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Quantitative phase-contrast MRI study of cerebrospinal fluid flow: a method for identifying patients with normal-pressure hydrocephalus. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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102
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Tung H, Liao YC, Wu CC, Chang MH, Chen CCC, Chen PL, Chen HC. Usefulness of phase-contrast magnetic resonance imaging for diagnosis and treatment evaluation in patients with SIH. Cephalalgia 2014; 34:584-93. [PMID: 24414094 DOI: 10.1177/0333102413519513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/29/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most diagnostic tools for spontaneous intracranial hypotension (SIH) are either invasive or occasionally inconsistent with the clinical condition. In this study, we examined the cerebrospinal fluid (CSF) dynamics in SIH using phase-contrast magnetic resonance (PC-MR) imaging. MATERIALS AND METHOD Seventeen SIH patients and 32 healthy individuals, matched by sex and age, were recruited. Each person underwent brain and PC-MR imaging using 3-Tesla MRI. We evaluated the differences in image parameters among patients during the initial and recovery stages against the status of the control group. RESULTS SIH patients had lower CSF flow-volume, flux, peak velocity, and higher systolic-to-diastolic time ratio, as well as systolic-to-diastolic volume ratio compared to the control group and the conditions when they recovered. The flow time and volume of the diastolic phase markedly increased after treatment. The discriminating power of PC-MR for SIH was good. Diffuse pachymeningeal enhancement and venous engorgement were present when their PC-MR values were lower than the cut-off values for SIH diagnosis. The headache scores correlated with the peak velocity and pituitary volume. CONCLUSION Noninvasive PC-MR could provide valid parameters for diagnosis and treatment follow-up in SIH patients. It may be more sensitive than conventional brain MRI.
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Affiliation(s)
- Hsin Tung
- Section of Neurology, Taichung Veterans General Hospital, Taiwan, ROC
| | - Yi-Chu Liao
- Section of Neurology, Taichung Veterans General Hospital, Taiwan, ROC Department of Neurology, National Yang-Ming University, School of Medicine, Taiwan, ROC
| | - Chih-Ceng Wu
- Department of Anesthesiology, Taichung Veterans General Hospital, Taiwan, ROC
| | - Ming-Hong Chang
- Section of Neurology, Taichung Veterans General Hospital, Taiwan, ROC Department of Neurology, National Yang-Ming University, School of Medicine, Taiwan, ROC
| | - Clayton Chi-Chang Chen
- Department of Radiology, Taichung Veterans General Hospital, Taiwan, ROC Department of Radiological Technology and Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Taiwan, ROC Department of Physical Therapy, Hungkuang University of Technology, Taiwan, ROC Department of Physical Therapy and Assistive Technology, National Yang Ming University, Taiwan, ROC
| | - Po-Lin Chen
- Section of Neurology, Taichung Veterans General Hospital, Taiwan, ROC Department of Neurology, National Yang-Ming University, School of Medicine, Taiwan, ROC
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taiwan, ROC Department of Radiology, National Yang-Ming University School of Medicine, Taiwan, ROC
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103
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Arterial elasticity, strength, fatigue, and endurance in older women. BIOMED RESEARCH INTERNATIONAL 2014; 2014:501754. [PMID: 24511534 PMCID: PMC3910517 DOI: 10.1155/2014/501754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022]
Abstract
Arterial health may influence muscle function in older adults. Study purpose was to determine whether arterial elasticity is related to strength, central and peripheral fatigue, fatigue at rest, and treadmill endurance. Subjects were 91 healthy women aged >60. Treadmill endurance and maximal oxygen uptake (VO2 max) were measured. Peripheral and central fatigue for the knee extensors were evaluated using two isometric fatigue tests (one voluntary and one adding electrical stimulation). Arterial elasticity was determined using radial artery pulse wave analysis. Linear multiple regression was used in statistical analysis. Large artery elasticity was associated with central fatigue (P < 0.01) and treadmill endurance (P < 0.02) after adjusting for VO2 max and knee extension strength. Subjective fatigue at rest was related to large artery elasticity after adjusting for ethnic origin (<0.02). Strength was significantly related to small artery elasticity after adjusting for ethnic origin, leg lean tissue, age, and blood pressure. Arterial elasticity is independently related to strength and fatigue in older women, especially in the central nervous system where arterial elasticity is independently related to perceptions of fatigue at rest and central fatigue. These results suggest that arterial health may be involved with the ability of the central nervous system to activate muscle in older women.
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104
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Zlatar ZZ, Wierenga CE, Bangen KJ, Liu TT, Jak AJ. Increased hippocampal blood flow in sedentary older adults at genetic risk for Alzheimer's disease. J Alzheimers Dis 2014; 41:809-17. [PMID: 24685629 PMCID: PMC4259215 DOI: 10.3233/jad-132252] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Resting cerebral blood flow (CBF) decreases with age; however regulatory increases in hippocampal CBF have been associated with genetic risk (Apolipoprotein E [APOE] ε4 carriers) for Alzheimer's disease (AD). Although physical activity exerts beneficial effects on CBF in healthy elderly, the effects of sedentary behaviors on CBF remain unknown. We measured resting hippocampal CBF (via arterial spin labeling magnetic resonance imaging) and sedentary time/physical activity (via accelerometry) on 33 cognitively healthy adults (ages 52-81), 9 of which were APOE ε4 carriers. Results indicate that the relationship between sedentary time and CBF in the left hippocampus differs by APOE status, whereby APOE ε4 carriers show higher CBF as a function of longer sedentary time (B = 10.8, SE = 3.17, β = 0.74, t = 3.41, p < 0.01) compared to noncarriers (B = 1.4, SE = 2.7, β = 0.096, t = 0.51, p = 0.61), possibly suggesting a CBF regulatory response to compensate for metabolic alterations in dementia risk. These preliminary data suggest that the relationship between CBF and sedentary time is different in APOE ε4 carriers and noncarriers and that sedentary time may act as a behavioral risk factor for CBF dysregulation in those at genetic risk for developing AD. More research is needed to further understand the role of sedentary behaviors and physical activity on CBF, especially in individuals at genetic risk of developing AD.
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Affiliation(s)
- Zvinka Z. Zlatar
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0664, USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA 92093-0664, USA
| | - Christina E. Wierenga
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0664, USA
- VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Katherine J. Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0664, USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA 92093-0664, USA
| | - Thomas T. Liu
- Center for Functional Magnetic Resonance Imaging, University of California San Diego, 9500 Gilman Drive, MC 0677, La Jolla, CA 92093-0677, USA
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, MC 0677, La Jolla, CA 92093-0677, USA
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0677, La Jolla, CA 92093-0677, USA
| | - Amy J. Jak
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0664, USA
- VA San Diego Healthcare System, La Jolla, CA 92161, USA
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105
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Cerebrovascular perfusion among older adults is moderated by strength training and gender. Neurosci Lett 2013; 560:26-30. [PMID: 24355360 DOI: 10.1016/j.neulet.2013.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/21/2013] [Accepted: 12/06/2013] [Indexed: 11/24/2022]
Abstract
Cerebral perfusion is important in older adults as it is linked to cognitive declines. Physical activity can improve blood flow in the body but little is known about the relationship between physical activity and cerebral perfusion in older adults. In particular, no study has investigated the relation between strength training and cerebral perfusion. We examined whether different types of physical activity (assessed with the Rapid Assessment of Physical Activity questionnaire) were associated with MRI cerebrovascular perfusion in 59 older adults. There was a significant interaction between gender and strength training, such that women who engaged in strength training (weight lifting or calisthenics) at least once per week exhibited significantly greater cerebrovascular perfusion than women who did not. This interaction remained significant after controlling for other physical activity, demographics, and health variables. These findings suggest that regular strength training can be beneficial for cerebrovascular health in women.
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106
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Bouzerar R, Chaarani B, Gondry-Jouet C, Zmudka J, Balédent O. Measurement of choroid plexus perfusion using dynamic susceptibility MR imaging: capillary permeability and age-related changes. Neuroradiology 2013; 55:1447-54. [DOI: 10.1007/s00234-013-1290-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/07/2013] [Indexed: 11/24/2022]
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Marques F, Sousa JC, Sousa N, Palha JA. Blood-brain-barriers in aging and in Alzheimer's disease. Mol Neurodegener 2013; 8:38. [PMID: 24148264 PMCID: PMC4015275 DOI: 10.1186/1750-1326-8-38] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/23/2013] [Indexed: 12/26/2022] Open
Abstract
The aging process correlates with a progressive failure in the normal cellular and organ functioning; these alterations are aggravated in Alzheimer's disease (AD). In both aging and AD there is a general decrease in the capacity of the body to eliminate toxic compounds and, simultaneously, to supply the brain with relevant growth and nutritional factors. The barriers of the brain are targets of this age related dysfunction; both the endothelial cells of the blood-brain barrier and the choroid plexus epithelial cells of the blood-cerebrospinal fluid barrier decrease their secretory capacity towards the brain and their ability to remove toxic compounds from the brain. Additionally, during normal aging and in AD, the permeability of the brain barriers increase. As such, a greater contact of the brain parenchyma with the blood content alters the highly controlled neural environment, which impacts on neural function. Of interest, the brain barriers are more than mere obstacles to the passage of molecules and cells, and therefore active players in brain homeostasis, which is still to be further recognized and investigated in the context of health and disease. Herein, we provide a review on how the brain barriers change during aging and in AD and how these processes impact on brain function.
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Affiliation(s)
- Fernanda Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, Braga 4710-057, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimaraes, Portugal
| | - João Carlos Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, Braga 4710-057, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimaraes, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, Braga 4710-057, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimaraes, Portugal
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, Braga 4710-057, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimaraes, Portugal
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108
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Macgowan CK, Chan KY, Laughlin S, Marrie RA, Banwell B. Cerebral arterial and venous blood flow in adolescent multiple sclerosis patients and age-matched controls using phase contrast MRI. J Magn Reson Imaging 2013; 40:341-7. [DOI: 10.1002/jmri.24388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/26/2013] [Indexed: 02/04/2023] Open
Affiliation(s)
- Christopher K. Macgowan
- Department of Medical Biophysics; University of Toronto/Hospital for Sick Children; Toronto ON Canada
- Department of Medical Imaging; University of Toronto/Hospital for Sick Children; Toronto ON Canada
| | - Katherine Y. Chan
- Department of Biomedical Engineering; University of Toronto/Hospital for Sick Children; Toronto ON Canada
| | - Suzanne Laughlin
- Department of Medical Imaging; University of Toronto/Hospital for Sick Children; Toronto ON Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine (Neurology) and Community Health Sciences; University of Manitoba; Winnipeg MB Canada
| | - Brenda Banwell
- Department of Pediatrics (Neurology); University of Toronto/Hospital for Sick Children; Toronto ON Canada
- Department of Neurology; Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
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109
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Bolduc V, Thorin-Trescases N, Thorin E. Endothelium-dependent control of cerebrovascular functions through age: exercise for healthy cerebrovascular aging. Am J Physiol Heart Circ Physiol 2013; 305:H620-33. [PMID: 23792680 DOI: 10.1152/ajpheart.00624.2012] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cognitive performances are tightly associated with the maximal aerobic exercise capacity, both of which decline with age. The benefits on mental health of regular exercise, which slows the age-dependent decline in maximal aerobic exercise capacity, have been established for centuries. In addition, the maintenance of an optimal cerebrovascular endothelial function through regular exercise, part of a healthy lifestyle, emerges as one of the key and primary elements of successful brain aging. Physical exercise requires the activation of specific brain areas that trigger a local increase in cerebral blood flow to match neuronal metabolic needs. In this review, we propose three ways by which exercise could maintain the cerebrovascular endothelial function, a premise to a healthy cerebrovascular function and an optimal regulation of cerebral blood flow. First, exercise increases blood flow locally and increases shear stress temporarily, a known stimulus for endothelial cell maintenance of Akt-dependent expression of endothelial nitric oxide synthase, nitric oxide generation, and the expression of antioxidant defenses. Second, the rise in circulating catecholamines during exercise not only facilitates adequate blood and nutrient delivery by stimulating heart function and mobilizing energy supplies but also enhances endothelial repair mechanisms and angiogenesis. Third, in the long term, regular exercise sustains a low resting heart rate that reduces the mechanical stress imposed to the endothelium of cerebral arteries by the cardiac cycle. Any chronic variation from a healthy environment will perturb metabolism and thus hasten endothelial damage, favoring hypoperfusion and neuronal stress.
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Affiliation(s)
- Virginie Bolduc
- Departments of Surgery and Pharmacology, Université de Montréal, and Centre de recherche, Montreal Heart Institute, Montreal, Quebec, Canada
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110
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Hasan KM, Ali H, Shad MU. Atlas-based and DTI-guided quantification of human brain cerebral blood flow: feasibility, quality assurance, spatial heterogeneity and age effects. Magn Reson Imaging 2013; 31:1445-52. [PMID: 23731534 DOI: 10.1016/j.mri.2013.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/27/2013] [Indexed: 12/28/2022]
Abstract
Accurate and noninvasive quantification of regional cerebral blood perfusion (CBF) of the human brain tissue would advance the study of the complex interplay between human brain structure and function, in both health and disease. Despite the plethora of works on CBF in gray matter, a detailed quantitative white matter perfusion atlas has not been presented on healthy adults using the International Consortium for Brain Mapping atlases. In this study, we present a host of assurance measures such as temporal stability, spatial heterogeneity and age effects of regional and global CBF in selected deep, cortical gray matter and white matter tracts identified and quantified using diffusion tensor imaging (DTI). We utilized whole brain high-resolution DTI combined with arterial spin labeling to quantify regional CBF on 15 healthy adults aged 23.2-57.1years. We present total brain and regional CBF, corresponding volume, mean diffusivity and fractional anisotropy spatial heterogeneity, and dependence on age as additional quality assurance measures to compare with published trends using both MRI and nuclear medicine methods. Total CBF showed a steady decrease with age in gray matter (r=-0.58; P=.03), whereas total CBF of white matter did not significantly change with age (r=0.11; P=.7). This quantitative report offers a preliminary baseline of CBF, volume and DTI measurements for the design of future multicenter and clinical studies utilizing noninvasive perfusion and DT-MRI.
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Affiliation(s)
- Khader M Hasan
- Medical School, Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center, Houston, TX 77030, USA.
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111
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Forner Giner J, Sanz-Requena R, Flórez N, Alberich-Bayarri A, García-Martí G, Ponz A, Martí-Bonmatí L. Quantitative phase-contrast MRI study of cerebrospinal fluid flow: a method for identifying patients with normal-pressure hydrocephalus. Neurologia 2013; 29:68-75. [PMID: 23643684 DOI: 10.1016/j.nrl.2013.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 02/19/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the use of phase-contrast MR imaging to diagnose normal pressure hydrocephalus (NPH) and differentiate it from other neurological disorders with similar clinical symptoms. METHODS The study included 108 subjects, of whom 61 were healthy controls and 47, patients; in the patient group, 19 had cerebrovascular disease (CVD) and 28 had NPH. All patients underwent a phase-contrast MRI study and several CSF flow and velocity parameters were measured at the aqueduct of Sylvius. Discriminant analyses were performed to evaluate the classification capacity of both individual parameters and the combination of different parameters. RESULTS Maximum diastolic velocity, mean flow, and stroke volume showed statistically significant differences that could be used to distinguish between NPH and CVD patients (P<.001). Stroke volume and mean flow showed no false positive results and successful classification rates of 86% and 79%, respectively. No other parameters or combination produced better results. CONCLUSIONS Phase-contrast MR imaging is a useful tool for the early diagnosis of patients with NPH. CSF flow quantitative parameters, along with morphological features in a conventional MR study, enable us to differentiate between NPH and CVD patients.
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Affiliation(s)
- J Forner Giner
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España.
| | - R Sanz-Requena
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España
| | - N Flórez
- Universidad de Santo Tomás, Bucaramanga, Colombia
| | | | - G García-Martí
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España; CIBER-SAM, ISCIII, Valencia, España
| | - A Ponz
- Servicio de Neurología, Hospital Clínic Universitari de Valencia, Valencia, España
| | - L Martí-Bonmatí
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España; Unidad de Radiología, Facultad de Medicina, Universidad de Valencia, Valencia, España
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112
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Spumiform capillary basement membrane swelling: a new type of microvascular degeneration in senescent hamster. Neurobiol Aging 2013; 34:1277-86. [DOI: 10.1016/j.neurobiolaging.2012.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 06/28/2012] [Accepted: 09/07/2012] [Indexed: 01/10/2023]
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113
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Gerrits P, Kortekaas R, de Weerd H, Luiten P, van der Want J, Veening J. Spumiform basement membrane aberrations in the microvasculature of the midbrain periaqueductal gray region in hamster: Rostro-caudal pathogenesis? Neuroscience 2013; 228:128-38. [DOI: 10.1016/j.neuroscience.2012.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/04/2012] [Accepted: 10/06/2012] [Indexed: 11/28/2022]
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114
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Schmidt W, Endres M, Dimeo F, Jungehulsing GJ. Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease. Cerebrovasc Dis 2013; 35:303-12. [DOI: 10.1159/000347061] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/02/2013] [Indexed: 11/19/2022] Open
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115
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Abstract
Better physical fitness in later life is associated positively with cognitive functioning. Novel data suggest that this association is mediated, in part, by increases in brain perfusion and the ability of cerebral blood vessels to respond to demand. This review presents evidence on the beneficial effects of exercise on cerebrovascular and cognitive health with aging and explores potential underlying vascular-related mechanisms.
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116
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Bardan G, Plouraboue F, Zagzoule M, Baledent O. Simple Patient-Based Transmantle Pressure and Shear Estimate From Cine Phase-Contrast MRI in Cerebral Aqueduct. IEEE Trans Biomed Eng 2012; 59:2874-83. [DOI: 10.1109/tbme.2012.2210716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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117
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Hamilton R, Baldwin K, Fuller J, Vespa P, Hu X, Bergsneider M. Intracranial pressure pulse waveform correlates with aqueductal cerebrospinal fluid stroke volume. J Appl Physiol (1985) 2012; 113:1560-6. [PMID: 22995390 DOI: 10.1152/japplphysiol.00357.2012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study identifies a novel relationship between cerebrospinal fluid (CSF) stroke volume through the cerebral aqueduct and the characteristic peaks of the intracranial pulse (ICP) waveform. ICP waveform analysis has become much more advanced in recent years; however, clinical practice remains restricted to mean ICP, mainly due to the lack of physiological understanding of the ICP waveform. Therefore, the present study set out to shed some light on the physiological meaning of ICP morphological metrics derived by the morphological clustering and analysis of continuous intracranial pulse (MOCAIP) algorithm by investigating their relationships with a well defined physiological variable, i.e., the stroke volume of CSF through the cerebral aqueduct. Seven patients received both overnight ICP monitoring along with a phase-contrast MRI (PC-MRI) of the cerebral aqueduct to quantify aqueductal stroke volume (ASV). Waveform morphological analysis of the ICP signal was performed by the MOCAIP algorithm. Following extraction of morphological metrics from the ICP signal, nine temporal ICP metrics and two amplitude-based metrics were compared with the ASV via Spearman's rank correlation. Of the nine temporal metrics correlated with the ASV, only the width of the P2 region (ICP-Wi2) reached significance. Furthermore, both ICP pulse pressure amplitude and mean ICP did not reach significance. In this study, we showed the width of the second peak (ICP-Wi2) of an ICP pulse wave is positively related to the volume of CSF movement through the cerebral aqueduct. This finding is an initial step in bridging the gap between ICP waveform morphology research and clinical practice.
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Affiliation(s)
- Robert Hamilton
- Neural Systems and Dynamics Laboratory, Department of Neurosurgery, the David Geffen School of Medicine, University of California-Los Angeles, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
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118
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Elsankari S, Czosnyka M, Lehmann P, Meyer ME, Deramond H, Balédent O. Cerebral Blood and CSF Flow Patterns in Patients Diagnosed for Cerebral Venous Thrombosis - An Observational Study. J Clin Imaging Sci 2012; 2:41. [PMID: 22919555 PMCID: PMC3424687 DOI: 10.4103/2156-7514.99158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/14/2012] [Indexed: 12/05/2022] Open
Abstract
Background and Purpose: Recent studies of the organization of the cerebral venous system in healthy subjects using phase contrast magnetic resonance imaging (PC-MRI) show its structural complexity and inter-individual variations. Our objective was to study the venous blood and CSF flows in cerebral venous thrombosis (CVT). Materials and Methods: PC-MRI sequences were added to brain MRI conventional protocol in 19 patients suspected of CVT, among whom 6 patients had CVT diagnosis confirmed by MR venography. Results were compared with 18 healthy age-matched volunteers (HV). Results: In patients without CVT (NoCVT) confirmed by venography, we found heterogeneous individual venous flows, and variable side dominance in paired veins and sinuses, comparable to those in healthy volunteers. In CVT patients, PC-MRI detected no venous flow in the veins and/or sinuses with thrombosis. Arterial flows were preserved. CSF aqueductal and cervical stroke volumes were increased in a patient with secondary cerebral infarction, and decreased in 4 patients with extended thrombosis in the superior sagittal and transverse sinuses. These results suggest the main role of the venous system in the regulation of the dynamic intracranial equilibrium. Conclusions: CVT produces highly individualized pattern of disturbance in venous blood drainage. Complementary to MRI venography, PC-MRI provides non-invasive data about venous blockage consequences on CSF flow disturbances.
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Affiliation(s)
- Souraya Elsankari
- Department of Imaging and Biophysics, Amiens University Hospital, 80054 Amiens Cedex, France
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119
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Mandalà M, Pedatella AL, Morales Palomares S, Cipolla MJ, Osol G. Maturation is associated with changes in rat cerebral artery structure, biomechanical properties and tone. Acta Physiol (Oxf) 2012; 205:363-71. [PMID: 22212496 DOI: 10.1111/j.1748-1716.2011.02406.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/04/2011] [Accepted: 12/20/2011] [Indexed: 01/17/2023]
Abstract
AIM This study evaluated the hypothesis that physiological maturation affects cerebral artery smooth muscle-endothelial interactions involved in pressure-induced tone and alters the dimensional and biomechanical properties of small posterior cerebral arteries (PCA). METHODS Secondary branches of PCA from young (4-5 weeks old, n=11), adult (14-16 weeks old, n=11) and mature (44-47 weeks old, n=11) male Sprague-Dawley rats were isolated, cannulated, pressurized and subjected to a range of intraluminal pressures (10-110 mmHg) to determine tone with and without pharmacologic nitric oxide synthase (NOS) inhibition. Measurements of passive lumen diameter and wall thickness as a function of pressure were used to determine changes in structure, distensibility and wall stress; histological analysis was performed on vessel cross-sections to assess collagen and elastin contents. RESULTS Although pressure-dependent tone decreased significantly during ageing, differences between groups were abolished by NOS inhibition. Vessel diameters increased in adult vs. young rats (at 90 mmHg, 233 ± 6.0 μm vs. 192 ± 4.5 μm; P<0.05), possibly secondary to somatic growth. Further ageing was associated with reductions in lumen diameter (207 ± 6.5 μm; P<0.05), increased wall and media thickness (and wall/lumen ratio) and cross-sectional area. Distensibility and wall collagen were unchanged, although elastin content was significantly reduced. CONCLUSIONS Maturation is associated with differences in PCA dimensional properties that indicate a pattern of initial outward eutrophic, followed by inward hypertrophic remodelling. Functionally, the contribution of basal NO increases with age in a way that reduces pressure-dependent tone and diminishes vasodilator reserve.
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Affiliation(s)
| | - A. L. Pedatella
- Department of Cell Biology; University of Calabria; Arcavacata di Rende; Italy
| | | | - M. J. Cipolla
- Department of Neurology; University of Vermont; Burlington; VT; USA
| | - G. Osol
- Department of Obstretrics and Gynecology; University of Vermont; Burlington; VT; USA
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Bottan S, Poulikakos D, Kurtcuoglu V. Phantom Model of Physiologic Intracranial Pressure and Cerebrospinal Fluid Dynamics. IEEE Trans Biomed Eng 2012; 59:1532-8. [DOI: 10.1109/tbme.2012.2187448] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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121
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Utriainen D, Feng W, Elias S, Latif Z, Hubbard D, Haacke EM. Using Magnetic Resonance Imaging as a Means to Study Chronic Cerebral Spinal Venous Insufficiency in Multiple Sclerosis Patients. Tech Vasc Interv Radiol 2012; 15:101-12. [DOI: 10.1053/j.tvir.2012.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Marsden KR, Haykowsky MJ, Smirl JD, Jones H, Nelson MD, Altamirano-Diaz LA, Gelinas JC, Tzeng YC, Smith KJ, Willie CK, Bailey DM, Ainslie PN. Aging blunts hyperventilation-induced hypocapnia and reduction in cerebral blood flow velocity during maximal exercise. AGE (DORDRECHT, NETHERLANDS) 2012; 34:725-35. [PMID: 21559869 PMCID: PMC3337932 DOI: 10.1007/s11357-011-9258-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 04/26/2011] [Indexed: 05/22/2023]
Abstract
Cerebral blood flow (CBF) increases from rest to ∼60% of peak oxygen uptake (VO(2peak)) and thereafter decreases towards baseline due to hyperventilation-induced hypocapnia and subsequent cerebral vasoconstriction. It is unknown what happens to CBF in older adults (OA), who experience a decline in CBF at rest coupled with a blunted ventilatory response during VO(2peak). In 14 OA (71 ± 10 year) and 21 young controls (YA; 23 ± 4 years), we hypothesized that OA would experience less hyperventilation-induced cerebral vasoconstriction and therefore an attenuated reduction in CBF at VO(2peak). Incremental exercise was performed on a cycle ergometer, whilst bilateral middle cerebral artery blood flow velocity (MCA V (mean); transcranial Doppler ultrasound), heart rate (HR; ECG) and end-tidal PCO(2) (P(ET)CO(2)) were monitored continuously. Blood pressure (BP) was monitored intermittently. From rest to 50% of VO(2peak), despite greater elevations in BP in OA, the change in MCA V(mean) was greater in YA compared to OA (28% vs. 15%, respectively; P < 0.0005). In the YA, at intensities >70% of VO(2peak), the hyperventilation-induced declines in both P(ET)CO(2) (14 mmHg (YA) vs. 4 mmHg (OA); P < 0.05) and MCA V(mean) (-21% (YA) vs. -7% (OA); P < 0.0005) were greater in YA compared to OA. Our findings show (1), from rest-to-mild intensity exercise (50% VO(2peak)), elevations in CBF are reduced in OA and (2) age-related declines in hyperventilation during maximal exercise result in less hypocapnic-induced cerebral vasoconstriction.
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Affiliation(s)
- K. R. Marsden
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - M. J. Haykowsky
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada T6G 2G4
| | - J. D. Smirl
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - H. Jones
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF UK
| | - M. D. Nelson
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada T6G 2G4
| | | | - J. C. Gelinas
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - Y. C. Tzeng
- Cardiovascular Systems Laboratory, Department of Surgery & Anesthesia, University of Otago, Wellington, New Zealand
| | - K. J. Smith
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - C. K. Willie
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - D. M. Bailey
- Neurovascular Research Laboratory, Faculty of Health, Science and Sport, University of Glamorgan, Wales, UK
| | - P. N. Ainslie
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
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Sato K, Morimoto N, Matsuura T, Ohta Y, Tsunoda M, Ikeda Y, Abe K. CSF flow dynamics in motor neuron disease. Neurol Res 2012; 34:512-7. [PMID: 22664138 DOI: 10.1179/1743132812y.0000000043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess cerebrospinal fluid (CSF) flow dynamics involvement in the pathogenesis of amyotrophic lateral sclerosis (ALS), we conducted CSF flow studies on 40 individuals with motor neuron diseases (MNDs) including ALS, and 28 age-matched normal and disease [cervical spondylosis (CS)] controls. METHODS The CSF pulsatile velocity anterior to the cervical cord at level C5 during one heart beat was determined non-invasively by phase-contrast electrocardiography-triggered magnetic resonance imaging. RESULTS In MND, caudal CSF velocity peaked at 25% of the cardiac cycle after the R wave (UT(c)/RR), showing an increased delay in comparison to normal controls, while amplitude H(c) was significantly larger than that in CS. DISCUSSION We conclude that CSF flow dynamics of MND differ from those of controls and may thus facilitate differentiation of MND from CS.
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Affiliation(s)
- Kota Sato
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
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Schmid Daners M, Knobloch V, Soellinger M, Boesiger P, Seifert B, Guzzella L, Kurtcuoglu V. Age-specific characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid dynamics. PLoS One 2012; 7:e37502. [PMID: 22666360 PMCID: PMC3364266 DOI: 10.1371/journal.pone.0037502] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/20/2012] [Indexed: 11/25/2022] Open
Abstract
The objective of this work is to quantify age-related differences in the characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid (CSF) dynamics. To this end, 3T phase-contrast magnetic resonance imaging blood and CSF flow data of eleven young ( years) and eleven elderly subjects ( years) with a comparable sex-ratio were acquired. Flow waveforms and their frequency composition, transfer functions from blood to CSF flows and cross-correlations were analyzed. The magnitudes of the frequency components of CSF flow in the aqueduct differ significantly between the two age groups, as do the frequency components of the cervical spinal CSF and the arterial flows. The males' aqueductal CSF stroke volumes and average flow rates are significantly higher than those of the females. Transfer functions and cross-correlations between arterial blood and CSF flow reveal significant age-dependence of phase-shift between these, as do the waveforms of arterial blood, as well as cervical-spinal and aqueductal CSF flows. These findings accentuate the need for age- and sex-matched control groups for the evaluation of cerebral pathologies such as hydrocephalus.
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Affiliation(s)
- Marianne Schmid Daners
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Verena Knobloch
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Michaela Soellinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Neuroimaging Research Unit, Department of Neurology, Medical University Graz, Graz, Austria
| | - Peter Boesiger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Lino Guzzella
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
- * E-mail:
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Filippini N, Nickerson L, Beckmann C, Ebmeier K, Frisoni G, Matthews P, Smith S, Mackay C. Age-related adaptations of brain function during a memory task are also present at rest. Neuroimage 2012; 59:3821-8. [PMID: 22155375 PMCID: PMC10652742 DOI: 10.1016/j.neuroimage.2011.11.063] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/04/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022] Open
Abstract
Several studies have demonstrated age-related regional differences in the magnitude of the BOLD signal using task-based fMRI. It has been suggested that functional changes reflect either compensatory or de-differentiation mechanisms, both of which assume response to a specific stimulus. Here, we have tested whether ageing affects both task-based and resting brain function, and the extent to which functional changes are mediated by reductions in grey matter (GM) volume. Two groups, of 22 healthy younger and 22 older volunteers, underwent an imaging protocol involving structural and functional MRI, both during a memory task and at rest. The two groups had similar socio-demographical characteristics and cognitive performance. Image analysis revealed both structural and functional differences. Increased BOLD signal in older relative to younger volunteers was mainly observed in the frontal lobes, both during the task and at rest. Functional changes in the frontal lobes were largely located in brain regions spared from GM loss, and adding GM covariates to the fMRI analysis did not significantly alter the group differences. Our results are consistent with the suggestion that, during normal ageing, the brain responds to neuronal loss by fine-tuning connections between spared neurons. Longitudinal studies will be necessary to fully test this hypothesis.
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Affiliation(s)
- N. Filippini
- University Department of Psychiatry, Oxford, UK
- FMRIB Centre, University of Oxford, Oxford, UK
- LENITEM, Laboratory of Epidemiology, Neuroimaging, & Telemedicine-IRCCS S. Giovanni di Dio-FBF, Brescia, Italy
| | - L.D. Nickerson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - C.F. Beckmann
- FMRIB Centre, University of Oxford, Oxford, UK
- Donders Centre for Cognitive Neuroimaging, Nijmegen, NL, Netherlands
| | | | - G.B. Frisoni
- LENITEM, Laboratory of Epidemiology, Neuroimaging, & Telemedicine-IRCCS S. Giovanni di Dio-FBF, Brescia, Italy
| | - P.M. Matthews
- Department of Clinical Neuroscience, Imperial College, Hammersmith Campus London, UK
- GlaxosmithKline Research and Development, Clinical Imaging Centre, London, UK
| | - S.M. Smith
- FMRIB Centre, University of Oxford, Oxford, UK
| | - C.E. Mackay
- University Department of Psychiatry, Oxford, UK
- FMRIB Centre, University of Oxford, Oxford, UK
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Lucas SJE, Ainslie PN, Murrell CJ, Thomas KN, Franz EA, Cotter JD. Effect of age on exercise-induced alterations in cognitive executive function: relationship to cerebral perfusion. Exp Gerontol 2012; 47:541-51. [PMID: 22230488 DOI: 10.1016/j.exger.2011.12.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/06/2011] [Accepted: 12/12/2011] [Indexed: 11/29/2022]
Abstract
Regular exercise improves the age-related decline in cerebral blood flow (CBF) and is associated with improved cognitive function; however, less is known about the direct relationship between CBF and cognitive function. We examined the influence of healthy aging on the capability of acute exercise to improve cognition, and whether exercise-induced improvements in cognition are related to CBF and cortical hemodynamics. Middle cerebral artery blood flow velocity (MCAv; Doppler) and cortical hemodynamics (NIRS) were measured in 13 young (24±5 y) and 9 older (62±3 y) participants at rest and during cycling at 30% and 70% of heart rate range (HRR). Cognitive performance was assessed using a computer-adapted Stroop task (i.e., test of executive function cognition) at rest and during exercise. Average response times on the Stroop task were slower for the older compared to younger group for both simple and difficult tasks (P<0.01). Independent of age, difficult-task response times improved during exercise (P<0.01), with the improvement greater at 70% HRR exercise (P=0.04 vs. 30% HRR). Higher MCAv was correlated with faster response times for simple and difficult tasks at rest (R(2)=0.47 and R(2)=0.47, respectively), but this relation uncoupled progressively during exercise. Exercise-induced increases in MCAv were similar and unaltered during cognitive tasks for both age groups. In contrast, prefrontal cortical hemodynamic NIRS measures [oxyhemoglobin (O(2)Hb) and total hemoglobin (tHb)] were differentially affected by exercise intensity, age and cognitive task; e.g., there were smaller increases in [O(2)Hb] and [tHb] in the older group between exercise intensities (P<0.05). These data indicate that: 1) Regardless of age, cognitive (executive) function is improved while exercising; 2) while MCAv is strongly related to cognition at rest, this relation becomes uncoupled during exercise, and 3) there is dissociation between global CBF and regional cortical oxygenation and NIRS blood volume markers during exercise and engagement of prefrontal cognition.
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Affiliation(s)
- Samuel J E Lucas
- Department of Physiology, University of Otago, Dunedin, New Zealand.
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127
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Kapsalaki E, Svolos P, Tsougos I, Theodorou K, Fezoulidis I, Fountas KN. Quantification of Normal CSF Flow Through the Aqueduct Using PC-Cine MRI at 3T. ACTA NEUROCHIRURGICA SUPPLEMENTUM 2012; 113:39-42. [DOI: 10.1007/978-3-7091-0923-6_8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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128
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Akazawa N, Choi Y, Miyaki A, Sugawara J, Ajisaka R, Maeda S. Aerobic exercise training increases cerebral blood flow in postmenopausal women. Artery Res 2012. [DOI: 10.1016/j.artres.2012.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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130
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Correlation between tap test and CSF aqueductal stroke volume in idiopathic normal pressure hydrocephalus. ACTA NEUROCHIRURGICA. SUPPLEMENT 2012; 113:43-6. [PMID: 22116421 DOI: 10.1007/978-3-7091-0923-6_9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The diagnosis and management of idiopathic normal pressure hydrocephalus (INPH) remains unclear despite the development of guidelines. In addition, the role of cerebrospinal fluid (CSF) aqueductal stroke volume (ASV) remains unspecified. OBJECTIVES The aim of this study was to compare the results of the tap test (TT) and ASV in patients with possible INPH. MATERIALS AND METHODS Among 21 patients investigated with both TT and phase-contrast (PC) MRI, we identified two groups, with either (1) a positive TT (PTT) or (2) a negative one (NTT), and we compared their ASV as measured by PC-MRI. ASV cutoff value was set at 70 μL/cardiac cycle (mean value +2 standard deviations in age-matched healthy subjects). RESULTS In the PTT group (n = 9), the mean ASV was 175 ± 71 μL. Among these patients, four were shunted, and improved after surgery. In the NTT group, two patients were finally diagnosed with aqueductal stenosis and excluded. Among the remaining patients (n = 10), the mean ASV was 96 ± 93 μL (p < 0.05). However, three of these patients presented with hyperdynamic ASV, and an associated neurodegenerative disorder was diagnosed. Two patients had ventriculoperitoneal shunting despite their NTT, and improved. DISCUSSION/CONCLUSIONS In our patient population, the noninvasive measurement of hyperdynamic ASV correlated with PTT, suggesting PC-MRI could be utilized to select those patients who would benefit from shunting. ASV may therefore be an interesting supplemental diagnosis tool.
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131
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Wåhlin A, Ambarki K, Hauksson J, Birgander R, Malm J, Eklund A. Phase contrast MRI quantification of pulsatile volumes of brain arteries, veins, and cerebrospinal fluids compartments: repeatability and physiological interactions. J Magn Reson Imaging 2011; 35:1055-62. [PMID: 22170792 DOI: 10.1002/jmri.23527] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 11/08/2011] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To study measurement repeatability and physiological determinants on measurement stability for phase contrast MRI (PC-MRI) measurements of cyclic volume changes (ΔV) of brain arteries, veins, and cerebrospinal fluid (CSF) compartments. MATERIALS AND METHODS Total cerebral blood flow (tCBF), total internal jugular flow (tJBF) and spinal CSF flow at C2-C3 level and CSF in the aqueduct was measured using five repetitions in 20 healthy subjects. After subtracting net flow, waveforms were integrated to calculate ΔV of arterial, venous, and cerebrospinal fluid compartments. The intraclass correlation coefficient (ICC) was used to measure repeatability. Systematic errors were investigated by a series of phantom measurements. RESULTS For ΔV calculated from tCBF, tJBF and both CSF waveforms, the ICC was ≥0.85. ΔV from the tCBF waveform decreased linearly between repetitions (P = 0.012). Summed CSF and venous volume being shifted out from the cranium was correlated with ΔV calculated from the tCBF waveform (r = 0.75; P < 0.001). Systematic errors increased at resolutions <4 pixels per diameter. CONCLUSION Repeatability of ΔV calculated from tCBF, tJBF, and CSF waveforms allows useful interpretations. The subject's time in the MR system and imaging resolution should be considered when interpreting volume changes. Summed CSF and venous volume changes was associated with arterial volume changes.
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Affiliation(s)
- Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.
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132
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Ohno N, Miyati T, Mase M, Osawa T, Kan H, Kasai H, Hara M, Shibamoto Y, Hayashi N, Gabata T, Matsui O. Idiopathic Normal-Pressure Hydrocephalus: Temporal Changes in ADC during Cardiac Cycle. Radiology 2011; 261:560-5. [DOI: 10.1148/radiol.11101860] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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133
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Moskalenko YE, Ryabchikova NA, Weinstein GB, Halvorson P, Vardy TC. Changes of circulatory-metabolic indices and skull biomechanics with brain activity during aging. J Integr Neurosci 2011; 10:131-60. [PMID: 21714135 DOI: 10.1142/s021963521100266x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 04/25/2011] [Indexed: 11/18/2022] Open
Abstract
The cerebral blood flow values used in experimental and clinical investigations as the informative criteria for brain blood supply are often misleading. The correlation between the cerebral blood supply and brain function is not proven in all cases. An increase of brain activity is known to be accompanied by a rise of blood flow in activated regions, while a decreased activity results in a decreased blood flow. This demonstrates the close correlation between the brain blood supply and its activity. Such a correlation had not been noted in the age-dependent decrease of cerebral blood flow, suggesting the existence of special age-related mechanisms that develop with age to maintain brain metabolism. The biomechanical properties are of special significance as predicted in the early 20th century. Only recently were they validated by the simultaneous recording of Transcranial Dopplerogram and Rheoencephalogram with in-depth analysis focused on single cardiac cycles. Functioning of the intracranial blood and cerebrospinal fluid dynamics was integrated with a special physiological test "Prognosis-2" to measure brain cognitive function. Correlation was demonstrated with the circulatory-metabolic state of brain activity, especially in people with changing cognitive function. The data supports a conceptual model of adequate circulatory-metabolic supply of brain activity, showing the functional unity, which follows from integration of the mentioned systems.
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Affiliation(s)
- Y E Moskalenko
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, St. Petersburg.
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134
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Seifert T, Secher NH. Sympathetic influence on cerebral blood flow and metabolism during exercise in humans. Prog Neurobiol 2011; 95:406-26. [PMID: 21963551 DOI: 10.1016/j.pneurobio.2011.09.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/13/2011] [Accepted: 09/19/2011] [Indexed: 11/26/2022]
Abstract
This review focuses on the possibility that autonomic activity influences cerebral blood flow (CBF) and metabolism during exercise in humans. Apart from cerebral autoregulation, the arterial carbon dioxide tension, and neuronal activation, it may be that the autonomic nervous system influences CBF as evidenced by pharmacological manipulation of adrenergic and cholinergic receptors. Cholinergic blockade by glycopyrrolate blocks the exercise-induced increase in the transcranial Doppler determined mean flow velocity (MCA Vmean). Conversely, alpha-adrenergic activation increases that expression of cerebral perfusion and reduces the near-infrared determined cerebral oxygenation at rest, but not during exercise associated with an increased cerebral metabolic rate for oxygen (CMRO(2)), suggesting competition between CMRO(2) and sympathetic control of CBF. CMRO(2) does not change during even intense handgrip, but increases during cycling exercise. The increase in CMRO(2) is unaffected by beta-adrenergic blockade even though CBF is reduced suggesting that cerebral oxygenation becomes critical and a limited cerebral mitochondrial oxygen tension may induce fatigue. Also, sympathetic activity may drive cerebral non-oxidative carbohydrate uptake during exercise. Adrenaline appears to accelerate cerebral glycolysis through a beta2-adrenergic receptor mechanism since noradrenaline is without such an effect. In addition, the exercise-induced cerebral non-oxidative carbohydrate uptake is blocked by combined beta 1/2-adrenergic blockade, but not by beta1-adrenergic blockade. Furthermore, endurance training appears to lower the cerebral non-oxidative carbohydrate uptake and preserve cerebral oxygenation during submaximal exercise. This is possibly related to an attenuated catecholamine response. Finally, exercise promotes brain health as evidenced by increased release of brain-derived neurotrophic factor (BDNF) from the brain.
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Affiliation(s)
- Thomas Seifert
- Department of Anaesthesia and The Copenhagen Muscle Research Centre, Rigshospitalet 2041, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
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135
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Abstract
Stroke is one of the most devastating manifestations of two common diseases, atherosclerosis and hypertension. It represents the second leading cause of death and a major cause of disability worldwide. Besides age (a nonmodifiable risk factor), hypertension is the most important cardiovascular risk factor for developing both ischemic and hemorrhagic stroke, as well as small vessel disease predisposing to lacunar infarction, white matter lesions, and cerebral microbleeds. In addition, hypertension predisposes to atherosclerosis and cardiac diseases (notably atrial fibrillation), thereby promoting cerebral embolism. Inflammatory mechanisms play a central role in the pathogenesis and progression of atherosclerosis, plaque rupture, thrombosis, and stroke. Endothelial dysfunction, in part resulting from excessive production of reactive oxygen species, is an important mechanism of cerebrovascular damage. This article reviews recent data on vascular mechanisms that participate in the pathogenesis of stroke.
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Affiliation(s)
- Cristina Sierra
- Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, QC H3T 1E2, Canada.
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136
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Teng PY, Bagci AM, Alperin N. Automated prescription of an optimal imaging plane for measurement of cerebral blood flow by phase contrast magnetic resonance imaging. IEEE Trans Biomed Eng 2011; 58:2566-73. [PMID: 21672671 DOI: 10.1109/tbme.2011.2159383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study describes and evaluates a semiautomated method for prescribing an optimal imaging plane that is located as close as possible to the skull base, and is simultaneously nearly perpendicular to the four arteries leading blood to the brain [internal carotid arteries (ICAs) and vertebral arteries (VAs)]. Such a method will streamline and improve reliability of the measurement of total cerebral blood flow and intracranial pressure by velocity encoding phase-contrast magnetic resonance imaging. The method first extracts the vessels' centerline from a 2-D time-of-flight magnetic resonance angiogram of the neck by performing distance transformations. An anatomical marker, the V2 segment of the VAs, is then identified to guide the imaging plane to be as close and below the skull base. An imaging plane that is nearly perpendicular to the ICAs and V2 segment of VAs is then identified by minimizing a misalignment value, estimated by a weighted mean of the angles between the plane's normal and the vessel axes at the vessel-plane intersections. The performance of the semiautomated method was evaluated by comparing manually selected planes to those found semiautomatically in nine magnetic resonance angiogram datasets. The semiautomated method consistently outperformed manual prescription with a significantly smaller misalignment value, 8.6° versus 20.7° (P < 0.001), respectively, and significantly improved reproducibility.
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Affiliation(s)
- Pang-yu Teng
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60612, USA.
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137
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Dubeau S, Desjardins M, Pouliot P, Beaumont E, Gaudreau P, Ferland G, Lesage F. Biophysical model estimation of neurovascular parameters in a rat model of healthy aging. Neuroimage 2011; 57:1480-91. [PMID: 21549843 DOI: 10.1016/j.neuroimage.2011.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 04/11/2011] [Accepted: 04/14/2011] [Indexed: 11/27/2022] Open
Abstract
Neuronal, vascular and metabolic factors result in a deterioration of the cerebral hemodynamic response with age. The interpretation of neuroimaging studies in the context of aging is rendered difficult due to the challenge in untangling the composite effect of these modifications. In this work we integrate multimodal optical imaging in biophysical models to investigate vascular and metabolic changes occurring in aging. Multispectral intrinsic optical imaging of an animal model of healthy aging, the LOU/c rat, is used in combination with somatosensory stimulation to study the modifications of the hemodynamic response with increasing age. Results are fitted with three macroscopic biophysical models to extract parameters, providing a phenomenological description of vascular and metabolic changes. Our results show that 1) biophysical parameters are estimable from multimodal data and 2) parameter estimates in this population change with aging.
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Affiliation(s)
- S Dubeau
- Department of Electrical Engineering, École Polytechnique de Montréal, Montréal, QC, Canada
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138
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Dubeau S, Ferland G, Gaudreau P, Beaumont E, Lesage F. Cerebrovascular hemodynamic correlates of aging in the Lou/c rat: a model of healthy aging. Neuroimage 2011; 56:1892-901. [PMID: 21497659 DOI: 10.1016/j.neuroimage.2011.03.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/07/2011] [Accepted: 03/28/2011] [Indexed: 11/18/2022] Open
Abstract
The LOU/c rat is an inbred strain considered a model of healthy aging. It exhibits a longer free disease lifespan and a low adiposity throughout life. While this animal model has been shown to maintain eating behavior and neuroendocrine, metabolic and cognitive functions with age, no study has yet investigated vascular correlates in this model of healthy aging. In the present work, multispectral optical imaging was used to investigate the hemodynamic response in the somatosensory cortex of LOU/c rats following forepaw stimulation in three age groups, 4, 24 and 40months. Results indicate reduced hemodynamic responses in the contralateral somatosensory cortex between young (4months) and older groups following stimulation. This decrease was associated with an increase in the spatial extent of activation. The ipsilateral response did not change with aging leading to decreased laterality. Estimations of the relative change in the local cerebral metabolic rate of oxygen during stimulation based on multimodal data showed no significant change with age. The exponent describing the relation between blood volume and blood flow changes, Grubb's parameter, did display a significant change with age which may suggest vessel compliance modifications. This work finds its relevance in recent findings underlying the importance of vascular changes with aging and its impact on neurodegenerative disease.
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Affiliation(s)
- S Dubeau
- Electrical Engineering Department, Ecole Polytechnique Montréal, Montreal, Quebec, Canada
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139
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Saliou G, Paradot G, Gondry C, Bouzerar R, Lehmann P, Meyers ME, Gars DL, Deramond H, Balédent O. A phase-contrast MRI study of acute and chronic hydrodynamic alterations after hydrocephalus induced by subarachnoid hemorrhage. J Neuroimaging 2011; 22:343-50. [PMID: 21447028 DOI: 10.1111/j.1552-6569.2011.00594.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine acute intracranial hydrodynamic changes after subarachnoid hemorrhage (SAH) via phase-contrast MRI (PC-MRI) analysis of the CSF stroke volume in the aqueduct (SVaq) and the foramen magnum (SVfm). METHODS A prospective PC-MRI study was performed on 34 SAH patients in the acute and late phase. Data on CSF flow and hemorrhage site were analyzed according to acute or chronic hydrocephalus (HC). RESULTS In the acute phase, CSF analysis was performed for 31 patients, 12 of whom presented HC. All 12 had an abnormal SVaq; those with communicating HC (n = 7) had an elevated SV and those with noncommunicating HC (n = 5) had a nil SV. None of the patients with a normal SVaq (n = 11) developed acute HC. Intraventricular bleeding led to more cases of acute HC (P = .005), which was communicating in 58% of cases. In the chronic phase, CSF analysis was performed for 27 patients, 7 of whom presented HC. None of these 7 patients displayed a depressed SVaq. CONCLUSION SAH led to changes in cerebrospinal fluid hydrodynamics in the majority of patients. Acute HC was communicating in most cases, even when there was intraventricular bleeding. In the late phase, all chronic HC were communicating and did not display aqueductal stenosis.
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Affiliation(s)
- Guillaume Saliou
- Service de Neuroradiologie, Centre Hospitalier Universitaire de Bicêtre, Kremlin Bicêtre Cedex, France.
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140
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Variation in supratentorial cerebrospinal fluid production rate in one day: measurement by nontriggered phase-contrast magnetic resonance imaging. Jpn J Radiol 2011; 29:110-5. [PMID: 21359936 DOI: 10.1007/s11604-010-0525-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Measuring the cerebrospinal fluid (CSF) production rate is important for understanding the physiology related to normal conditions and neurological disorders. Triggered phase-contrast magnetic resonance imaging (MRI) has been used to measure CSF production rate, but the use of nontriggered phase-contrast MRI has not been reported. The purposes of this study were to assess the feasibility of using nontriggered phase-contrast MRI to measure CSF flow and to determine whether CSF production exhibits circadian rhythm. MATERIALS AND METHODS The feasibility of phase-contrast MRI was assessed with a phantom simulated human cerebral aqueduct. CSF flow through the cerebral aqueduct was measured with nontriggered phase-contrast MRI four times during 1 day in 10 normal volunteers. RESULTS In the phantom study, linear regression analysis gave the following measured values (ml/h): 0.80 × (value of steady flow) - 10.0 for triggered phase-contrast MRI and 1.27 × (value of steady flow) - 12.2 for nontriggered phase-contrast MRI. One-factor analysis of variance showed no significant effect of the time of the measurements (P = 0.47). The supratentorial CSF production rate was 510 ± 549 ml/day (mean ± SD). CONCLUSION Nontriggered phase-contrast MRI provided good estimates of the flow rate in the phantom study. We observed no circadian rhythm in CSF production.
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El Sankari S, Gondry-Jouet C, Fichten A, Godefroy O, Serot JM, Deramond H, Meyer ME, Balédent O. Cerebrospinal fluid and blood flow in mild cognitive impairment and Alzheimer's disease: a differential diagnosis from idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 2011; 8:12. [PMID: 21349149 PMCID: PMC3045982 DOI: 10.1186/2045-8118-8-12] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/17/2011] [Indexed: 11/29/2022] Open
Abstract
Background Phase-contrast magnetic resonance imaging (PC-MRI) enables quantification of cerebrospinal fluid (CSF) flow and total cerebral blood (tCBF) flow and may be of value for the etiological diagnosis of neurodegenerative diseases. This investigation aimed to study CSF flow and intracerebral vascular flow in patients with Alzheimer's disease (AD) and patients with amnesic mild cognitive impairment (a-MCI) and to compare the results with patients with idiopathic normal pressure hydrocephalus (NPH) and with healthy elderly volunteers (HEV). Methods Ten a-MCI and 9 mild AD patients were identified in a comprehensive neurological and neuropsychological assessment. They underwent brain MRI; PC-MRI pulse sequence was performed with the following parameters: two views per segment; flip angle: 25° for vascular flow and 20° for CSF flow; field-of-view (FOV): 14 × 14 mm²; matrix: 256 × 128; slice thickness: 5 mm; with one excitation for exams on the 3 T machine, and 2 excitations for the 1.5 T machine exams. Velocity (encoding) sensitization was set to 80 cm/s for the vessels at the cervical level, 10 or 20 cm/s for the aqueduct and 5 cm/s for the cervical subarachnoid space (SAS). Dynamic flow images were analyzed with in-house processing software. The patients' results were compared with those obtained for HEVs (n = 12), and for NPH patients (n = 13), using multivariate analysis. Results Arterial tCBF and the calculated pulsatility index were significantly greater in a-MCI patients than in HEVs. In contrast, vascular parameters were lower in NPH patients. Cervical CSF flow analysis yielded similar values for all four populations. Aqueductal CSF stroke volumes (in μl per cardiac cycle) were similar in HEVs (34 ± 17) and AD patients (39 ± 18). In contrast, the aqueductal CSF was hyperdynamic in a-MCI patients (73 ± 33) and even more so in NPH patients (167 ± 89). Conclusion Our preliminary data show that a-MCI patients present with high systolic arterial peak flows, which are associated with higher mean total cerebral arterial flows. Aqueductal CSF oscillations are within normal range in AD and higher than normal in NPH. This study provides an original dynamic vision of cerebral neurodegenerative diseases, consistent with the vascular theory for AD, and supporting primary flow disturbances different from those observed in NPH.
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Affiliation(s)
- Soraya El Sankari
- Department of Image Processing, Jules Verne University of Picardy and Amiens University Hospital, CHU d'Amiens, F-80054 Amiens cedex, France.
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Shepherd SJ, Beggs CB. Cerebral hydrodynamics are at a most a third order system. Med Hypotheses 2011; 76:648-52. [PMID: 21292407 DOI: 10.1016/j.mehy.2011.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 10/18/2010] [Accepted: 01/13/2011] [Indexed: 11/17/2022]
Abstract
The human body employs a sophisticated windkessel mechanism to dampen the arterial pulse entering the brain, thus ensuring the smooth flow of blood through the cerebral capillary bed. The energy from the arterial pulse is transferred to the cerebrospinal fluid (CSF), which pulses backwards and forwards across the foramen magnum. The dynamics associated with this system are complex and poorly understood. In an attempt to better understand the physiology, a number of researchers have constructed electrical analogue circuits to simulate the hydrodynamic behaviour of the brain. These generally consist of several low-pass filters. While such models have great potential, to date, they have met with only limited success. We suspect that this is in part due to a failure to identify the order of the model required to successfully capture the hydrodynamics of the brain. Here, we advance the hypothesis that the cerebral hydrodynamic system is at most a third order system, using evidence collected from the spectral eigen-system of the arterial, venous and CSF flows. Using singular spectrum analysis we computed the singular vectors for the measured arterial, venous and CSF flows from an individual. This revealed that the first singular vector contributes 67% of the observed variance; the first plus the second singular vectors contribute 96% of the variance; and sum of the first three singular vectors contribute more than 99.5% of the observed variance.
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Affiliation(s)
- Simon J Shepherd
- Medical Biophysics Laboratory, University of Bradford, Richmond Road, Bradford BD7 1DP, UK
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143
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A comparison of the effects of preanesthetic administration of crystalloid versus colloid on intrathecal spread of isobaric spinal anesthetics and cerebrospinal fluid movement. Anesth Analg 2011; 112:924-30. [PMID: 21288972 DOI: 10.1213/ane.0b013e31820d93d8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Movement of the cerebrospinal fluid (CSF) is one of the most important factors in determining the intrathecal spread of isobaric spinal anesthetics. Preanesthetic administration of either crystalloid or colloid immediately before spinal anesthesia (preload) may result in different CSF pulsatile movement because of their different physical properties. We examined whether preload of crystalloid versus colloid may have different effects on the intrathecal spread of isobaric spinal anesthetics as a result of their different CSF dynamics regarding its pulsatile movement. METHODS In a clinical study of isobaric spinal anesthesia, patients were allocated into 1 of 2 groups according to preload with either crystalloid (n = 30) or colloid (n = 30) before spinal anesthesia with 0.5 isobaric tetracaine. The pulsatile movements of CSF at the L2-3 intervertebral space and midportion of the aqueduct of Sylvius were also examined by magnetic resonance images in healthy volunteers (n = 23) at 0, 30, and 60 minutes after administering either crystalloid or colloid. RESULTS In the clinical study, the time to reach the peak sensory block level was delayed significantly in the crystalloid preload group (27.2 ± 17.8 minutes; P < 0.01) compared with the colloid preload group (13.9 ± 7.0 minutes). The median sensory block levels of the crystalloid preload group at 15 minutes (T10, P < 0.05) and 20 minutes (T9.5, P < 0.05) were significantly lower than those (T8, T7, respectively) of the colloid preload group. In the magnetic resonance imaging study, cranially directed CSF pulsatile movement decreased significantly at the L2-3 intervertebral intrathecal space at 30 minutes after crystalloid administration, but not after colloid administration. The CSF production rate significantly increased at 30 minutes (637 μL/min, P < 0.05) after crystalloid preload compared with the baseline measurement (448 μL/min), and then slightly decreased (609 μL/min) at 60 minutes. In the colloid preload group, the CSF production rate was not statistically significant compared with the baseline measurement (464, 512, and 542 μL/min at baseline, 30, and 60 minutes, respectively). CONCLUSIONS Compared with a colloid preload, which may be comparable to the no-preload condition, crystalloid preload prolonged the time to reach the peak sensory block level in isobaric spinal anesthesia, which might have been caused by a significant decrease in CSF pulsatile movement. This attenuated CSF pulsatile movement in the crystalloid preload group might have resulted from significant increases of CSF production.
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Abstract
Although most people who have headache pain do not present with an underlying mass lesion, a large number of patients with brain tumors do report headache (as many as 60% in our institution). The problem for clinicians is that the tumor-headache association is not universal, as evidenced by anecdotal reports of patients with large tumors and increased intracranial pressure, but a complete absence of headache pain. In this review, we examine more than 80 years of research on brain tumor headaches, delineating the link between tumor location, laterality, growth rate, and pain. Most importantly, we position our review within the context of current etiological theories and propose new models involving the peripheral and central sensitization of nociresponsive neurons. This review will help clinicians understand why debulking surgery sometimes fails to alleviate neoplastic headache pain in select patients. A brief examination of headaches as a result of surgery and adjuvant chemoradiation therapy is also provided. Headaches can be an early indicator of central nervous system tumors. However, headaches are present in a wide variety of other condition, and are sometimes (surprisingly) absent in patients with primary neoplasms or metastatic tumors. This observation complicates the possibility of linking headaches to brain tumors. Nevertheless, some generalizations concerning brain tumor headaches can be drawn. The following sections review these generalizations, presenting caveats where appropriate. Lingering questions in the field are also addressed and presented together with promising future research avenues.
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Affiliation(s)
- Philippe Goffaux
- Department of Neurosurgery and Neuro-oncology, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Québec, Canada.
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145
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Wagshul ME, Eide PK, Madsen JR. The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility. Fluids Barriers CNS 2011; 8:5. [PMID: 21349153 PMCID: PMC3042979 DOI: 10.1186/2045-8118-8-5] [Citation(s) in RCA: 261] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 01/18/2011] [Indexed: 02/01/2023] Open
Abstract
The maintenance of adequate blood flow to the brain is critical for normal brain function; cerebral blood flow, its regulation and the effect of alteration in this flow with disease have been studied extensively and are very well understood. This flow is not steady, however; the systolic increase in blood pressure over the cardiac cycle causes regular variations in blood flow into and throughout the brain that are synchronous with the heart beat. Because the brain is contained within the fixed skull, these pulsations in flow and pressure are in turn transferred into brain tissue and all of the fluids contained therein including cerebrospinal fluid. While intracranial pulsatility has not been a primary focus of the clinical community, considerable data have accrued over the last sixty years and new applications are emerging to this day. Investigators have found it a useful marker in certain diseases, particularly in hydrocephalus and traumatic brain injury where large changes in intracranial pressure and in the biomechanical properties of the brain can lead to significant changes in pressure and flow pulsatility. In this work, we review the history of intracranial pulsatility beginning with its discovery and early characterization, consider the specific technologies such as transcranial Doppler and phase contrast MRI used to assess various aspects of brain pulsations, and examine the experimental and clinical studies which have used pulsatility to better understand brain function in health and with disease.
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Affiliation(s)
- Mark E Wagshul
- Albert Einstein College of Medicine, Department of Radiology, Bronx, NY 10461, USA.
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146
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Czosnyka M, Czosnyka Z, Baledent O, Weerakkody R, Kasprowicz M, Smielewski P, Pickard JD. Dynamics of Cerebrospinal Fluid: From Theoretical Models to Clinical Applications. BIOMECHANICS OF THE BRAIN 2011. [DOI: 10.1007/978-1-4419-9997-9_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Austin BP, Nair VA, Meier TB, Xu G, Rowley HA, Carlsson CM, Johnson SC, Prabhakaran V. Effects of hypoperfusion in Alzheimer's disease. J Alzheimers Dis 2011; 26 Suppl 3:123-33. [PMID: 21971457 PMCID: PMC3303148 DOI: 10.3233/jad-2011-0010] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The role of hypoperfusion in Alzheimer's disease (AD) is a vital component to understanding the pathogenesis of this disease. Disrupted perfusion is not only evident throughout disease manifestation, it is also demonstrated during the pre-clinical phase of AD (i.e., mild cognitive impairment) as well as in cognitively healthy persons at high-risk for developing AD due to family history or genetic factors. Studies have used a variety of imaging modalities (e.g., SPECT, MRI, PET) to investigate AD, but with its recent technological advancements and non-invasive use of blood water as an endogenous tracer, arterial spin labeling (ASL) MRI has become an imaging technique of growing popularity. Through numerous ASL studies, it is now known that AD is associated with both global and regional cerebral hypoperfusion and that there is considerable overlap between the regions implicated in the disease state (consistently reported in precuneus/posterior cingulate and lateral parietal cortex) and those implicated in disease risk. Debate exists as to whether decreased blood flow in AD is a cause or consequence of the disease. Nonetheless, hypoperfusion in AD is associated with both structural and functional changes in the brain and offers a promising putative biomarker that could potentially identify AD in its pre-clinical state and be used to explore treatments to prevent, or at least slow, the progression of the disease. Finally, given that perfusion is a vascular phenomenon, we provide insights from a vascular lesion model (i.e., stroke) and illustrate the influence of disrupted perfusion on brain structure and function and, ultimately, cognition in AD.
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Affiliation(s)
- Benjamin P. Austin
- UW Cardiovascular Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, USA
- Department of Veterans Affairs (VA) Geriatric Research, Education and Clinical Center (GRECC), Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Veena A. Nair
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Timothy. B. Meier
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Guofan Xu
- Department of Veterans Affairs (VA) Geriatric Research, Education and Clinical Center (GRECC), Madison, WI, USA
| | - Howard A. Rowley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Cynthia M. Carlsson
- Department of Veterans Affairs (VA) Geriatric Research, Education and Clinical Center (GRECC), Madison, WI, USA
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Sterling C. Johnson
- Department of Veterans Affairs (VA) Geriatric Research, Education and Clinical Center (GRECC), Madison, WI, USA
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53706, USA
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Kalaria RN. Vascular basis for brain degeneration: faltering controls and risk factors for dementia. Nutr Rev 2010; 68 Suppl 2:S74-87. [PMID: 21091952 DOI: 10.1111/j.1753-4887.2010.00352.x] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The integrity of the vascular system is essential for the efficient functioning of the brain. Aging-related structural and functional disturbances in the macro- or microcirculation of the brain make it vulnerable to cognitive dysfunction, leading to brain degeneration and dementing illness. Several faltering controls, including impairment in autoregulation, neurovascular coupling, blood-brain barrier leakage, decreased cerebrospinal fluid, and reduced vascular tone, appear to be responsible for varying degrees of neurodegeneration in old age. There is ample evidence to indicate vascular risk factors are also linked to neurodegenerative processes preceding cognitive decline and dementia. The strongest risk factor for brain degeneration, whether it results from vascular or neurodegenerative mechanisms or both, is age. However, several modifiable risks such as cardiovascular disease, hypertension, dyslipidemia, diabetes, and obesity enhance the rate of cognitive decline and increase the risk of Alzheimer's disease in particular. The ultimate accumulation of brain pathological lesions may be modified by genetic influences, such as the apolipoprotein E ε4 allele and the environment. Lifestyle measures that maintain or improve cardiovascular health, including consumption of healthy diets, moderate use of alcohol, and implementation of regular physical exercise are important factors for brain protection.
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Affiliation(s)
- Raj N Kalaria
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne NE4 5PL, UK.
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Ogami R, Nakahara T, Hamasaki O, Araki H, Kurisu K. Cerebrospinal fluid enhancement on fluid attenuated inversion recovery images after carotid artery stenting with neuroprotective balloon occlusions: hemodynamic instability and blood-brain barrier disruption. Cardiovasc Intervent Radiol 2010; 34:936-41. [PMID: 21127870 DOI: 10.1007/s00270-010-0035-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 10/24/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE A rare complication of carotid artery stenting (CAS), prolonged reversible neurological symptoms with delayed cerebrospinal fluid (CSF) space enhancement on fluid attenuated inversion recovery (FLAIR) images, is associated with blood-brain barrier (BBB) disruption. We prospectively identified patients who showed CSF space enhancement on FLAIR images. METHODS Nineteen patients-5 acute-phase and 14 scheduled-underwent 21 CAS procedures. Balloon catheters were navigated across stenoses, angioplasty was performed using a neuroprotective balloon, and stents were placed with after dilation under distal balloon protection. CSF space hyperintensity or obscuration on FLAIR after versus before CAS indicated CSF space enhancement. Correlations with clinical factors were examined. RESULTS CSF space was enhanced on FLAIR in 12 (57.1%) cases. Postprocedural CSF space enhancement was significantly related to age, stenosis rate, acute-stage procedure, and total occlusion time. All acute-stage CAS patients showed delayed enhancement. Only age was associated with delayed CSF space enhancement in scheduled CAS patients. CONCLUSIONS Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemic intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications.
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Affiliation(s)
- Ryo Ogami
- Department of Neurosurgery, Mazda Hospital, 2-15 Aosaki-minami, Fuchu-cho, Aki-gun, Hiroshima 735-8585, Japan.
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Galvin SD, Celi LA, Thomas KN, Clendon TR, Galvin IF, Bunton RW, Ainslie PN. Effects of age and coronary artery disease on cerebrovascular reactivity to carbon dioxide in humans. Anaesth Intensive Care 2010; 38:710-7. [PMID: 20715736 DOI: 10.1177/0310057x1003800415] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alterations in cerebrovascular reactivity to CO2, an index of cerebrovascular function, have been associated with increased risk of stroke. We hypothesised that cerebrovascular reactivity is impaired with increasing age and in patients with symptomatic coronary artery disease (CAD). Cerebrovascular and cardiovascular reactivity to CO2 was assessed at rest and during hypercapnia (5% CO2) and hypocapnia (hyperventilation) in subjects with symptomatic CAD (n=13) and age-matched old (n=9) and young (n=20) controls without CAD. Independent of CAD, reductions in middle cerebral artery blood velocity (transcranial Doppler) and cerebral oxygenation (near-infrared spectroscopy) were correlated with increasing age (r = -0.68, r = -0.51, respectively, P < 0.01). In CAD patients, at rest and during hypercapnia, cerebral oxygenation was lower (P < 0.05 vs. young). Although middle cerebral artery blood velocity reactivity was unaltered in the hypercapnic range, middle cerebral artery blood velocity reactivity to hypocapnia was elevated in the CAD and age-matched controls (P < 0.01 vs. young), and was associated with age (r = 0.62, P < 0.01). Transient drops in arterial PCO2 occur in a range of physiological and pathophysiological situations, therefore, the elevated middle cerebral artery blood velocity reactivity to hypocapnia combined with reductions in middle cerebral artery blood velocity may be important mechanisms underlying neurological risk with aging. In CAD patients, additional reductions in cerebral oxygenation may place them at additional risk of cerebral ischaemia.
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Affiliation(s)
- S D Galvin
- Department of Cardiothoracic Surgery, Section of Surgery, University of Otago and Dunedin Hospital, New Zealand
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