotation errors, should be more involved in ensuring correct and fair use of references. Finally, this paper suggests that major misleading quotations, if pointed out by readers of the journal, should, as a rule, be corrected by way of an erratum statement.
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Affiliation(s)
- Peer Tfelt-Hansen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
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Sorond FA, Tan CO, LaRose S, Monk AD, Fichorova R, Ryan S, Lipsitz LA. Deferoxamine, Cerebrovascular Hemodynamics, and Vascular Aging: Potential Role for Hypoxia-Inducible Transcription Factor-1-Regulated Pathways. Stroke 2015; 46:2576-83. [PMID: 26304864 DOI: 10.1161/strokeaha.115.009906] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/02/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Iron chelation therapy is emerging as a novel neuroprotective strategy. The mechanisms of neuroprotection are diverse and include both neuronal and vascular pathways. We sought to examine the effect of iron chelation on cerebrovascular function in healthy aging and to explore whether hypoxia-inducible transcription factor-1 activation may be temporally correlated with vascular changes. METHODS We assessed cerebrovascular function (autoregulation, vasoreactivity, and neurovascular coupling) and serum concentrations of vascular endothelial growth factor and erythropoietin, as representative measures of hypoxia-inducible transcription factor-1 activation, during 6 hours of deferoxamine infusion in 24 young and 24 older healthy volunteers in a randomized, blinded, placebo-controlled cross-over study design. Cerebrovascular function was assessed using the transcranial Doppler ultrasound. Vascular endothelial growth factor and erythropoietin serum protein assays were conducted using the Meso Scale Discovery platform. RESULTS Deferoxamine elicited a strong age- and time-dependent increase in the plasma concentrations of erythropoietin and vascular endothelial growth factor, which persisted ≤3 hours post infusion (age effect P=0.04; treatment×time P<0.01). Deferoxamine infusion also resulted in a significant time- and age-dependent improvement in cerebral vasoreactivity (treatment×time P<0.01; age P<0.01) and cerebral autoregulation (gain: age×time×treatment P=0.04). CONCLUSIONS Deferoxamine infusion improved cerebrovascular function, particularly in older individuals. The temporal association between improved cerebrovascular function and increased serum vascular endothelial growth factor and erythropoietin concentrations is supportive of shared hypoxia-inducible transcription factor-1-regulated pathways. Therefore, pharmacological activation of hypoxia-inducible transcription factor-1 to enhance cerebrovascular function may be a promising neuroprotective strategy in acute and chronic ischemic syndromes, especially in elderly patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT013655104.
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Affiliation(s)
- Farzaneh A Sorond
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.).
| | - Can Ozan Tan
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Sarah LaRose
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Andrew D Monk
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Raina Fichorova
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Stanthia Ryan
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Lewis A Lipsitz
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
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25
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The role of purinergic signaling in the etiology of migraine and novel antimigraine treatment. Purinergic Signal 2015; 11:307-16. [PMID: 25957584 PMCID: PMC4529850 DOI: 10.1007/s11302-015-9453-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/28/2015] [Indexed: 12/23/2022] Open
Abstract
Etiopathogenesis of migraine involves different structures of the central nervous system: the trigeminal nerve with nuclei located in the brain stem, vascular system, and the cerebral cortex as well as diverse mechanisms and pathological processes. The multidirectional action of purines in different cell types (blood vessels, neurons, and satellite glial cells) and through different types of purinergic receptors contributes to the etiopathogenesis of migraine pain. Adenosine triphosphate (ATP) and its derivatives are involved in initiation and propagation of migrenogenic signals in several ways: they participate in vasomotor mechanism, cortical spreading depression, and in fast transmission or cross-excitation based on the satellite glial cells in trigeminal ganglion. Contribution of purinergic signaling in the conduction of pain is realized through the activation of P1 and P2 receptors expressed widely in the central nervous system: on the neurons and glial cells as well as on the smooth muscles and endothelium in the vascular system. Therefore, the purinergic receptors can be an excellent target for pharmacologists constructing new antimigraine therapeutics. Moreover, the mechanisms facilitating ATP and adenosine degradation may prevent vasodilatation and thus avoid a secondary central sensitization during a migraine attack. Thus, agonists and antagonists of P receptors as well as ecto-enzymes metabolizing nucleotides/nucleosides could gain the growing attention as therapeutic agents.
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26
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Erkan H, Kırış G, Korkmaz L, Ağaç MT, Çavuşoğlu İG, Dursun İ, Yılmaz AS, Aslan AO, Kırcı DC, Çelik Ş. Relationship between Nitrate-Induced Headache and Coronary Artery Lesion Complexity. Med Princ Pract 2015; 24:560-4. [PMID: 26160139 PMCID: PMC5588274 DOI: 10.1159/000434754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). SUBJECTS AND METHODS Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. RESULTS The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore. CONCLUSION The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD.
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Affiliation(s)
- Hakan Erkan
- Department of Cardiology, Trabzon, Turkey
- *Hakan Erkan, MD, Department of Cardiology, Ahi Evren Cardiovascular and, Thoracic Surgery Training and Research Hospital, çamlýk Street, TR-61400 Trabzon (Turkey), E-Mail
| | | | | | | | - İsmail Gökhan Çavuşoğlu
- Department of Radiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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27
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Pryazhnikov E, Kislin M, Tibeykina M, Toptunov D, Ptukha A, Shatillo A, Gröhn O, Giniatullin R, Khiroug L. Opposite reactivity of meningeal versus cortical microvessels to the nitric oxide donor glyceryl trinitrate evaluated in vivo with two-photon imaging. PLoS One 2014; 9:e89699. [PMID: 24586970 PMCID: PMC3938546 DOI: 10.1371/journal.pone.0089699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 01/23/2014] [Indexed: 11/18/2022] Open
Abstract
Vascular changes underlying headache in migraine patients induced by Glyceryl trinitrate (GTN) were previously studied with various imaging techniques. Despite the long history of medical and experimental use of GTN, its effects on the brain vasculature are still poorly understood presumably due to low spatial resolution of the imaging modalities used so far. We took advantage of the micrometer-scale vertical resolution of two-photon microscopy to differentiate between the vasodynamic effects of GTN on meningeal versus cortical vessels imaged simultaneously in anesthetized rats through either thinned skull or glass-sealed cranial window. Intermediate and small calibre vessels were visualized in vivo by imaging intravascular fluorescent dextran, and detection of blood flow direction allowed identification of individual arterioles and venules. We found that i.p.-injected GTN induced a transient constriction of meningeal arterioles, while their cortical counterparts were, in contrast, dilated. These opposing effects of GTN were restricted to arterioles, whereas the effects on venules were insignificant. Interestingly, the NO synthase inhibitor L-NAME did not affect the diameter of meningeal vessels but induced a constriction of cortical vessels. The different cellular environment in cortex versus meninges as well as distinct vessel wall anatomical features probably play crucial role in the observed phenomena. These findings highlight differential region- and vessel-type-specific effects of GTN on cranial vessels, and may implicate new vascular mechanisms of NO-mediated primary headaches.
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Affiliation(s)
- Evgeny Pryazhnikov
- Neuroscience Center, University of Helsinki, Helsinki, Finland
- Neurotar LTD, Helsinki, Finland
| | - Mikhail Kislin
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | | | | | - Anna Ptukha
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Artem Shatillo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Rashid Giniatullin
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Leonard Khiroug
- Neuroscience Center, University of Helsinki, Helsinki, Finland
- Neurotar LTD, Helsinki, Finland
- * E-mail:
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28
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Thomsen LL, Kruuse C, Iversen HK, Olesen J. A nitric oxide donor (nitroglycerin) triggers genuine migraine attacks. Eur J Neurol 2013; 1:73-80. [PMID: 24283432 DOI: 10.1111/j.1468-1331.1994.tb00053.x] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Supersensitivity to induction of headache and arterial dilatation by a donor of nitric oxide (nitroglycerin) has recently been demonstrated in migraine sufferers. The aims of the present study were to examine whether the nitric oxide donor nitroglycerin may induce a typical migraine attack, to exclude placebo-related effects and to describe the relation between middle cerebral artery dilatation and provoked migraine. Nitroglycerin (0.5 μg/kg/min for 20 min) or placebo was infused into 12 migraine patients in a double-blind cross-over trial. Blood velocity in the middle cerebral artery was measured with transcranial Doppler and characteristics of headache and accompanying symptoms were recorded frequently. Headache occurred during the nitroglycerin infusion as previously described but peak headache intensity did first occur 5.5 h after infusion. At this time the induced headaches in 8 of 10 completing patients fulfilled the diagnostic criteria for migraine without aura of the International Headache Society. Furthermore, all patients who normally had unilateral spontaneous migraine attacks also had unilateral headaches after nitroglycerin. Only one subject developed migraine after placebo (p < 0.03). The time pattern of headache and estimated middle cerebral artery dilatation corresponded well. The study therefore demonstrates that activation of the nitric oxide cGMP pathway may cause typical migraine attacks.
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Affiliation(s)
- L L Thomsen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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29
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Chang JJ, Sanossian N. Pre-Hospital Glyceryl Trinitrate: Potential for Use in Intracerebral Hemorrhage. JOURNAL OF NEUROLOGICAL DISORDERS 2013; 2:141. [PMID: 25309942 PMCID: PMC4193474 DOI: 10.4172/2329-6895.1000141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Intracerebral hemorrhage is associated with poor clinical outcome and high mortality. Research and treatment modalities have focused on the expansion of the primary hematoma through blood pressure control and activation of coagulation factors. However, clinical trials have failed to show decreased rates of death or disability in intracerebral hemorrhage following hospital initiation of blood pressure control. However, as clinical deterioration often occurs immediately after onset, pre-hospital initiation of blood pressure control may be more ideal. METHODS Relevant terms in the National Library of Medicine PubMed database and selected research including basic science, translational reports, meta-analyses, and clinical studies were searched. RESULTS Trends indicating improved clinical outcome in intracerebral hemorrhage after hospital-initiated intensive systolic blood pressure control (goal<140 mmHg) have been demonstrated. Statistical significance may not have been obtained because of late treatment times of blood pressure control that approached median 4-6 hours after clinical onset. One trial utilizing glyceryl trinitrate in the pre-hospital setting has been shown to significantly decrease blood pressure within fifteen minutes and improve 90-day clinical outcome. CONCLUSIONS Glyceryl trinitrate represents an ideal pre-hospital blood pressure medication because it can be delivered via sublingual or transdermal routes, has a quick and graded onset of action, has neuroprotective effects, maintains cerebral perfusion, and has an established record of safety. As intracerebral hemorrhage requires prompt action to prevent clinical deterioration, more emphasis on pre-hospital therapies for blood pressure reduction will become essential in future therapies.
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Affiliation(s)
- Jason J Chang
- Department of Neurology, University of Southern California, USA
| | - Nerses Sanossian
- Department of Neurology, University of Southern California, USA
- Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, USA
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30
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Van Noord BA, Stalker CL, Roffey P, Thangathurai D. The use of regional cerebral oximetry monitoring during controlled hypotension: a case series. J Clin Monit Comput 2013; 28:319-23. [PMID: 24136194 DOI: 10.1007/s10877-013-9523-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 10/12/2013] [Indexed: 11/26/2022]
Abstract
Regional cerebral oximetry monitoring was used to guide nitroglycerin infusion and IV fluid administration during controlled hypotension in order to optimize each individual patient's mean arterial pressure in a series of 20 consecutive patients who underwent major open urological or abdominal surgery. Although controlled hypotension offers a definite benefit in patients undergoing complex surgery where blood loss will be elevated or would severely compromise the surgical field, it is not without risk as low arterial pressure may compromise tissue perfusion and promote ischemia. In this case series, despite an average mean arterial pressure decrease of 19.5 % (p < 0.001), cerebral oximetry values increased by an average of 22.7 % (p < 0.001) after the nitroglycerin infusion had been initiated (220 mcg/min average). Patients received an average of 3.15L crystalloid and 437 ml albumin in fluid resuscitation.
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Affiliation(s)
- Brandon A Van Noord
- Department of Anesthesia, Keck Medical Center, University of Southern California, Los Angeles, CA, USA,
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31
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Liu J, Zhu YS, Hill C, Armstrong K, Tarumi T, Hodics T, Hynan LS, Zhang R. Cerebral autoregulation of blood velocity and volumetric flow during steady-state changes in arterial pressure. Hypertension 2013; 62:973-9. [PMID: 24041946 DOI: 10.1161/hypertensionaha.113.01867] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The validity of using transcranial Doppler measurement of cerebral blood flow velocity (CBFV) to assess cerebral autoregulation (CA) still is a concern. This study measured CBFV in the middle cerebral artery using transcranial Doppler and volumetric cerebral blood flow (CBF) in the internal carotid artery (ICA) using color-coded duplex ultrasonography to assess CA during steady-state changes in mean arterial pressure (MAP). Twenty-one healthy adults participated. MAP was changed stepwise by intravenous infusion of sodium nitroprusside and phenylephrine. Changes in CBFV, CBF, cerebrovascular resistance (CVR=MAP/CBF), or cerebrovascular resistance index (CVRi=MAP/CBFV) were measured to assess CA by linear regression analysis. The relationship between changes in ICA diameter and MAP was assessed. All values were normalized as percentage changes from baseline. Drug-induced changes in MAP were from -26% to 31%. Changes in CBFV and CVRi in response to MAP were linear, and the regression slopes were similar between middle cerebral artery and ICA. However, CBF in ICA remained unchanged despite large changes in MAP. Consistently, a steeper slope of changes in CVR relative to CVRi was observed (0.991 versus 0.804; P<0.05). The ICA diameter changed inversely in response to MAP (r=-0.418; P<0.05). These findings indicate that CA can be assessed with transcranial Doppler measurements of CBFV and CVRi in middle cerebral artery. However, it is likely to be underestimated when compared with the measurements of CBF and CVR in ICA. The inverse relationship between changes in ICA diameter and MAP suggests that large cerebral arteries are involved in CA.
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Affiliation(s)
- Jie Liu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave, Dallas, TX 75231.
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32
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Antonova M, Wienecke T, Olesen J, Ashina M. Prostaglandin E(2) induces immediate migraine-like attack in migraine patients without aura. Cephalalgia 2012; 32:822-33. [PMID: 22718556 DOI: 10.1177/0333102412451360] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Prostaglandin E(2) (PGE(2)) has been suggested to play an important role in the pathogenesis of migraine. In the present experiment we investigated if an intravenous infusion of PGE(2) would induce migraine-like attacks in patients with migraine. METHODS Twelve patients with migraine without aura were randomly allocated to receive 0.4 µg/kg/min PGE(2) (Prostin(®)E2, dinoprostone) or placebo over 25 minutes in a two-way, crossover study. Headache intensity was recorded on a verbal rating scale, middle cerebral artery blood flow velocity (V(MCA)) was measured by transcranial Doppler (TCD) and diameter of the superficial temporal artery (STA) was obtained by c-series scan (Dermascan C). RESULTS In total, nine migraine patients (75%) experienced migraine-like attacks after PGE(2) compared to none after placebo (p = 0.004). Seven out of 9 (58%) patients reported the migraine-like attacks during the immediate phase (0-90 min) (p = 0.016). Only two patients experienced the delayed migraine-like attacks several hours after the PGE(2) infusion stop (p = 0.500). The V(MCA) decreased during the PGE(2) infusion (p = 0.005) but there was no significant dilatation of the STA (p = 0.850). CONCLUSION The migraine-like attacks during, and immediately after, the PGE(2) infusion contrast with those found in previous provocation studies, in which the other pharmacological compounds triggered the delayed migraine-like attacks several hours after the infusion. We suggest that PGE(2) may be one of the important final products involved in the generation of migraine attacks.
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Affiliation(s)
- Maria Antonova
- Danish Headache Center and Department of Neurology, University of Copenhagen, Denmark
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33
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Zuj KA, Edgell H, Shoemaker JK, Custaud MA, Arbeille P, Hughson RL. WISE 2005: responses of women to sublingual nitroglycerin before and after 56 days of 6° head-down bed rest. J Appl Physiol (1985) 2012; 113:434-41. [PMID: 22653986 DOI: 10.1152/japplphysiol.00445.2012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study tested the hypothesis that cardiovascular effects of sublingual nitroglycerin (NG) would be exaggerated after 56 days of 6° head-down bed rest (HDBR) in women, and that an aerobic and resistive exercise countermeasure (EX, n = 8) would reduce the effect compared with HDBR without exercise (CON, n = 7). Middle cerebral artery maximal blood flow velocity (CBFV), cardiac stroke volume (SV), and superficial femoral artery blood flow (Doppler ultrasound) were recorded at baseline rest and for 5 min following 0.3 mg sublingual NG. Post-HDBR, NG caused greater increases in heart rate (HR) in CON compared with EX (+24.9 ± 7.7 and +18.8 ± 6.6 beats/min, respectively, P < 0.0001). The increase in HR combined with reductions in SV to maintain cardiac output. Systolic, mean, and pulse pressures were reduced 5-10 mmHg by NG, but total peripheral resistance was only slightly reduced at 3 min after NG. Reductions in CBFV of -12.5 ± 3.8 cm/s were seen after NG, but a reduction in the Doppler resistance index suggested dilation of the middle cerebral artery with no differences after HDBR. The femoral artery dilated with NG and blood flow was reduced ∼50% with the appearance of large negative waves suggesting a marked increase in downstream resistance, but there were no effects of HDBR. In general, responses of women to NG were not altered by HDBR; the greater increase in HR in CON but not EX was probably a consequence of cardiovascular deconditioning. These results contrast with the hypothesis and a previous investigation of men after HDBR by revealing no change in cardiovascular responses to exogenous nitric oxide.
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Affiliation(s)
- K A Zuj
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Kim YS, Davis SC, Truijen J, Stok WJ, Secher NH, van Lieshout JJ. Intensive Blood Pressure Control Affects Cerebral Blood Flow in Type 2 Diabetes Mellitus Patients. Hypertension 2011; 57:738-45. [DOI: 10.1161/hypertensionaha.110.160523] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Type 2 diabetes mellitus is associated with microvascular complications, hypertension, and impaired dynamic cerebral autoregulation. Intensive blood pressure (BP) control in hypertensive type 2 diabetic patients reduces their risk of stroke but may affect cerebral perfusion. Systemic hemodynamic variables and transcranial Doppler-determined cerebral blood flow velocity (CBFV), cerebral CO
2
responsiveness, and cognitive function were determined after 3 and 6 months of intensive BP control in 17 type 2 diabetic patients with microvascular complications (T2DM+), in 18 diabetic patients without (T2DM−) microvascular complications, and in 16 nondiabetic hypertensive patients. Cerebrovascular reserve capacity was lower in T2DM+ versus T2DM− and nondiabetic hypertensive patients (4.6±1.1 versus 6.0±1.6 [
P
<0.05] and 6.6±1.7 [
P
<0.01], Δ%mean CBFV/mm Hg). After 6 months, the attained BP was comparable among the 3 groups. However, in contrast to nondiabetic hypertensive patients, intensive BP control reduced CBFV in T2DM− (58±9 to 54±12 cm · s
−1
) and T2DM+ (57±13 to 52±11 cm · s
−1
) at 3 months, but CBFV returned to baseline at 6 months only in T2DM−, whereas the reduction in CBFV progressed in T2DM+ (to 48±8 cm · s
−1
). Cognitive function did not change during the 6 months. Static cerebrovascular autoregulation appears to be impaired in type 2 diabetes mellitus, with a transient reduction in CBFV in uncomplicated diabetic patients on tight BP control, but with a progressive reduction in CBFV in diabetic patients with microvascular complications, indicating that maintenance of cerebral perfusion during BP treatment depends on the progression of microvascular disease. We suggest that BP treatment should be individualized, aiming at a balance between BP reduction and maintenance of CBFV.
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Affiliation(s)
- Yu-Sok Kim
- From the Departments of Internal Medicine (Y.-S.K., J.T., J.J.v.L.) and Physiology (W.J.S.), Academic Medical Center and Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Center for Heart Failure Research (Y.-S.K., S.C.A.T.D., J.T., W.J.S., J.J.v.L.), University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesia (N.H.S.), Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Shyrin C.A.T. Davis
- From the Departments of Internal Medicine (Y.-S.K., J.T., J.J.v.L.) and Physiology (W.J.S.), Academic Medical Center and Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Center for Heart Failure Research (Y.-S.K., S.C.A.T.D., J.T., W.J.S., J.J.v.L.), University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesia (N.H.S.), Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jasper Truijen
- From the Departments of Internal Medicine (Y.-S.K., J.T., J.J.v.L.) and Physiology (W.J.S.), Academic Medical Center and Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Center for Heart Failure Research (Y.-S.K., S.C.A.T.D., J.T., W.J.S., J.J.v.L.), University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesia (N.H.S.), Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wim J. Stok
- From the Departments of Internal Medicine (Y.-S.K., J.T., J.J.v.L.) and Physiology (W.J.S.), Academic Medical Center and Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Center for Heart Failure Research (Y.-S.K., S.C.A.T.D., J.T., W.J.S., J.J.v.L.), University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesia (N.H.S.), Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels H. Secher
- From the Departments of Internal Medicine (Y.-S.K., J.T., J.J.v.L.) and Physiology (W.J.S.), Academic Medical Center and Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Center for Heart Failure Research (Y.-S.K., S.C.A.T.D., J.T., W.J.S., J.J.v.L.), University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesia (N.H.S.), Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Johannes J. van Lieshout
- From the Departments of Internal Medicine (Y.-S.K., J.T., J.J.v.L.) and Physiology (W.J.S.), Academic Medical Center and Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Center for Heart Failure Research (Y.-S.K., S.C.A.T.D., J.T., W.J.S., J.J.v.L.), University of Amsterdam, Amsterdam, The Netherlands; Department of Anesthesia (N.H.S.), Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Byeon HS, Moon SK, Park SU, Jung WS, Park JM, Ko CN, Cho KH, Kim YS, Bae HS. Effects of GV20 Acupuncture on Cerebral Blood Flow Velocity of Middle Cerebral Artery and Anterior Cerebral Artery Territories, and CO2 Reactivity During Hypocapnia in Normal Subjects. J Altern Complement Med 2011; 17:219-24. [DOI: 10.1089/acm.2010.0232] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hyung-sik Byeon
- Department of Cardiovascular and Neurologic Diseases (Stroke Center), College of Oriental Medicine, Kyung-Hee University, Seoul, Republic of Korea
| | - Sang-kwan Moon
- Department of Cardiovascular and Neurologic Diseases (Stroke Center), College of Oriental Medicine, Kyung-Hee University, Seoul, Republic of Korea
| | - Seong-uk Park
- Stroke and Neurologic Disorder Center, East-West Neo Medical Center, Kyung-Hee University, Seoul, Republic of Korea
| | - Woo-sang Jung
- Department of Cardiovascular and Neurologic Diseases (Stroke Center), College of Oriental Medicine, Kyung-Hee University, Seoul, Republic of Korea
| | - Jung-mi Park
- Stroke and Neurologic Disorder Center, East-West Neo Medical Center, Kyung-Hee University, Seoul, Republic of Korea
| | - Chang-nam Ko
- Stroke and Neurologic Disorder Center, East-West Neo Medical Center, Kyung-Hee University, Seoul, Republic of Korea
| | - Ki-ho Cho
- Department of Cardiovascular and Neurologic Diseases (Stroke Center), College of Oriental Medicine, Kyung-Hee University, Seoul, Republic of Korea
| | - Young-suk Kim
- Department of Cardiovascular and Neurologic Diseases (Stroke Center), College of Oriental Medicine, Kyung-Hee University, Seoul, Republic of Korea
| | - Hyung-sup Bae
- Stroke and Neurologic Disorder Center, East-West Neo Medical Center, Kyung-Hee University, Seoul, Republic of Korea
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Thomsen L. Arterial mechanisms in the pathophysiology of migraine headache-implications for modern therapy. Eur J Neurol 2011; 2:403-15. [DOI: 10.1111/j.1468-1331.1995.tb00149.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sorond FA, Hollenberg NK, Panych LP, Fisher NDL. Brain blood flow and velocity: correlations between magnetic resonance imaging and transcranial Doppler sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1017-1022. [PMID: 20587424 PMCID: PMC2906813 DOI: 10.7863/jum.2010.29.7.1017] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Because transcranial Doppler sonography (TCD) is unable to measure arterial diameter, it remains unproven whether the changes in cerebral blood velocity it measures are representative of changes in cerebral blood flow (CBF). Our study was designed to compare velocity changes with flow changes measured by two magnetic resonance imaging (MRI) techniques, perfusion MRI and arterial spin labeling (ASL), using flavanol-rich cocoa to induce CBF changes in healthy volunteers. METHODS We enrolled 20 healthy volunteers aged 62 to 80 years (mean, 73 years). Each was studied at baseline and after drinking standardized servings of cocoa for 7 to 14 days. RESULTS Changes in middle cerebral artery (MCA) flow by TCD were significantly correlated with changes in perfusion assessed by gadolinium-enhanced MRI (r = 0.63; P < .03). Measurements with ASL showed a stronger correlation with borderline significance. CONCLUSIONS Changes in flow velocity in the MCA associated with drinking cocoa were highly correlated with changes in CBF measured by the two MRI techniques using the tracer gadolinium and ASL. These results validate Doppler measurements of CBF velocity as representative assessments of CBF.
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Affiliation(s)
- Farzaneh A Sorond
- Department of Neurology, Stroke Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02117, USA.
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Wienecke T, Olesen J, Ashina M. Discrepancy between strong cephalic arterial dilatation and mild headache caused by prostaglandin D2 (PGD2). Cephalalgia 2010; 31:65-76. [DOI: 10.1177/0333102410373156] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Prostaglandins (PGs) are involved in nociception and mast cell degranulation. Prostaglandin D2 (PGD2) is a vasodilatator released during mast cell degranulation. The headache-eliciting effect of PGD2 has not been studied in man. Subjects and methods: Twelve healthy volunteers were randomly allocated to receive intravenous infusion of 384 ng/kg/min PGD2 over 25 min in a placebo-controlled, double-blind cross-over study. We recorded headache intensity and associated symptoms, velocity in the middle cerebral artery (VMCA) and diameter of the superficial temporal artery (STA) and radial artery (RA) using ultrasonography. Results: In the period 0–14 h, 11 subjects reported headache on PGD2 compared to one subject on placebo ( P = 0.002). During the in-hospital phase (0–120 min), the area under the headache curve was larger on PGD2 compared to placebo ( P < 0.05). Median peak headache, 1 (0–1), occurred 10 min after start of PGD2 infusion. There was no difference in incidence of headache in the post-hospital phase between PGD2 ( n = 3) and placebo ( n = 1). There was a decrease in VMCA ( P < 0.001), increase in STA ( P < 0.001) and RA ( P < 0.006) diameter during PGD2 infusion compared to placebo. Peak decrease in VMCA was 28.3% after 10 min and peak increase in STA was 55.7% after 20 min on the PGD2 day. Conclusions: The present study shows that PGD2 is a very strong vasodilator of MCA, STA and RA, but causes only mild headache.
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Brunel C, Ferrand JF. Céphalées intenses après simple contrôle visuel de stocks d’explosifs : à propos de cinq cas. ARCH MAL PROF ENVIRO 2010. [DOI: 10.1016/j.admp.2010.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Daugaard D, Thomsen LL, Iversen HK, Olesen J. Delayed Migraine-Like Headache in Healthy Volunteers After a Combination of Acetazolamide and Glyceryl Trinitrate. Cephalalgia 2009; 29:1294-300. [DOI: 10.1111/j.1468-2982.2009.01887.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Glyceryl trinitrate (GTN) is a pro-drug dissociating nitric oxide throughout the body. It dilates cephalic arteries without increasing cerebral blood flow (CBF). GTN induces headache in healthy volunteers and migraine attacks in migraineurs. Acetazolamide (Az) increases CBF but does not dilate cerebral arteries. The hypothesis tested here was that Az, by dilating cerebral arterioles but not arteries and thereby decreasing pulsatile stretching of the wall of the large arteries and their perivascular sensory nerves, would reduce or prevent the GTN-induced headache We tested this hypothesis in 14 healthy volunteers. In a randomized, double-blind, cross-over study, they were pretreated with Az or placebo followed on both study days by a GTN infusion of 0.5 μg kg-1 min-1 for 20 min. Headache was scored on a verbal rating scale and a headache diary was kept for 12 h. Mean blood velocity of the middle cerebral artery was measured (transcranial Doppler). Our hypothesis was disproved, as Az did not decrease GTN-induced headache. Unexpectedly but interestingly, GTN combined with Az induced more delayed headache than GTN alone. Furthermore, a migraine-like headache was observed in three volunteers, who did not develop migraine after GTN alone. The fact that a suitable pharmacological intervention may trigger migraine in individuals with no prior migraine may suggest that the ability to develop migraine without aura is a quantitative genetic trait.
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Affiliation(s)
- D Daugaard
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - LL Thomsen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - HK Iversen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - J Olesen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark
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Schytz HW, Wienecke T, Olesen J, Ashina M. Carbachol induces headache, but not migraine-like attacks, in patients with migraine without aura. Cephalalgia 2009; 30:337-45. [DOI: 10.1111/j.1468-2982.2009.01929.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Carbachol induces headache in healthy subjects, but the migraine eliciting effect of carbachol has not previously been studied. We hypothesized that the cholinomimetic agonist carbachol would induce headache and migraine-like attacks in migraineurs. Carbachol (3 µg/kg) or placebo was randomly infused into 18 patients with migraine without aura in a double-blind crossover study. Headache was scored on a verbal rating scale from 0 to 10. Velocity in the middle cerebral artery (VMCA) and diameter of the superficial temporal artery (STA) were recorded. Fifteen patients experienced headache after carbachol compared with eight after placebo ( P = 0.039). There was no difference in incidence of migraine-like attacks after carbachol ( n = 8) compared with placebo ( n = 6) ( P = 0.687). Carbachol caused a decrease in VMCA ( P = 0.044), but no change in STA ( P = 0.089) compared with placebo. The study demonstrated that carbachol provocation is not a good model for experimental migraine.
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Affiliation(s)
- HW Schytz
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - T Wienecke
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - J Olesen
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - M Ashina
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
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Tfelt-Hansen PC, Tfelt-Hansen J. Nitroglycerin headache and nitroglycerin-induced primary headaches from 1846 and onwards: a historical overview and an update. Headache 2009; 49:445-56. [PMID: 19267787 DOI: 10.1111/j.1526-4610.2009.01342.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nitroglycerin (NTG) (glyceryl trinitrate) was synthesized by the Italian chemist Ascanio Sobrero in Paris in 1846. A very unstable explosive, Alfred Nobel while working on explosives, combined it with Kiselguhr and patented it as dynamite in 1867. NTG was introduced in 1879 in medicine in the treatment of angina pectoris by the English doctor William Murrell. NTG-induced headache was quickly recognized as an important adverse event both in the industrial use of NTG, where it was used to produce dynamite, as well as in the use of NTG as drug. This review traces the evolution of our understanding of NTG headache.
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Affiliation(s)
- Peer C Tfelt-Hansen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
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Bellapart J, Fraser JF. Transcranial Doppler assessment of cerebral autoregulation. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:883-893. [PMID: 19329245 DOI: 10.1016/j.ultrasmedbio.2009.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 01/04/2009] [Accepted: 01/09/2009] [Indexed: 05/27/2023]
Abstract
Cerebral autoregulation describes the process by which cerebral blood flow is maintained despite fluctuations in cerebral perfusion pressure. The assessment of cerebral autoregulation is a key to the optimisation of cerebral perfusion pressure in patients with brain injury. This review evaluates the current evidence for transcranial Doppler in the assessment of cerebral autoregulation. The study of cerebral autoregulation classically assesses changes in cerebral perfusion pressure secondary to changes in systemic blood pressure. It is defined static autoregulation if blood pressure changes are progressive, thereby allowing a steady-state autoregulatory response to be completed. For sudden changes in blood pressure, the autoregulatory response is defined as dynamic. The static and dynamic components of cerebral autoregulation have been approached using linear mathematical models (models based in direct correlations). Over the past decade, demonstration of the nonstationary (the property of changing over time or space) behaviour of cerebral autoregulation has emphasised the benefit obtained in using nonlinear statistical models (models based on changeable functions), suggesting that these methods may improve the mathematical representation of cerebral autoregulation. Despite the multiple determinants involved in cerebral autoregulation, it appears feasible to reliably assess cerebral autoregulation through the combination of linear and nonlinear methods. Nonlinear methods appear attractive in the research setting, but the challenge is how to adopt these methods to the clinical setting.
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Affiliation(s)
- Judith Bellapart
- Royal Brisbane Woman Hospital, Intensive Care Department, Herston, Queensland, Australia.
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Wienecke T, Olesen J, Oturai PS, Ashina M. Prostaglandin E2 (PGE2) Induces Headache in Healthy Subjects. Cephalalgia 2009; 29:509-19. [DOI: 10.1111/j.1468-2982.2008.01748.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The role of prostanoids in nociception is well established. The headache-eliciting effects of prostaglandin E2 (PGE2) and its possible mechanisms have previously not been systematically studied in man. We hypothesized that infusion of PGE2 might induce headache and vasodilation of cranial vessels. PGE2 (0.40 μg kg−1 min−1) or saline was infused for 25 min into 11 healthy subjects in a cross-over, double-blind study. Headache intensity was scored on a verbal rating scale from 0 to 10. In addition, we recorded mean flow in the middle cerebral artery (VMCA) by transcranial Doppler and diameter of the superficial temporal artery (STA) by high-resolution ultrasonography. All 11 subjects reported headache on the PGE2 day and no subjects reported headache on the placebo day ( P = 0.001). During the immediate phase (0–30 min) ( P = 0.005) and the postinfusion phase (30–90 min) ( P = 0.005), the area under the curve for headache score was significantly larger on the PGE2 day compared with the placebo day. PGE2 caused dilatation of the STA (23.5%; 95% CI 14.0, 37.8) and the MCA (8.3%; 95% CI 4.0, 12.6). We suggest that PGE2 induces headache by activation and sensitization of cranial perivascular sensory afferents.
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Affiliation(s)
- T Wienecke
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - J Olesen
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - PS Oturai
- Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - M Ashina
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Glostrup, Copenhagen, Denmark
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Mazzucco S, Bifari F, Trombetta M, Guidi GC, Mazzi M, Anzola GP, Rizzuto N, Bonadonna R. Evaluating endothelial function of the common carotid artery: an in vivo human model. Nutr Metab Cardiovasc Dis 2009; 19:205-210. [PMID: 18804986 DOI: 10.1016/j.numecd.2008.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 05/09/2008] [Accepted: 06/19/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Flow mediated dilation (FMD) of peripheral conduit arteries is a well-established tool to evaluate endothelial function. The aims of this study are to apply the FMD model to cerebral circulation by using acetazolamide (ACZ)-induced intracranial vasodilation as a stimulus to increase common carotid artery (CCA) diameter in response to a local increase of blood flow velocity (BFV). METHODS AND RESULTS In 15 healthy subjects, CCA end-diastolic diameter and BFV, middle cerebral artery (MCA) BFV and mean arterial blood pressure (MBP) were measured at basal conditions, after an intravenous bolus of 1g ACZ, and after placebo (saline) sublingual administration at the 15th and 20th minute. In a separate session, the same parameters were evaluated after placebo (saline) infusion instead of ACZ and after 10 microg/m(2) bs and 300 microg of glyceryl trinitrate (GTN), administered sublingually, at the 15th and 20th minute, respectively. After ACZ bolus, there was a 35% maximal MCA mean BFV increment (14th minute), together with a 22% increase of mean CCA end-diastolic BFV and a CCA diameter increment of 3.9% at the 3rd minute (p=0.024). There were no MBP significant variations up to the 15th minute (p=0.35). After GTN administration, there was a significant increment in CCA diameter (p<0.00001). CONCLUSIONS ACZ causes a detectable CCA dilation in healthy individuals concomitantly with an increase in BFV. Upon demonstration that this phenomenon is endothelium dependent, this experimental model might become a valuable tool to assess endothelial function in the carotid artery.
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Affiliation(s)
- S Mazzucco
- Department of Neurological and Visual Sciences, Section of Clinical Neurology, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134 Verona, Italy.
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Schytz HW, Wienecke T, Oturai PS, Olesen J, Ashina M. The cholinomimetic agent carbachol induces headache in healthy subjects. Cephalalgia 2009; 29:258-68. [PMID: 19143771 DOI: 10.1111/j.1468-2982.2008.01715.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The parasympathetic nervous system is likely to be involved in migraine pathogenesis. We hypothesized that the cholinomimetic agonist carbachol would induce headache and vasodilation of cephalic and radial arteries. Carbachol (3 microg/kg) or placebo was randomly infused into 12 healthy subjects in a double-blind crossover study. Headache was scored on a verbal rating scale from 0-10. Velocity in the middle cerebral artery (V(MCA)) and diameter of the superficial temporal artery (STA) and radial artery (RA) were recorded. Nine participants developed headache after carbachol compared with three after placebo. The area under the curve for headache was increased after carbachol compared with placebo both during infusion (0-30 min) (P = 0.042) and in the postinfusion period (30-90 min) (P = 0.027). Carbachol infusion caused a drop in V(MCA) (P = 0.003) and an increase in STA diameter (P = 0.006), but no increase in the RA diameter (P = 0.200). In conclusion, the study demonstrated that carbachol caused headache and dilation of cephalic arteries in healthy subjects.
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Affiliation(s)
- H W Schytz
- Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
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Petersen KA, Birk S, Kitamura K, Olesen J. Effect of Adrenomedullin on the Cerebral Circulation: Relevance to Primary Headache Disorders. Cephalalgia 2009; 29:23-30. [DOI: 10.1111/j.1468-2982.2008.01695.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adrenomedullin (ADM) is closely related to calcitonin gene-related peptide, which has a known causative role in migraine. Animal studies have strongly suggested that ADM has a vasodilatory effect within the cerebral circulation. For these reasons, ADM is also likely to be involved in migraine. However, the hypothetical migraine-inducing property and effect on human cerebral circulation of ADM have not previously been investigated. Human ADM (0.08 µg kg−1 min−1) or placebo (saline 0.9%) was administered as a 20-min intravenous infusion to 12 patients suffering from migraine without aura in a crossover double-blind study. The occurrence of headache and associated symptoms were registered regularly 24 h post infusion. Cerebral blood flow (CBF) was measured by 133Xenon single-photon emission computed tomography, mean blood flow velocity in the middle cerebral artery (VMCA) by transcranial Doppler and the diameter of peripheral arteries by transdermal ultrasound (C-scan). ADM did not induce significantly more headache or migraine compared with placebo ( P = 0.58). CBF was unaffected by ADM infusion (global CBF, P = 0.32 and rCBFMCA, P = 0.38) and the same applied for the VMCA ( P = 0.18). The superficial temporal artery dilated compared with placebo ( P < 0.001), and facial flushing was seen after ADM administration ( P = 0.001). In conclusion, intravenous ADM is not a mediator of migraine headache and does not dilate intracranial arteries.
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Affiliation(s)
- KA Petersen
- Danish Headache Centre, University of Copenhagen, Copenhagen
- Department of Neurology, Glostrup University Hospital, Glostrup, Denmark
| | - S Birk
- Danish Headache Centre, University of Copenhagen, Copenhagen
- Department of Neurology, Glostrup University Hospital, Glostrup, Denmark
| | - K Kitamura
- First Department of Internal Medicine, Miyazaki Medical College, University of Miyazaki, Miyazaki, Japan
| | - J Olesen
- Danish Headache Centre, University of Copenhagen, Copenhagen
- Department of Neurology, Glostrup University Hospital, Glostrup, Denmark
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Schytz HW, Birk S, Wienecke T, Kruuse C, Olesen J, Ashina M. PACAP38 induces migraine-like attacks in patients with migraine without aura. Brain 2008; 132:16-25. [DOI: 10.1093/brain/awn307] [Citation(s) in RCA: 288] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes. Clin Sci (Lond) 2008; 115:255-62. [PMID: 18348713 DOI: 10.1042/cs20070458] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Type 2 diabetes is associated with an increased risk of endothelial dysfunction and microvascular complications with impaired autoregulation of tissue perfusion. Both microvascular disease and cardiovascular autonomic neuropathy may affect cerebral autoregulation. In the present study, we tested the hypothesis that, in the absence of cardiovascular autonomic neuropathy, cerebral autoregulation is impaired in subjects with DM+ (Type 2 diabetes with microvascular complications) but intact in subjects with DM- (Type 2 diabetes without microvascular complications). Dynamic cerebral autoregulation and the steady-state cerebrovascular response to postural change were studied in subjects with DM+ and DM-, in the absence of cardiovascular autonomic neuropathy, and in CTRL (healthy control) subjects. The relationship between spontaneous changes in MCA V(mean) (middle cerebral artery mean blood velocity) and MAP (mean arterial pressure) was evaluated using frequency domain analysis. In the low-frequency region (0.07-0.15 Hz), the phase lead of the MAP-to-MCA V(mean) transfer function was 52+/-10 degrees in CTRL subjects, reduced in subjects with DM- (40+/-6 degrees ; P<0.01 compared with CTRL subjects) and impaired in subjects with DM+ (30+/-5 degrees ; P<0.01 compared with subjects with DM-), indicating less dampening of blood pressure oscillations by affected dynamic cerebral autoregulation. The steady-state response of MCA V(mean) to postural change was comparable for all groups (-12+/-6% in CTRL subjects, -15+/-6% in subjects with DM- and -15+/-7% in subjects with DM+). HbA(1c) (glycated haemoglobin) and the duration of diabetes, but not blood pressure, were determinants of transfer function phase. In conclusion, dysfunction of dynamic cerebral autoregulation in subjects with Type 2 diabetes appears to be an early manifestation of microvascular disease prior to the clinical expression of diabetic nephropathy, retinopathy or cardiovascular autonomic neuropathy.
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Pfister D, Strebel S, Steiner L. Effects of glyceryl trinitrate on cerebrovascular autoregulation. Br J Anaesth 2008; 101:574; author reply 574-5. [DOI: 10.1093/bja/aen254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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