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Vagli C, Fisicaro F, Vinciguerra L, Puglisi V, Rodolico MS, Giordano A, Ferri R, Lanza G, Bella R. Cerebral Hemodynamic Changes to Transcranial Doppler in Asymptomatic Patients with Fabry's Disease. Brain Sci 2020; 10:brainsci10080546. [PMID: 32806660 PMCID: PMC7464747 DOI: 10.3390/brainsci10080546] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with Fabry's disease (FD) may be asymptomatic or show a spectrum of clinical manifestations, including cerebrovascular disease, mainly affecting posterior circulation. Few and conflicting studies on cerebral blood flow (CBF) velocity by transcranial Doppler sonography (TCD) in asymptomatic FD (aFD) subjects have been published. Our study aims to assess TCD in aFD subjects to identify any preclinical CBF change. METHODS A total of 30 aFD subjects were consecutively recruited and compared to 28 healthy controls. Brain magnetic resonance imaging was normal in all participants. TCD was used to study blood flow velocity and indices of resistance of intracranial arteries from the middle cerebral artery (MCA), bilaterally, and from the basilar artery (BA). Cerebral vasomotor reactivity (CVR) was also evaluated from MCA. RESULTS No difference was found between groups for MCA parameters of CBF velocity and CVR. Compared to controls, a higher mean blood flow velocity and a lower resistance index from BA were observed in FD subjects. No correlation was found between any BA-derived TCD parameter and the level of lyso-globotriaosylceramide. CONCLUSIONS aFD subjects show evidence of altered CBF velocity in posterior circulation. Preclinical detection of neurovascular involvement in FD might allow appropriate management and prevention of future cerebrovascular complications and disability.
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Affiliation(s)
- Carla Vagli
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Science, University of Catania, Via Santa Sofia 89, 95123 Catania, Italy;
| | - Luisa Vinciguerra
- Department of Neurology, Azienda Socio-Sanitaria Territoriale (ASST) Cremona, Viale Concordia 1, 26100 Cremona, Italy; (L.V.); (V.P.)
| | - Valentina Puglisi
- Department of Neurology, Azienda Socio-Sanitaria Territoriale (ASST) Cremona, Viale Concordia 1, 26100 Cremona, Italy; (L.V.); (V.P.)
| | - Margherita Stefania Rodolico
- C.N.R. Institute for Biomedical Research and Innovation–IRIB, Section of Catania, Via P. Gaifami 18, 95126 Catania, Italy;
| | - Antonello Giordano
- Department of Neurology, Guzzardi Hospital, Via Papa Giovanni XXIII, 97019 Vittoria, Italy;
| | - Raffaele Ferri
- Department of Neurology IC, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (R.F.); (G.L.)
| | - Giuseppe Lanza
- Department of Neurology IC, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (R.F.); (G.L.)
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
- Correspondence: ; Tel.: +39-095-3782699
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Cerebral Hemodynamic Changes to Transcranial Doppler in Asymptomatic Patients with Fabry's Disease. Brain Sci 2020. [PMID: 32806660 DOI: 10.3390/brainsci10080546.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with Fabry's disease (FD) may be asymptomatic or show a spectrum of clinical manifestations, including cerebrovascular disease, mainly affecting posterior circulation. Few and conflicting studies on cerebral blood flow (CBF) velocity by transcranial Doppler sonography (TCD) in asymptomatic FD (aFD) subjects have been published. Our study aims to assess TCD in aFD subjects to identify any preclinical CBF change. METHODS A total of 30 aFD subjects were consecutively recruited and compared to 28 healthy controls. Brain magnetic resonance imaging was normal in all participants. TCD was used to study blood flow velocity and indices of resistance of intracranial arteries from the middle cerebral artery (MCA), bilaterally, and from the basilar artery (BA). Cerebral vasomotor reactivity (CVR) was also evaluated from MCA. RESULTS No difference was found between groups for MCA parameters of CBF velocity and CVR. Compared to controls, a higher mean blood flow velocity and a lower resistance index from BA were observed in FD subjects. No correlation was found between any BA-derived TCD parameter and the level of lyso-globotriaosylceramide. CONCLUSIONS aFD subjects show evidence of altered CBF velocity in posterior circulation. Preclinical detection of neurovascular involvement in FD might allow appropriate management and prevention of future cerebrovascular complications and disability.
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Sackett JR, Schlader ZJ, Cruz C, Hostler D, Johnson BD. The effect of water immersion and acute hypercapnia on ventilatory sensitivity and cerebrovascular reactivity. Physiol Rep 2018; 6:e13901. [PMID: 30369098 PMCID: PMC6204237 DOI: 10.14814/phy2.13901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/14/2018] [Accepted: 09/19/2018] [Indexed: 11/24/2022] Open
Abstract
The partial pressure of end tidal carbon dioxide (PETCO2 ), ventilatory sensitivity to CO2 , and cerebral perfusion are augmented during thermoneutral head out water immersion (HOWI). We tested the hypotheses that HOWI and acute hypercapnia augments minute ventilation, ventilatory sensitivity to CO2 , cerebral perfusion, and cerebrovascular reactivity to CO2 . Twelve subjects (age: 24 ± 3 years, BMI: 25.3 ± 2.9 kg/m2 , 6 women) participated in two experimental visits: a HOWI visit (HOWI) and a matched hypercapnia visit (Dry + CO2 ). A rebreathing test was conducted at baseline, 10, 30, 60 min, and post HOWI and Dry + CO2 . PETCO2 , minute ventilation, expired gases, blood pressure, heart rate, and middle cerebral artery blood velocity were recorded continuously. PETCO2 increased throughout HOWI (baseline: 42 ± 2 mmHg; maximum at 10 min: 44 ± 2 mmHg, P ≤ 0.013) and Dry + CO2 (baseline: 42 ± 2 mmHg; maximum at 10 min: 44 ± 2 mmHg, P ≤ 0.013) and was matched between conditions (condition main effect: P = 0.494). Minute ventilation was lower during HOWI versus Dry + CO2 (maximum difference at 60 min: 13.2 ± 1.9 vs. 16.2 ± 2.7 L/min, P < 0.001). Ventilatory sensitivity to CO2 and middle cerebral artery blood velocity were greater during HOWI versus Dry + CO2 (maximum difference at 10 min: 2.60 ± 1.09 vs. 2.20 ± 1.05 L/min/mmHg, P < 0.001, and 63 ± 18 vs. 53 ± 14 cm/sec, P < 0.001 respectively). Cerebrovascular reactivity to CO2 decreased throughout HOWI and Dry + CO2 and was not different between conditions (condition main effect: P = 0.777). These data indicate that acute hypercapnia, matched to what occurs during HOWI, augments minute ventilation but not ventilatory sensitivity to CO2 or middle cerebral artery blood velocity despite an attenuated cerebrovascular reactivity to CO2 .
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Affiliation(s)
- James R. Sackett
- Center for Research and Education in Special EnvironmentsDepartment of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNew York
| | - Zachary J. Schlader
- Center for Research and Education in Special EnvironmentsDepartment of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNew York
| | - Carol Cruz
- Center for Research and Education in Special EnvironmentsDepartment of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNew York
| | - David Hostler
- Center for Research and Education in Special EnvironmentsDepartment of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNew York
| | - Blair D. Johnson
- Center for Research and Education in Special EnvironmentsDepartment of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNew York
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Lekic T, Krafft PR, Coats JS, Obenaus A, Tang J, Zhang JH. Infratentorial strokes for posterior circulation folks: clinical correlations for current translational therapeutics. Transl Stroke Res 2013; 2:144-51. [PMID: 23060944 DOI: 10.1007/s12975-011-0068-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Approximately 20 percent of all strokes will occur in the Infratentorial brain. This is within the vascular territory of the posterior vascular circulation. Very few clinical specifics are known about the therapeutic needs of this patient sub-population. Most evidence-based practices are founded from research about the treatment of anterior circulatory stroke. As a consequence, little is known about how stroke in the Infratentorial brain region would require a different approach. We characterized the neurovascular features of Infratentorial stroke, pathophysiological responses, and experimental models for further translational study.
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Affiliation(s)
- Tim Lekic
- Department of Physiology, School of Medicine, Loma Linda University, Loma Linda, Calif
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Cerebral Hemodynamic Changes at Basilar Artery in Obstructive Sleep Apnea Syndrome after Continuous Positive Airway Pressure Treatment. J Stroke Cerebrovasc Dis 2013; 22:e93-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/01/2012] [Accepted: 07/13/2012] [Indexed: 11/17/2022] Open
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Gavlak JC, Stocks J, Laverty A, Fettes E, Bucks R, Sonnappa S, Cooper J, Grocott MP, Levett DZ, Martin DS, Imray CH, Kirkham FJ. The Young Everest Study: preliminary report of changes in sleep and cerebral blood flow velocity during slow ascent to altitude in unacclimatised children. Arch Dis Child 2013; 98:356-62. [PMID: 23471157 PMCID: PMC3625826 DOI: 10.1136/archdischild-2012-302512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cerebral blood flow velocity (CBFV) and sleep physiology in healthy children exposed to hypoxia and hypocarbia are under-researched. AIM To investigate associations between sleep variables, daytime end-tidal carbon dioxide (EtCO2) and CBFV in children during high-altitude ascent. METHODS Vital signs, overnight cardiorespiratory sleep studies and transcranial Doppler were undertaken in nine children (aged 6-13 years) at low altitude (130 m), and then at moderate (1300 m) and high (3500 m) altitude during a 5-day ascent. RESULTS Daytime (130 m: 98%; 3500 m: 90%, p=0.004) and mean (130 m: 97%, 1300 m: 94%, 3500: 87%, p=0.0005) and minimum (130 m: 92%, 1300 m: 84%, 3500 m: 79%, p=0.0005) overnight pulse oximetry oxyhaemoglobin saturation decreased, and the number of central apnoeas increased at altitude (130 m: 0.2/h, 1300 m: 1.2/h, 3500 m: 3.5/h, p=0.2), correlating inversely with EtCO2 (R(2) 130 m: 0.78; 3500 m: 0.45). Periodic breathing occurred for median (IQR) 0.0 (0; 0.3)% (130 m) and 0.2 (0; 1.2)% (3500 m) of total sleep time. At 3500 m compared with 130 m, there were increases in middle (MCA) (mean (SD) left 29.2 (42.3)%, p=0.053; right 9.9 (12)%, p=0.037) and anterior cerebral (ACA) (left 65.2 (69)%, p=0.024; right 109 (179)%; p=0.025) but not posterior or basilar CBFV. The right MCA CBFV increase at 3500 m was predicted by baseline CBFV and change in daytime SpO2 and EtCO2 at 3500 m (R(2) 0.92); these associations were not seen on the left. CONCLUSIONS This preliminary report suggests that sleep physiology is disturbed in children even with slow ascent to altitude. The regional variations in CBFV and their association with hypoxia and hypocapnia require further investigation.
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Affiliation(s)
- Johanna C Gavlak
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Trust, Walrus Ward Level 1, Morgan Stanley Clinical Building, Great Ormond Street, London WC1N 3JH, UK.
| | - Janet Stocks
- Portex Respiratory Unit, UCL Institute of Child Health, London, UK
| | - Aidan Laverty
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emma Fettes
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Romola Bucks
- Department of Psychology, University of Western Australia, Perth, Australia
| | - Samatha Sonnappa
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK,Portex Respiratory Unit, UCL Institute of Child Health, London, UK
| | - Janine Cooper
- Developmental Neuroscience Unit, UCL Institute of Child Health, London, UK
| | - Michael P Grocott
- Centre for Altitude Space and Extreme Environment Medicine, UCL Institute of Child Health, London, UK,Anaesthesia and Critical Care Research Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK,Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Denny Z Levett
- Centre for Altitude Space and Extreme Environment Medicine, UCL Institute of Child Health, London, UK
| | - Daniel S Martin
- Centre for Altitude Space and Extreme Environment Medicine, UCL Institute of Child Health, London, UK
| | - Christopher H Imray
- Department of Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Warwick Medical School, Coventry, UK
| | - Fenella J Kirkham
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK,Neurosciences Units, UCL Institute of Child Health, London, UK,Department of Child Health, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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Posterior circulation stroke: animal models and mechanism of disease. J Biomed Biotechnol 2012; 2012:587590. [PMID: 22665986 PMCID: PMC3361739 DOI: 10.1155/2012/587590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/06/2012] [Accepted: 03/12/2012] [Indexed: 02/08/2023] Open
Abstract
Posterior circulation stroke refers to the vascular occlusion or bleeding, arising from the vertebrobasilar vasculature of the brain. Clinical studies show that individuals who experience posterior circulation stroke will develop significant brain injury, neurologic dysfunction, or death. Yet the therapeutic needs of this patient subpopulation remain largely unknown. Thus understanding the causative factors and the pathogenesis of brain damage is important, if posterior circulation stroke is to be prevented or treated. Appropriate animal models are necessary to achieve this understanding. This paper critically integrates the neurovascular and pathophysiological features gleaned from posterior circulation stroke animal models into clinical correlations.
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Ainslie PN, Duffin J. Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: mechanisms of regulation, measurement, and interpretation. Am J Physiol Regul Integr Comp Physiol 2009; 296:R1473-95. [PMID: 19211719 DOI: 10.1152/ajpregu.91008.2008] [Citation(s) in RCA: 398] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cerebral blood flow (CBF) and its distribution are highly sensitive to changes in the partial pressure of arterial CO(2) (Pa(CO(2))). This physiological response, termed cerebrovascular CO(2) reactivity, is a vital homeostatic function that helps regulate and maintain central pH and, therefore, affects the respiratory central chemoreceptor stimulus. CBF increases with hypercapnia to wash out CO(2) from brain tissue, thereby attenuating the rise in central Pco(2), whereas hypocapnia causes cerebral vasoconstriction, which reduces CBF and attenuates the fall of brain tissue Pco(2). Cerebrovascular reactivity and ventilatory response to Pa(CO(2)) are therefore tightly linked, so that the regulation of CBF has an important role in stabilizing breathing during fluctuating levels of chemical stimuli. Indeed, recent reports indicate that cerebrovascular responsiveness to CO(2), primarily via its effects at the level of the central chemoreceptors, is an important determinant of eupneic and hypercapnic ventilatory responsiveness in otherwise healthy humans during wakefulness, sleep, and exercise and at high altitude. In particular, reductions in cerebrovascular responsiveness to CO(2) that provoke an increase in the gain of the chemoreflex control of breathing may underpin breathing instability during central sleep apnea in patients with congestive heart failure and on ascent to high altitude. In this review, we summarize the major factors that regulate CBF to emphasize the integrated mechanisms, in addition to Pa(CO(2)), that control CBF. We discuss in detail the assessment and interpretation of cerebrovascular reactivity to CO(2). Next, we provide a detailed update on the integration of the role of cerebrovascular CO(2) reactivity and CBF in regulation of chemoreflex control of breathing in health and disease. Finally, we describe the use of a newly developed steady-state modeling approach to examine the effects of changes in CBF on the chemoreflex control of breathing and suggest avenues for future research.
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Affiliation(s)
- Philip N Ainslie
- Department of Physiology, University of Otago, Dunedin, New Zealand.
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Abstract
BACKGROUND AND PURPOSE Dynamic autoregulation has been studied predominantly in the middle cerebral artery (MCA). Because certain clinical conditions, ie, presyncopal symptoms or hypertensive encephalopathy, suggest a higher vulnerability of autoregulation within posterior parts of the brain, we investigated whether the cerebral blood flow velocity (CBFV) is modulated differently within the posterior cerebral artery (PCA). METHODS Spontaneous oscillations of CBFV and arterial blood pressure (ABP) in the frequency range of 0.5 to 20 cycles per minute were studied in 30 volunteers (supine and tilted positions). Analysis was based on the "high-pass filter model," which predicts a specific frequency-dependent phase and amplitude relationship between oscillations in CBFV to ABP. These parameters, characterized as phase shift angles and transfer function gains, were calculated from simultaneously recorded beat-to-beat blood pressure and transcranial Doppler signals of the PCA and MCA by means of cross-spectrum analysis. RESULTS In the MCA and PCA, phase shift angles were decreased, and gains were elevated with increasing oscillation frequency. The PCA gain values in supine and tilted positions were significantly higher than in the MCA. CONCLUSIONS The phase and amplitude relationship between CBFV and ABP showed a frequency dependence in the PCA similar to that in the MCA. The study therefore suggests that the high-pass filter model of dynamic cerebral autoregulation can be applied to the PCA. In this model the generally higher gain values in the PCA indicate a lower damping of ABP oscillations, which are transmitted to the posterior part of cerebral circulation.
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Affiliation(s)
- C Haubrich
- Department of Neurology, University Hospital Aachen, Pauwelsstrasse 31, 52074 Aachen, Germany.
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Park CW, Sturzenegger M, Douville CM, Aaslid R, Newell DW. Autoregulatory response and CO2 reactivity of the basilar artery. Stroke 2003; 34:34-9. [PMID: 12511747 DOI: 10.1161/01.str.0000047122.42591.b3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Transcranial Doppler has been extensively used to measure cerebrovascular control mechanisms, including autoregulation in humans and in patients with cerebrovascular diseases. There have been sufficient reports on the measurement of normal autoregulatory response (AR) and CO2 reactivity (CR) of the middle cerebral artery (MCA) but few reports of these indices for the basilar artery (BA). We measured AR and CR in the BA in healthy volunteers to determine normal values and compared them with simultaneous measurements made in the MCA. METHODS Sixteen normal subjects were enrolled. Time-averaged mean velocities of maximum blood flow in the BA and MCA were continuously and simultaneously monitored by using transcranial Doppler along with continuous measurement of mean arterial blood pressure (MABP). Values were obtained during rest, alterations of end-tidal PaCO2 (ETCO2), and acute decrease and recovery of MABP. AR was evaluated by using the thigh cuff method and graded by the standard dynamic autoregulatory index (ARI), with values between 0 and 9. CR was measured as percentage change in time-averaged mean velocity per mm Hg ETCO2. RESULTS The mean age of 16 subjects was 27.38+/-8.50 years. Average baseline values for MABP and ETCO2 were 82.29+/-7.10 and 42.75+/-3.77 mm Hg, respectively. Mean ARI was 4.62+/-1.26 for the BA and was 4.77+/-1.23 for the MCA (n=15) (P=0.598). Average CR was 2.54+/-0.39%/mm Hg ETCO2 for the BA and 2.51+/-0.29%/mm Hg ETCO2 for the MCA (n=16) (P=0.686). CONCLUSIONS Our study demonstrates that ARI and CR values for the BA are similar to those for the MCA.
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Affiliation(s)
- Cheol Wan Park
- Cerebrovascular Laboratory, Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle 98104-2499, USA.
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Gur AY, Bornstein NM. Cerebral vasomotor reactivity of the posterior circulation in patients with carotid occlusive disease. Eur J Neurol 2003; 10:75-8. [PMID: 12534998 DOI: 10.1046/j.1468-1331.2003.00533.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We evaluated the hemodynamic features of the posterior circulation in patients with severe carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. Sixty symptomatic and 111 asymptomatic patients with unilateral severe (>70%) internal carotid artery stenosis were studied. The VMR was 19.2 +/- 18.9% for the MCA ipsilateral to the stenosis and 27.3 +/- 17.4% on the contralateral side (P < 0.0001) for all patients. It was 18.2 +/- 23.2% for the VA ipsilateral to the stenosis and 19.7 +/- 21% on the contralateral side (P = NS). The symptomatic patients' VMR of the MCA on the side of stenosis and the opposite side were 19.2 +/- 17.6 and 29 +/- 17.2%, respectively (P < 0.03). The VMR of the VA remained similar (15.1 +/- 21 and 21.6 +/- 6%, respectively, P = NS). The asymptomatic patients' VMR of the MCA on the side of the stenosis was also lower (19.2 +/- 19.7 vs. 26.5 +/- 17.5% on the opposite side, P < 0.001). In contrast, the VMR in the VA was similar (19.8 +/- 21.4 and 18.7 +/- 19.5%, respectively, P < 0.6, NS). Thus, the VMR of the posterior circulation remained similar regardless of carotid stenosis and a symptomatic/asymptomatic course of carotid occlusive disease, suggesting an independent cerebral vascular reserve capacity of the posterior circulation.
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Affiliation(s)
- A Y Gur
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Barrett KM, Ackerman RH, Gahn G, Romero JM, Candia M. Basilar and middle cerebral artery reserve: a comparative study using transcranial Doppler and breath-holding techniques. Stroke 2001; 32:2793-6. [PMID: 11739975 DOI: 10.1161/hs1201.098640] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A 1997 report suggests that the posterior circulation of the normal brain has diminished vasoreactivity compared with the anterior circulation. To further study this, we quantified and compared the vasodilatory capacities of the middle cerebral (MCA) and basilar artery (BA) territories in response to changes in PaCO(2), as indices of respective cerebrovascular reserve (CVR). If posterior circulation CVR is indeed physiologically lower than that of the MCA, it might indicate a greater risk of low-flow ischemia distal to basilar obstructive cerebrovascular lesions and provide a rationale for earlier treatment of such lesions with interventional techniques. We also wished to establish normal baseline CVR values for the posterior circulation. METHODS Twelve patients with signs and/or symptoms suggestive of posterior circulation disease but without flow-limiting obstructive changes and 11 normal controls were entered into the study. With the use of transcranial Doppler techniques, alterations in blood flow velocity in response to sequential breath-holding trials of varying duration were simultaneously monitored in both MCAs and the BA. CVR was measured as the percent velocity increase (during breath-holding) from resting baseline values. RESULTS No significant differences were found in CVR between the MCA and BA territories in or between patients and controls. CONCLUSIONS Our study suggests that the anterior and posterior circulations have similar reserve capacities in individuals without flow-limiting cerebrovascular obstructive lesions and that the BA territory, relative to the MCA territory, is not at increased risk for low-flow stroke on the basis of limited reserve potential.
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Affiliation(s)
- K M Barrett
- Department of Neurology, Massachusetts General Hospital, and the Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
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Fukushima U, Miyashita K, Okano S, Higuchi S, Takase K, Hagio M. Evaluation of intracranial pressure by transcranial Doppler ultrasonography in dogs with intracranial hypertension. J Vet Med Sci 2000; 62:353-5. [PMID: 10770614 DOI: 10.1292/jvms.62.353] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transcranial Doppler ultrasonography (TCD) has been used to confirm changes in cerebral hemodynamics. In this study, we investigated whether the parameters for the basilar artery measured by TCD were correlated with the intracranial and cerebral perfusion pressures in extreme intracranial hypertension. An intracranial hypertension model was produced in seven dogs by inflating a balloon inserted into the epidural space. The resistance index was compared with the corresponding intracranial pressure and cerebral perfusion pressure values during intracranial hypertension. A significant correlation was recognized between the resistance index and cerebral perfusion pressure. Therefore, measurement of the basilar artery by TCD in the dog with intracranial hypertension is useful in estimating the intracranial circulation in cases where the measurement of intracranial pressure is not available or not indicated.
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Affiliation(s)
- U Fukushima
- Department of Small Animal Medicine, School of Veterinary Medicine and Animal Sciences, Kitasuro University, Towada, Aomori, Japan
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Fukushima U, Sasaki S, Okano S, Takase K, Hagio M. The comparison between the cerebral blood flow directly measures and cerebral blood flow velocity in the middle and basilar cerebral arteries measured by transcranial Doppler ultrasonography. J Vet Med Sci 1999; 61:1293-7. [PMID: 10651049 DOI: 10.1292/jvms.61.1293] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transcranial Doppler ultrasonography (TCD) may be useful for determining alterations in cerebral blood flow (CBF) during excessive hemodynamic changes by non-invasive measurement of the CBF velocity. The purpose of this study was to measure the correlation between CBF and the middle cerebral artery (MCA) and basilar artery (BA) flow velocities, as measured by TCD during excessive hemodynamic changes produced by hypertension and hypotension in adult dogs. The peak, diastolic, and mean flow velocities were measured by TCD. Arterial hypertension was induced by administration of dopamine at 5 and 15 microg/kg/min, and hypotension was induced by hemorrhage. During the hemodynamic changes, the BA velocity correlated more closely with the alteration in the CBF than the MCA velocity. In terms of percentages of the values during anesthesia, there was good correlation between CBF and the MCA and BA velocities. In conclusion, our findings indicate that MCA and BA velocity measurements, as a percentage of the values during anesthesia, both give an equally accurate indication of alterations in CBF during excessive hemodynamic changes.
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Affiliation(s)
- U Fukushima
- Department of Small Animal Medicine, School of Veterinary Medicine and Animal Sciences, Kitasato University, Aomori, Japan
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