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Kim WJ, Samarage HM, Jafari M, Zarrin D, Goel K, Qi X, Wang AC, Johnson J, Colby GP. Novel endovascular transmural technique for pharmacological block of superior cervical ganglion prevents sympathetic-mediated cerebral vasospasm. J Neurointerv Surg 2024; 16:770-774. [PMID: 37500479 PMCID: PMC10818000 DOI: 10.1136/jnis-2023-020636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Sympathetic-mediated vasoconstriction from the superior cervical ganglion (SCG) is a significant contributor to cerebral vasospasm. Inhibition of the SCG has been shown to improve cerebral blood flow and reverse cerebral vasospasm in swine models. We evaluated the efficacy of a novel minimally invasive endovascular approach to target and pharmacologically inhibit the SCG, using a Micro-Infusion Device for transmural drug delivery. METHODS Eight SCGs in four Yorkshire swine were surgically identified. After confirming appropriate sympathetic-mediated intracranial vasoconstriction response with SCG stimulation, an endovascular Micro-Infusion Device was used for transmural targeting of the SCG and delivery of 1.5-2 mL of 1% lidocaine-contrast mixture to the perivascular space. Digital subtraction angiography was obtained at: (1) baseline; (2) with SCG stimulation; and (3) after lidocaine delivery to the SCG using the Micro-Infusion Device with concurrent SCG stimulation. Vessel diameters were measured and compared. RESULTS Endovascular transmural delivery of lidocaine to the SCG and carotid perivascular tissue using the Micro-Infusion Device successfully inhibited sympathetic-mediated vasoconstriction response. Measured vessel diameters after lidocaine delivery were comparable to baseline despite SCG stimulation. CONCLUSION A novel endovascular technique of transmural delivery of lidocaine to the SCG and carotid artery perivascular tissues successfully inhibits the sympathetic input to the cerebral vasculature and modulates sympathetic-mediated cerebral vasospasm. These results suggest promising steps towards translation to potential clinical use for patients suffering from cerebral vasospasm.
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Affiliation(s)
- Wi Jin Kim
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Hasitha Milan Samarage
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Matiar Jafari
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - David Zarrin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Keshav Goel
- University of California Los Angeles, Los Angeles, California, USA
| | - Xin Qi
- School of Medicine, UCLA, Los Angeles, California, USA
| | - Anthony C Wang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
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Katz BM, Walton LR, Houston KM, Cerri DH, Shih YYI. Putative neurochemical and cell type contributions to hemodynamic activity in the rodent caudate putamen. J Cereb Blood Flow Metab 2023; 43:481-498. [PMID: 36448509 PMCID: PMC10063835 DOI: 10.1177/0271678x221142533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022]
Abstract
Functional magnetic resonance imaging (fMRI) is widely used by researchers to noninvasively monitor brain-wide activity. The traditional assumption of a uniform relationship between neuronal and hemodynamic activity throughout the brain has been increasingly challenged. This relationship is now believed to be impacted by heterogeneously distributed cell types and neurochemical signaling. To date, most cell-type- and neurotransmitter-specific influences on hemodynamics have been examined within the cortex and hippocampus of rodent models, where glutamatergic signaling is prominent. However, neurochemical influences on hemodynamics are relatively unknown in largely GABAergic brain regions such as the rodent caudate putamen (CPu). Given the extensive contribution of CPu function and dysfunction to behavior, and the increasing focus on this region in fMRI studies, improved understanding of CPu hemodynamics could have broad impacts. Here we discuss existing findings on neurochemical contributions to hemodynamics as they may relate to the CPu with special consideration for how these contributions could originate from various cell types and circuits. We hope this review can help inform the direction of future studies as well as interpretation of fMRI findings in the CPu.
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Affiliation(s)
- Brittany M Katz
- Neuroscience Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Animal MRI, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsay R Walton
- Center for Animal MRI, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kaiulani M Houston
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Domenic H Cerri
- Center for Animal MRI, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yen-Yu Ian Shih
- Neuroscience Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Animal MRI, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kim WJ, Dacey M, Samarage HM, Zarrin D, Goel K, Chan C, Qi X, Wang A, Shivkumar K, Ardell J, Colby G. Sympathetic nervous system hyperactivity results in potent cerebral hypoperfusion in swine. Auton Neurosci 2022; 241:102987. [DOI: 10.1016/j.autneu.2022.102987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/14/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
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Koike H, Morikawa M, Uetani M, Sato C, Tsuda M. A case of intracranial vasospasm in a patient with extensive retropharyngeal cellulitis. Radiol Case Rep 2021; 16:2697-2700. [PMID: 34345332 PMCID: PMC8319001 DOI: 10.1016/j.radcr.2021.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
Retropharyngeal cellulitis/abscesses are deep neck infections that may become life-threatening if airway compromise occurs. This condition is more common in children than in adults, and associated intracranial vessel narrowing has been reported. We report an adult patient with extensive retropharyngeal cellulitis and intracranial vasospasm. The patient was a 62-year-old woman who presented with fever, sore throat, and neck pain. She also had uncontrolled type 2 diabetes mellitus. Leukocytosis, prolonged erythrocyte sedimentation rate, elevated C-reactive protein, and hyperglycemia were present on admission. Computed tomography and contrast-enhanced magnetic resonance imaging revealed severe swelling in the nasopharyngeal, retropharyngeal, prevertebral, and bilateral carotid spaces. Gadolinium enhancement extended to the middle cranial fossa and visceral space. Multiple stenoses in several intracranial vessels was also identified. Intravenous antibiotic therapy was initiated, the patient's symptoms resolved, and repeat imaging confirmed improvement. Intracranial vasospasm should be considered in patients with retropharyngeal cellulitis.
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Affiliation(s)
- Hirofumi Koike
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Minoru Morikawa
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chisei Sato
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masayuki Tsuda
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Zhang J, Nie Y, Pang Q, Zhang X, Wang Q, Tang J. Effects of stellate ganglion block on early brain injury in patients with subarachnoid hemorrhage: a randomised control trial. BMC Anesthesiol 2021; 21:23. [PMID: 33472582 PMCID: PMC7816408 DOI: 10.1186/s12871-020-01215-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Subarachnoid hemorrhage (SAH) is a common neurosurgical emergency, and early brain injury (EBI) plays an important role in acute brain injury of SAH. Our objective is to investigate the effect of stellate ganglion block (SGB) on the clinical prognosis of patients with SAH (registration number ChiCTR2000030910). Methods A randomized controlled trial was conducted with 102 participants. Patients with SAH were assigned to the SGB or nSGB group. Patients in the SGB group received SGB four times (once every other day starting on the day of the surgery). In contrast, patients in the nSGB group only received standard care. Data were collected on the day before surgery (T0) and on the 1st (T1), 3rd (T2) and 7th day (T3) after surgery. The primary outcomes included EBI markers (including IL-1β, IL-6, TNF-α, ET-1, NPY, NSE and S100β), the mean cerebral blood flow velocity of the middle cerebral artery (Vm-MCA) and the basilar artery (Vm-BA). All cases were followed up for 6 months after surgery. Results The levels of the EBI markers in both groups were higher at T1–T3 than at T0 (P<0.05), and the Vm-MCA and Vm-BA were also increased at the same times. However, the levels of the EBI markers were lower in the SGB group than in the nSGB group (P<0.05), and the increases of Vm-MCA and Vm-BA were also lower (P<0.05). The prognosis score and neurological deficit were better in the SGB group than in the nSGB group (P<0.05). Conclusions SGB can improve the prognosis of SAH patients by inhibiting the inflammatory response during EBI and by reducing endothelial dysfunction and relieving CVS. Trial registration Clinical trial number: ChiCTR2000030910; Registry URL: Chinese Clinical Trial Registry; Principal investigator's name: Ying Nie; Date of Trial registration: March, 2020 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-020-01215-3.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, 999 Brain Hospital, Guangzhou, 510515, Guangdong, China
| | - Ying Nie
- Department of Anesthesiology, 999 Brain Hospital, Guangzhou, 510515, Guangdong, China
| | - Qiongni Pang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xubiao Zhang
- Department of Neurosurgery, 999 Brain Hospital, Guangzhou, 510515, Guangdong, China
| | - Qianting Wang
- Department of Neurosurgery, 999 Brain Hospital, Guangzhou, 510515, Guangdong, China
| | - Jing Tang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China. .,Department of Anesthesia, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong, China.
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Ashley JD, Shelley JH, Sun J, Song J, Trent JA, Ambrosio LD, Larson DJ, Larson RD, Yabluchanskiy A, Kellawan JM. Cerebrovascular responses to graded exercise in young healthy males and females. Physiol Rep 2020; 8:e14622. [PMID: 33112497 PMCID: PMC7592493 DOI: 10.14814/phy2.14622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/04/2020] [Indexed: 01/06/2023] Open
Abstract
Although systemic sex-specific differences in cardiovascular responses to exercise are well established, the comparison of sex-specific cerebrovascular responses to exercise has gone under-investigated especially, during high intensity exercise. Therefore, our purpose was to compare cerebrovascular responses in males and females throughout a graded exercise test (GXT). Twenty-six participants (13 Females and 13 Males, 24 ± 4 yrs.) completed a GXT on a recumbent cycle ergometer consisting of 3-min stages. Each sex completed 50W, 75W, 100W stages. Thereafter, power output increased 30W/stage for females and 40W/stage for males until participants were unable to maintain 60-80 RPM. The final stage completed by the participant was considered maximum workload(Wmax ). Respiratory gases (End-tidal CO2 , EtCO2 ), middle cerebral artery blood velocity (MCAv), heart rate (HR), non-invasive mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) were continuously recorded on a breath-by-breath or beat-by-beat basis. Cerebral perfusion pressure, CPP = MAP (0. 7,355 distance from heart-level to doppler probe) and cerebral vascular conductance index, CVCi = MCAv/CPP 100mmHg were calculated. The change from baseline (Δ) in MCAv was similar between the sexes during the GXT (p = .091, ωp2 = 0.05). However, ΔCPP (p < .001, ωp2 = 0.25) was greater in males at intensities ≥ 80% Wmax and ΔCVCi (p = .005, ωp2 = 0.15) was greater in females at 100% Wmax . Δ End-tidal CO2 (ΔEtCO2 ) was not different between the sexes during exercise (p = .606, ωp2 = -0.03). These data suggest there are sex-specific differences in cerebrovascular control, and these differences may only be identifiable at high and severe intensity exercise.
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Affiliation(s)
- John D. Ashley
- Department of Health and Exercise ScienceHuman Circulation Research LaboratoryUniversity of OklahomaNormanOKUSA
| | - Joe H. Shelley
- Department of Health and Exercise ScienceHuman Circulation Research LaboratoryUniversity of OklahomaNormanOKUSA
| | - Jongjoo Sun
- Department of Health and Exercise ScienceHuman Circulation Research LaboratoryUniversity of OklahomaNormanOKUSA
| | - Jiwon Song
- Department of Health and Exercise ScienceHuman Circulation Research LaboratoryUniversity of OklahomaNormanOKUSA
| | - Jacob A. Trent
- Department of Health and Exercise ScienceHuman Circulation Research LaboratoryUniversity of OklahomaNormanOKUSA
| | - Luis D. Ambrosio
- Department of Health and Exercise ScienceHuman Circulation Research LaboratoryUniversity of OklahomaNormanOKUSA
| | - Daniel J. Larson
- Department of Health and Exercise Science, Sport, Health, and Exercise Data Analytics LaboratoryUniversity of OklahomaNormanOKUSA
| | - Rebecca D. Larson
- Department of Health and Exercise ScienceBody Composition and Physical Performance Research LaboratoryUniversity of OklahomaNormanOKUSA
| | - Andriy Yabluchanskiy
- Oklahoma Center for GeroscienceDepartment of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - J. Mikhail Kellawan
- Department of Health and Exercise ScienceHuman Circulation Research LaboratoryUniversity of OklahomaNormanOKUSA
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Bortolato A, Simonato D, Feltracco P, Munari M. Continuous stellate ganglion block in delayed cerebral ischemia: A possible supplementary approach to traditional therapy? J Anaesthesiol Clin Pharmacol 2020; 36:265-267. [PMID: 33013046 PMCID: PMC7480307 DOI: 10.4103/joacp.joacp_251_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/08/2019] [Accepted: 10/24/2019] [Indexed: 11/22/2022] Open
Abstract
Delayed Cerebral Ischemia (DCI) is a major contributor to morbidity and mortality after SAH. Currently the prevention of vasospasm and DCI relies on nimodipine administration and on maintaining an adequate cerebral perfusion pressure. We report a patient with initial DCI after SAH in which stellate ganglion block (SGB) was performed after nimodipine administration. Firstly the procedure was characterized by a iv and intra-arterial nimodipine administration which did not result into a normal perfusion pattern. Therefore a single-shot stellate ganglion block was performed, as suggested in literature. Because of the not sufficient but promising perfusion improvement, we decided to deliver a continuous ganglion block (cSGB) for 5 days. Consequently a further improvement of the cerebral perfusion on CTPerfusion and Real Time Angiographic Perfusion Assessment was registered. In order to treat cerebral vasospasm, SGB is known to be a further valuable treatment, despite its temporary effect. However the continuous use of SGB during initial DCI has never been described before.
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8
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Özbay PS, Chang C, Picchioni D, Mandelkow H, Chappel-Farley MG, van Gelderen P, de Zwart JA, Duyn J. Sympathetic activity contributes to the fMRI signal. Commun Biol 2019; 2:421. [PMID: 31754651 PMCID: PMC6861267 DOI: 10.1038/s42003-019-0659-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
The interpretation of functional magnetic resonance imaging (fMRI) studies of brain activity is often hampered by the presence of brain-wide signal variations that may arise from a variety of neuronal and non-neuronal sources. Recent work suggests a contribution from the sympathetic vascular innervation, which may affect the fMRI signal through its putative and poorly understood role in cerebral blood flow (CBF) regulation. By analyzing fMRI and (electro-) physiological signals concurrently acquired during sleep, we found that widespread fMRI signal changes often co-occur with electroencephalography (EEG) K-complexes, signatures of sub-cortical arousal, and episodic drops in finger skin vascular tone; phenomena that have been associated with intermittent sympathetic activity. These findings support the notion that the extrinsic sympathetic innervation of the cerebral vasculature contributes to CBF regulation and the fMRI signal. Accounting for this mechanism could help separate systemic from local signal contributions and improve interpretation of fMRI studies.
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Affiliation(s)
- Pinar Senay Özbay
- Advanced MRI Section, LFMI, NINDS, National Institutes of Health, Bethesda, MD USA
| | | | - Dante Picchioni
- Advanced MRI Section, LFMI, NINDS, National Institutes of Health, Bethesda, MD USA
| | - Hendrik Mandelkow
- Advanced MRI Section, LFMI, NINDS, National Institutes of Health, Bethesda, MD USA
| | | | - Peter van Gelderen
- Advanced MRI Section, LFMI, NINDS, National Institutes of Health, Bethesda, MD USA
| | | | - Jeff Duyn
- Advanced MRI Section, LFMI, NINDS, National Institutes of Health, Bethesda, MD USA
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Effects of Voluntary Locomotion and Calcitonin Gene-Related Peptide on the Dynamics of Single Dural Vessels in Awake Mice. J Neurosci 2016; 36:2503-16. [PMID: 26911696 DOI: 10.1523/jneurosci.3665-15.2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The dura mater is a vascularized membrane surrounding the brain and is heavily innervated by sensory nerves. Our knowledge of the dural vasculature has been limited to pathological conditions, such as headaches, but little is known about the dural blood flow regulation during behavior. To better understand the dynamics of dural vessels during behavior, we used two-photon laser scanning microscopy (2PLSM) to measure the diameter changes of single dural and pial vessels in the awake mouse during voluntary locomotion. Surprisingly, we found that voluntary locomotion drove the constriction of dural vessels, and the dynamics of these constrictions could be captured with a linear convolution model. Dural vessel constrictions did not mirror the large increases in intracranial pressure (ICP) during locomotion, indicating that dural vessel constriction was not caused passively by compression. To study how behaviorally driven dynamics of dural vessels might be altered in pathological states, we injected the vasodilator calcitonin gene-related peptide (CGRP), which induces headache in humans. CGRP dilated dural, but not pial, vessels and significantly reduced spontaneous locomotion but did not block locomotion-induced constrictions in dural vessels. Sumatriptan, a drug commonly used to treat headaches, blocked the vascular and behavioral the effects of CGRP. These findings suggest that, in the awake animal, the diameters of dural vessels are regulated dynamically during behavior and during drug-induced pathological states.
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Gao YR, Greene SE, Drew PJ. Mechanical restriction of intracortical vessel dilation by brain tissue sculpts the hemodynamic response. Neuroimage 2015; 115:162-76. [PMID: 25953632 PMCID: PMC4470397 DOI: 10.1016/j.neuroimage.2015.04.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/28/2015] [Accepted: 04/27/2015] [Indexed: 12/22/2022] Open
Abstract
Understanding the spatial dynamics of dilation in the cerebral vasculature is essential for deciphering the vascular basis of hemodynamic signals in the brain. We used two-photon microscopy to image neural activity and vascular dynamics in the somatosensory cortex of awake behaving mice during voluntary locomotion. Arterial dilations within the histologically-defined forelimb/hindlimb (FL/HL) representation were larger than arterial dilations in the somatosensory cortex immediately outside the FL/HL representation, demonstrating that the vascular response during natural behaviors was spatially localized. Surprisingly, we found that locomotion drove dilations in surface vessels that were nearly three times the amplitude of intracortical vessel dilations. The smaller dilations of the intracortical arterioles were not due to saturation of dilation. Anatomical imaging revealed that, unlike surface vessels, intracortical vessels were tightly enclosed by brain tissue. A mathematical model showed that mechanical restriction by the brain tissue surrounding intracortical vessels could account for the reduced amplitude of intracortical vessel dilation relative to surface vessels. Thus, under normal conditions, the mechanical properties of the brain may play an important role in sculpting the laminar differences of hemodynamic responses.
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Affiliation(s)
- Yu-Rong Gao
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802, USA; Neuroscience Graduate Program, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802, USA
| | - Stephanie E Greene
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802, USA
| | - Patrick J Drew
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802, USA; Neuroscience Graduate Program, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802, USA; Department of Neurosurgery, Pennsylvania State University, University Park, PA 16802, USA.
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Kim MS, Yoon KB, Yoon DM, Kim DH. Effect of cervical sympathetic block on optic nerve sheath diameter measured by ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1599-1604. [PMID: 25747936 DOI: 10.1016/j.ultrasmedbio.2015.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
Optic nerve sheath diameter (ONSD) measurement using ocular ultrasonography was introduced as a non-invasive technique to assess intracranial pressure. We investigated changes in ONSD after cervical sympathetic block (CSB). Ultrasound-guided CSB was performed with a lateral approach at the C6 level in 35 patients. ONSD was measured before CSB and after checking for Horner's syndrome 15 minutes after CSB. The mean ONSD was significantly higher after CSB than before (5.15 ± 0.38 mm vs. 4.75 ± 0.32 mm, p < 0.001). A comparison of ONSDs between the blocked and non-blocked sides revealed that these values did not differ significantly between sides at baseline and after CSB. On the basis of these preliminary data, CSB caused an increase in ONSD in patients without intracranial pathology or neurologic disorders. Further larger and controlled studies of the effect of CSB on intracranial pressure in humans are needed to confirm our findings.
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Affiliation(s)
- Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Mi Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Do-Hyeong Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Nogami S, Yamauchi K, Shiiba S, Kataoka Y, Hirayama B, Takahashi T. Evaluation of the Treatment Modalities for Neurosensory Disturbances of the Inferior Alveolar Nerve Following Retromolar Bone Harvesting for Bone Augmentation. PAIN MEDICINE 2015; 16:501-12. [DOI: 10.1111/pme.12618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hu N, Wu Y, Chen BZ, Han JF, Zhou MT. Protective effect of stellate ganglion block on delayed cerebral vasospasm in an experimental rat model of subarachnoid hemorrhage. Brain Res 2014; 1585:63-71. [DOI: 10.1016/j.brainres.2014.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/27/2014] [Accepted: 08/07/2014] [Indexed: 11/26/2022]
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Ulvi H, Demir R, Aygül R, Kotan D, Çalik M, Aydin MD. Effects of ischemic phrenic nerve root ganglion injury on respiratory disturbances in subarachnoid hemorrhage: an experimental study. Arch Med Sci 2013; 9:1125-31. [PMID: 24482661 PMCID: PMC3902712 DOI: 10.5114/aoms.2013.39227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 10/24/2011] [Accepted: 11/19/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Phrenic nerves have important roles on the management of respiration rhythm. Diaphragm paralysis is possible in phrenic nerve roots ischemia in subarachnoid hemorrhage (SAH). We examined whether there is a relationship between phrenic nerve root ischemia and respiratory disturbances in SAH. MATERIAL AND METHODS This study was conducted on 5 healthy control and 14 rabbits with experimentally induced SAH by injecting autologous blood into their cisterna magna. Animals were followed up via monitors for detecting the heart and respiration rhythms for 20 days and then decapitaed by humanely. Normal and degenerated neuron densities of phrenic nerve root at the level of C4 dorsal root ganglia (C4DRG) were estimated by Stereological methods. Between the mean numerical density of degenerated neurons of C4DRG and respiratory rate/minute of groups were compared statistically. RESULTS Phrenic nerve roots, artery and diaphragm muscles degeneration was detected in respiratory arrest developed animals. The mean neuronal density of C4DRG was 13272 ±1201/mm3 with a mean respiration rate of 23 ±4/min in the control group. The mean degenerated neuron density was 2.240 ±450/mm(3) and respiration rhythm was 31 ±6/min in survivors. But, the mean degenerated neuron density was 5850 ±650/mm(3) and mean respiration rhythm was 34 ±7/min in respiratory arrest developed animals (n = 7). A linear relationship was noticed between the degenerated neuron density of C4DRG and respiraton rate (r = -0.758; p < 0.001). CONCLUSIONS Phrenic nerve root ischemia may be an important factor in respiration rhythms deteriorations in SAH which has not been mentioned in the literature.
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Affiliation(s)
- Hızır Ulvi
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Recep Demir
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Recep Aygül
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Muhammet Çalik
- Department of Pathology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Mehmet Dumlu Aydin
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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15
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Elman I, Gurvits TV, Tschibelu E, Spring JD, Lasko NB, Pitman RK. Neurological soft signs in individuals with pathological gambling. PLoS One 2013; 8:e60885. [PMID: 23593341 PMCID: PMC3617209 DOI: 10.1371/journal.pone.0060885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/04/2013] [Indexed: 01/26/2023] Open
Abstract
Increased neurological soft signs (NSSs) have been found in a number of neuropsychiatric syndromes, including chemical addiction. The present study examined NSSs related to perceptual-motor and visuospatial processing in a behavioral addiction viz., pathological gambling (PG). As compared to mentally healthy individuals, pathological gamblers displayed significantly poorer ability to copy two- and three-dimensional figures, to recognize objects against a background noise, and to orient in space on a road-map test. Results indicated that PG is associated with subtle cerebral cortical abnormalities. Further prospective clinical research is needed to address the NSSs' origin and chronology (e.g., predate or follow the development of PG) as well as their response to therapeutic interventions and/or their ability to predict such a response.
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Affiliation(s)
- Igor Elman
- Providence VA Medical Center, Harvard Medical School, Cambridge, Massachusetts, United States of America.
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16
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Ibrahim GM, Macdonald RL. Electrocardiographic Changes Predict Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage. Stroke 2012; 43:2102-7. [DOI: 10.1161/strokeaha.112.658153] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- George M. Ibrahim
- From the Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - R. Loch Macdonald
- From the Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Jain V, Rath GP, Dash HH, Bithal PK, Chouhan RS, Suri A. Stellate ganglion block for treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage - A preliminary study. J Anaesthesiol Clin Pharmacol 2011; 27:516-21. [PMID: 22096287 PMCID: PMC3214559 DOI: 10.4103/0970-9185.86598] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stellate ganglion block improves cerebral perfusion by decreasing the cerebral vascular tone. Its effects on cerebral vasospasm to relieve neurological deficits have not been evaluated. This prospective observational study was carried out to evaluate the effect of stellate ganglion block on cerebral hemodynamics in patients with symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. MATERIALS AND METHODS Fifteen patients of either sex, aged 18-75 years, who underwent surgical clipping of aneurysm and developed refractory cerebral vasospasm were included. Stellate ganglion block was performed using 10 ml of bupivacaine 0.5% on the side with maximum cerebral blood flow velocity. Neurological status, cerebral blood flow velocity and pulsatility index were assessed before and 10 minutes, 30 minutes, 2 hours, 6 hours, 12 hours and 24 hours after stellate ganglion block. RESULTS Improved Glasgow coma score was observed 30 minutes after stellate ganglion block. Neurological deficits reduced in 11 patients. Ipsilateral middle cerebral artery mean flow velocity decreased from 133.66 cm/sec before stellate ganglion block to 110.53 cm/sec at 6 hours (P<0.001) and 121.62 cm/sec at 24 hours (P<0.001) after stellate ganglion block. There was a decrease in ipsilateral anterior cerebral artery mean flow velocity after stellate ganglion block (P<0.001), which persisted for 12 hours. A decline in flow velocities was observed in contralateral middle cerebral artery (P=0.008) and anterior cerebral artery (P=0.041) for 12 hours. CONCLUSION This study suggests stellate ganglion block to be an effective modality of treatment for refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Virendra Jain
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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18
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Kanat A, Yilmaz A, Aydin MD, Musluman M, Altas S, Gursan N. Role of degenerated neuron density of dorsal root ganglion on anterior spinal artery vasospasm in subarachnoid hemorrhage: experimental study. Acta Neurochir (Wien) 2010; 152:2167-72. [PMID: 20835838 DOI: 10.1007/s00701-010-0793-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/30/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND The spinal arteries are innervated by several systems that contribute to the control of spinal cord blood flow. The sensory fibers of upper cervical nerves have vasodilatatory effect on the anterior spinal arteries (ASA). Subarachnoid hemorrhage (SAH) causes severe vasospasm by various neurochemical mechanisms. We examined whether there is a relationship between the neuron density of the C3 dorsal root ganglion and the severity of ASA vasospasm in SAH. METHODS This study was conducted on 20 rabbits. Four of them were used as baseline group. Experimental SAH has been applied to all of 16 animals by injecting homologous blood into cisterna magna. After 20 days of injection, ASA and C3 dorsal root ganglia (C3DRG) were examined histopathologically. ASA volume values and normal and degenerated neuron densities of C3DRG were estimated stereologically and the results were analyzed statistically. RESULTS The mean ASA volume was 1.050±0.450 mm³, [corrected] and the mean neuronal density of C3DRG was 10,500 ± 850 in all animals. The mean volume value of ASA was 0.970±0.150 [corrected] mm³, and the normal neuron density of C3DRG fell to 8,600 ± 400/mm³ in slight vasospasm group. In severe vasospasm-developed animals, mean volume value of ASA was 0.540±0.90 [corrected]mm³ and the normal neuron density of C3DRG fell to 5,500 ± 360/mm³. An inverse relationship between the degenerated neuronal density of the C3DRG and ASA volume values may indicate the severity of ASA vasospasm. CONCLUSION The neuron density of C3DRG may be an important factor on the regulation of ASA volume values and the continuation of spinal cord blood flow. Low neuron density of C3DRG may be considered as an important factor in the pathogenesis of severe ASA vasospasm in SAH.
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Affiliation(s)
- Ayhan Kanat
- Department of Neurosurgery, Rize University, Turkey.
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19
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Cho EJ, Shim HS, Park CM. The effects of superior cervical ganglionectomy on the anxiety in the rats. Korean J Anesthesiol 2009; 57:742-748. [DOI: 10.4097/kjae.2009.57.6.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eun Jung Cho
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Seon Shim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chong Min Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Cassaglia PA, Griffiths RI, Walker AM. Sympathetic nerve activity in the superior cervical ganglia increases in response to imposed increases in arterial pressure. Am J Physiol Regul Integr Comp Physiol 2008; 294:R1255-61. [PMID: 18216142 DOI: 10.1152/ajpregu.00332.2007] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sympathetic vasoconstriction of cerebral vessels has been proposed to be a protective mechanism for the brain, limiting cerebral perfusion and microcirculatory pressure during transient increases in arterial pressure. To furnish direct neural evidence for this proposition, we aimed to develop a method for recording cerebral sympathetic nerve activity (SNA) from the superior cervical ganglion (SCG). We hypothesized that SNA recorded from the SCG increases during imposed hypertension, but not during hypotension. Lambs (n = 11) were anesthetized (alpha-chloralose, 20 mg.kg(-1).h(-1)) and ventilated. SNA was measured using 25-microm tungsten microelectrodes inserted into the SCG. Arterial blood pressure (AP) was pharmacologically raised (adrenaline, phenylephrine, or ANG II, 1-50 microg/kg iv), mechanically raised (intravascular balloon in the thoracic aorta), or lowered (sodium nitroprusside, 1-50 microg/kg iv). In response to adrenaline (n = 10), mean AP increased 135 +/- 10% from baseline (mean +/- SE), and the RMS value of SNA (Square Root of the Mean of the Squares, SNA(RMS)) increased 255 +/- 120%. In response to mechanically induced hypertension, mean AP increased 43 +/- 3%, and SNA(RMS) increased 53 +/- 13%. Generally, (9 of 10 animals), SNA(RMS) did not increase, as AP was lowered with sodium nitroprusside. Using a new model for direct recording of cerebral SNA from the SCG, we have demonstrated that SNA increases in response to large induced rises, but not falls, in AP. These findings furnish direct support for the proposed protective role for sympathetic nerves in the cerebral circulation.
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Affiliation(s)
- Priscila A Cassaglia
- Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Clayton, Melbourne, VIC 3168, Australia
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21
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Jeon HY, Joung KW, Choi JM, Kim YK, Shin JW, Leem JG, Han SM. The Effects of Superior Cervical Sympathetic Ganglion Block on the Acute Phase Injury and Long Term Protection against Focal Cerebral Ischemia/Reperfusion Injury in Rats. Korean J Pain 2008. [DOI: 10.3344/kjp.2008.21.2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hae Young Jeon
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Woon Joung
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Moon Choi
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo Kyung Kim
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Shin
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Gill Leem
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Min Han
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, Korea
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22
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Kim HH, Leem JG, Shin JW, Shim JY, Lee DM. Superior Cervical Sympathetic Ganglion Block may not Influence Early Brain Damage Induced by Permanent Focal Cerebral Ischemia in Rats. Korean J Pain 2008. [DOI: 10.3344/kjp.2008.21.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyun Hae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan Univercity College of Medicine, Seoul, Korea
| | - Jeong Gill Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan Univercity College of Medicine, Seoul, Korea
| | - Jin Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan Univercity College of Medicine, Seoul, Korea
| | - Ji Yeon Shim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan Univercity College of Medicine, Seoul, Korea
| | - Dong Myung Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan Univercity College of Medicine, Seoul, Korea
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23
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Prabhakar H, Jain V, Rath GP, Bithal PK, Dash HH. Stellate Ganglion Block as Alternative to Intrathecal Papaverine in Relieving Vasospasm Due to Subarachnoid Hemorrhage. Anesth Analg 2007; 104:1311-2. [PMID: 17456713 DOI: 10.1213/01.ane.0000260467.57144.57] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Lee AR, Yoon MO, Kim HH, Choi JM, Jeon HY, Shin JW, Leem JG. Effect of Superior Cervical Sympathetic Ganglion Block on Brain Injury Induced by Focal Cerebral Ischemia/Reperfusion in a Rat Model. Korean J Pain 2007. [DOI: 10.3344/kjp.2007.20.2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ae Ryoung Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Mi Ok Yoon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Hae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hae Yuong Jeon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Gill Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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25
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He J, Devonshire IM, Mayhew JEW, Papadakis NG. Simultaneous laser Doppler flowmetry and arterial spin labeling MRI for measurement of functional perfusion changes in the cortex. Neuroimage 2006; 34:1391-404. [PMID: 17188519 DOI: 10.1016/j.neuroimage.2006.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 10/13/2006] [Accepted: 11/07/2006] [Indexed: 11/30/2022] Open
Abstract
This study compares laser Doppler flowmetry (LDF) and arterial spin labeling (ASL) for the measurement of functional changes in cerebral blood flow (CBF). The two methods were applied concurrently in a paradigm of electrical whisker stimulation in the anaesthetised rat. Multi-channel LDF was used, with each channel corresponding to different fiber separation (and thus measurement depth). Continuous ASL was applied using separate imaging and labeling coils at 3 T. Careful experimental set up ensured that both techniques recorded from spatially concordant regions of the barrel cortex, where functional responses were maximal. Strong correlations were demonstrated between CBF changes measured by each LDF channel and ASL in terms of maximum response magnitude and response time-course within a 6-s-long temporal resolution imposed by ASL. Quantitatively, the measurements of the most superficial LDF channels agreed strongly with those of ASL, whereas the deeper LDF channels underestimated consistently the ASL measurement. It was thus confirmed that LDF quantifies CBF changes consistently at a superficial level, and for this case the two methods provided concordant measures of functional CBF changes, despite their essentially different physical principles and spatiotemporal characteristics.
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Affiliation(s)
- Jiabao He
- Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
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26
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Gupta MM, Bithal PK, Dash HH, Chaturvedi A, Mahajan RP. Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography. Br J Anaesth 2005; 95:669-73. [PMID: 16155036 DOI: 10.1093/bja/aei230] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stellate ganglion block (SGB) causes vasodilatation in the skin of the head and neck because of regional sympathetic block. Its effects on cerebral haemodynamics, in health or in disease, are not clear. We evaluated the effects of SGB on ipsilateral middle cerebral artery flow velocity (MCAFV), estimated cerebral perfusion pressure (eCPP), zero flow pressure (ZFP), carbon dioxide reactivity (CO2R) and cerebral autoregulation using transcranial Doppler ultrasonography (TCD). METHODS Twenty male patients, with pre-existing brachial plexus injury, and undergoing SGB for the treatment of complex regional pain syndrome of the upper limb, were studied. For SGB, 10 ml of plain lidocaine 2% was used and the onset of block was confirmed by presence of ipsilateral Horner's syndrome. The MCAFV, eCPP, ZFP, CO2R, and cerebral autoregulation were assessed before and after SGB using established TCD methods. The changes in these variables were analysed using Wilcoxon's signed rank test. RESULTS The block caused a significant decrease in MCAFV from median (inter-quartile range) value of 61 (53, 67) to 55 (46, 60) cm s(-1), a significant increase in eCPP from 59 (51, 67) to 70 (60, 78) mm Hg, and a significant decrease in ZFP from 32 (26, 39) to 25 (16, 30) mm Hg. There were no significant changes in CO2R or cerebral autoregulation. CONCLUSION The increase in eCPP, decrease in ZFP, and no changes in CO2R or cerebral autoregulation suggest that the SGB decreases cerebral vascular tone without affecting the capacity of the vessels to autoregulate. These effects may be of therapeutic advantage in relieving cerebral vasospasm in certain clinical settings.
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Affiliation(s)
- M M Gupta
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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27
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Treggiari MM, Romand JA, Martin JB, Reverdin A, Rüfenacht DA, de Tribolet N. Cervical sympathetic block to reverse delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. Stroke 2003; 34:961-7. [PMID: 12649526 DOI: 10.1161/01.str.0000060893.72098.80] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the present study was to evaluate the feasibility and safety of a locoregional cervical sympathetic block to improve cerebral perfusion in patients suffering from cerebral vasospasm after aneurysmal subarachnoid hemorrhage. METHODS Nine consecutive patients with symptoms of delayed ischemic deficits, induced by angiographically confirmed cerebral vasospasm, were treated with the injection of locoregional anesthesia to block the ascending cervical sympathetic chain at the level of the superior cervical ganglion. Neurological status was recorded before and after the procedure, and cerebral angiography was performed before and after the procedure. RESULTS No complications occurred in this short series. The procedure appeared to be simple and safe. Horner's signs appeared within 12+/-0.1 minutes and lasted for an average of 6.3+/-4 hours. In all patients, improved cerebral perfusion was detected at the confirmatory angiography but without change in vessel caliber. One patient died of the complications of the initial hemorrhage, and 2 died of the consequences of the severe vasospasm despite maximal medical treatment. In all the other cases, the neurological status promptly returned to normal within 48 hours after the locoregional treatment. CONCLUSIONS Patients with mild to moderate symptoms seem to benefit greatly from transient ipsilateral cervical sympathetic block. This simple technique may be helpful when used as an adjunct to the standard therapy to improve cerebral perfusion.
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Affiliation(s)
- Miriam M Treggiari
- Division of Surgical Intensive Care, Department of Anesthesia, Pharmacology, and Surgical Intensive Care, Geneva University Hospital, Geneva, Switzerland.
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28
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Wingfield BR, Gorman RF. Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: a prospective case study and discussion. J Manipulative Physiol Ther 2000; 23:428-34. [PMID: 10951314 DOI: 10.1067/mmt.2000.108139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To discuss the case of a patient with severely reduced visual fields arising from terminal glaucomatous retinal damage and the treatment of this condition by spinal manipulation. CLINICAL FEATURES A 25-year-old uniocular female patient with congenital glaucoma sought chiropractic treatment for spinal pain, headache, and classic migraine. Advanced optic disk cupping was present, and loss of vision was near complete. A 3-degree island of central vision and a small area of peripheral light sensitivity had remained relatively stable for 3 years after a trabeculectomy procedure that had resulted in intraocular hypotony. INTERVENTION AND OUTCOME It was considered possible that chiropractic spinal manipulative therapy may have a positive outcome in visual performance. Before commencing chiropractic spinal manipulative therapy, an ophthalmologic examination was performed, and visual performance was monitored through a course of treatment. Immediately after the first treatment, significant visual field improvement was recorded in the remaining eye. Maximal improvement of vision was achieved after 1 week (4 treatment sessions). Total monocular visual field had increased from approximately 2% to approximately 20% of normal. Corrected central acuity had improved from 6/12 to 6/9. Independent reexamination by the patient's regular ophthalmic surgeon confirmed the results. CONCLUSION Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.
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Roatta S, Micieli G, Bosone D, Losano G, Bini R, Cavallini A, Passatore M. Effect of generalised sympathetic activation by cold pressor test on cerebral haemodynamics in healthy humans. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1998; 71:159-66. [PMID: 9760052 DOI: 10.1016/s0165-1838(98)00075-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There is no general agreement regarding several aspects of the role of the sympathetic system on cerebral haemodynamics such as extent of effectiveness, operational range and site of action. This study was planned to identify the effect of a generalised sympathetic activation on the cerebral haemodynamics in healthy humans before it is masked by secondary corrections, metabolic or myogenic in nature. A total of 35 healthy volunteers aged 20-35 underwent a 5 min lasting cold pressor test (CPT) performed on their left hand. The cerebral blood flow (CBF) velocity in the middle cerebral arteries and arterial blood pressure were recorded with transcranial Doppler sonography and with a non-invasive finger-cuff method, respectively. The ratio of arterial blood pressure to mean blood velocity (ABP/Vm) and Pulsatility Index (PI) were calculated throughout each trial. CPT induced an increase in mean ABP (range 2-54 mmHg depending on the subject) and only a slight, though significant, increase in blood velocity in the middle cerebral artery (+2.4 and +4.4% on ipsi- and contralateral side, respectively). During CPT, the ratio ABP/Vm increased and PI decreased in all subjects on both sides. These changes began simultaneously with the increase in blood pressure. The increase in ABP/Vm ratio is attributed to an increase in the cerebrovascular resistance, while the concomitant reduction in PI is interpreted as due to the reduction in the compliance of the middle cerebral artery. The results suggest that generalised increases in the sympathetic discharge, causing increases in ABP, can prevent concomitant increases in CBF by acting on both small resistance and large compliant vessels. This effect is also present when a slight increase in blood pressure occurs, which suggests a moderate increase in the sympathetic discharge, i.e. when ABP remains far below the upper limit of CBF autoregulation.
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Affiliation(s)
- S Roatta
- Department of Neuroscience, Centro Interuniversitario per la Neurofisiologia del Dolore, University of Torino Medical School, Italy
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30
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Deriu F, Roatta S, Grassi C, Urciuoli R, Micieli G, Passatore M. Sympathetically-induced changes in microvascular cerebral blood flow and in the morphology of its low-frequency waves. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1996; 59:66-74. [PMID: 8816367 DOI: 10.1016/0165-1838(96)00008-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The effect of bilateral cervical sympathetic nerve stimulation on microvascular cerebral blood flow, recorded at various depths in the parietal lobe and in ponto-mesencephalic areas, was investigated by laser-Doppler flowmetry in normotensive rabbits. These areas were chosen as representative of the vascular beds supplied by the carotid and vertebro-basilar systems, which exhibit different degrees of sympathetic innervation, the former being richer than the latter. Sympathetic stimulation at 30 imp/s affects cerebral blood flow in 77% of the parietal lobe and in 43% of the ponto-mesencephalic tested areas. In both cases the predominant effect was a reduction in blood flow (14.7 +/- 5.1% and 4.1 +/- 2.4%, respectively). The extent of the reduction in both areas was less if the stimulation frequency was decreased. Sometimes mean cerebral blood flow showed a small and transient increase, mainly in response to low-frequency stimulation. The morphology was analysed of low-frequency spontaneous oscillations in cerebral blood flow, attributed to vasomotion. Present in 41% of the tested areas (frequency 4-12 cycles/min, peak-to-peak amplitude 10-40% of mean value), these waves decreased in amplitude and increased in frequency during sympathetic stimulation, irrespective of changes in mean flow. The possibility has been proposed that the sympathetic action on low-frequency spontaneous oscillations may contribute to the protective influence that this system is known to exert on the blood-brain barrier in hypertension.
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Affiliation(s)
- F Deriu
- Department of Anatomy and Human Physiology, Faculty of Medicine, University of Turin, Italy
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31
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Passatore M, Deriu F, Grassi C, Roatta S. A comparative study of changes operated by sympathetic nervous system activation on spindle afferent discharge and on tonic vibration reflex in rabbit jaw muscles. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1996; 57:163-7. [PMID: 8964942 DOI: 10.1016/0165-1838(95)00074-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The effect of sympathetic activation on the spindle afferent response to vibratory stimuli eliciting the tonic vibration reflex in jaw closing muscles was studied in precollicularly decerebrate rabbits. Stimulation of the cervical sympathetic trunk, at frequencies within the physiologic range, consistently induced a decrease in spindle response to muscle vibration, which was often preceded by a transient enhancement. Spindle discharge was usually correlated with the EMG activity in the masseter muscle and the tension reflexly developed by jaw muscles. The changes in spindle response to vibration were superimposed on variations of the basal discharge which exhibited different patterns in the studied units, increases in the firing rate being more frequently observed. These effects were mimicked by close arterial injection of the selective alpha 1-adrenoceptor agonist phenylephrine. Data presented here suggest that sympathetically-induced modifications of the tonic vibration reflex are due to changes exerted on muscle spindle afferent information.
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Affiliation(s)
- M Passatore
- Department of Anatomy and Human Physiology, Faculty of Medicine, University of Turin, Italy
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Umeyama T, Kugimiya T, Ogawa T, Kandori Y, Ishizuka A, Hanaoka K. Changes in cerebral blood flow estimated after stellate ganglion block by single photon emission computed tomography. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1995; 50:339-46. [PMID: 7714328 DOI: 10.1016/0165-1838(94)00105-s] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The validity of the hypothesis that the cerebral vasculature is under the control of sympathetic innervation was investigated using brain scintigraphy imaging before and after stellate ganglion block (SGB). The experiment with HM-PAO showed a definite increase in the blood flow of the brain on the block side on both by the dynamic images and the SPECT images. The tympanic temperature (Tty) of the block side decreased significantly after SGB, compared to the unblock side in this study, as had been reported before. This change in Tty coinsided with the increase in cerebral blood flow as mentioned above. This study demonstrated that the cerebral vasculature is under the control of sympathetic innervation, the pathway of which is relayed and/or passes through the stellate ganglion. We conclude that SGB increases intracerebral blood flow and can also exert secondary effects systemically due to CNS blood flow changes as have been previously reported.
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Affiliation(s)
- T Umeyama
- Department of Anesthesiology, University of Tokyo Branch Hospital, Japan
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Ogawa T, Sugenoya J, Ohnishi N, Natsume K, Imai K, Kandori Y, Ishizuka A, Osada A. Effects of body and head positions on bilateral difference in tympanic temperatures. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1993; 67:354-9. [PMID: 8299604 DOI: 10.1007/bf00357635] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have examined the nonparallel changes in tympanic membrane temperatures (Tty) from the two ears in response to various changes in body and head positions. Upon assuming a lateral recumbent position, the Tty on the lower side increased while that on the upper side decreased. Pressure application over a wide area of the lateral chest only caused inconsistent and obscure asymmetric changes in Tty. A lateral flexion of the head with the subject sitting upright and a rotation of the head to the side in a supine position induced an increase in the Tty on the lower side compared to that on the upper side. The temperature and blood flow of the forehead often decreased on the lower side and increased on the upper side, although such responses were not always concomitant with the asymmetric changes in Tty. A dorsal flexion of the head with the subject in a reclining position caused a slight increase in the Tty, whereas raising the head upright induced a slight decrease in them. Two additional experiments were carried out with single photon emission computed tomography using 99mTc-hexamethylpropyleneamine oxime as tracer, and a slight, relative decrease in counts was noted in the right hemisphere during rotation of the head to the right. These results would strongly suggest that unilateral increases and decreases in Tty could have been caused by one-sided decreases and increases, respectively, in blood flow to the brain and/or the tympanic membrane, induced by a vasomotor reflex involving vestibular stimulation.
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Affiliation(s)
- T Ogawa
- Department of Physiology, Aichi Medical University, Nagakute, Japan
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