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Smith RL, Ikeda AK, Rowley CA, Khandhadia A, Gorbach AM, Chimalizeni Y, Taylor TE, Seydel K, Ackerman HC. Increased brain microvascular hemoglobin concentrations in children with cerebral malaria. Sci Transl Med 2023; 15:eadh4293. [PMID: 37703350 DOI: 10.1126/scitranslmed.adh4293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
Brain swelling is associated with death from cerebral malaria, but it is unclear whether brain swelling is caused by cerebral edema or vascular congestion-two pathological conditions with distinct effects on tissue hemoglobin concentrations. We used near-infrared spectroscopy (NIRS) to noninvasively study cerebral microvascular hemoglobin concentrations in 46 Malawian children with cerebral malaria. Cerebral malaria was defined by the presence of the malaria parasite Plasmodium falciparum on a blood smear, a Blantyre coma score of 2 or less, and retinopathy. Children with uncomplicated malaria (n = 33) and healthy children (n = 29) were enrolled as comparators. Cerebral microvascular hemoglobin concentrations were higher among children with cerebral malaria compared with those with uncomplicated malaria [median (25th, 75th): 145.2 (95.2, 190.0) μM versus 82.9 (65.7, 105.4) μM, P = 0.008]. Cerebral microvascular hemoglobin concentrations correlated with brain swelling score determined by MRI (r = 0.37, P = 0.03). Fluctuations in cerebral microvascular hemoglobin concentrations over a 30-min time period were characterized using detrended fluctuation analysis (DFA). DFA determined self-similarity of the cerebral microvascular hemoglobin concentration signal to be lower among children with cerebral malaria compared with those with uncomplicated malaria [0.63 (0.54, 0.70) versus 0.91 (0.82, 0.94), P < 0.0001]. The lower self-similarity of the hemoglobin concentration signal in children with cerebral malaria suggested impaired regulation of cerebral blood flow. The elevated cerebral tissue hemoglobin concentration and its correlation with brain swelling suggested that excess blood volume, potentially due to vascular congestion, may contribute to brain swelling in cerebral malaria.
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Affiliation(s)
- Rachel L Smith
- Physiology Unit, Laboratory of Malaria and Vector Research, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Allison K Ikeda
- Physiology Unit, Laboratory of Malaria and Vector Research, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Carol A Rowley
- Physiology Unit, Laboratory of Malaria and Vector Research, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Amit Khandhadia
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Alexander M Gorbach
- Infrared Imaging and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Yamikani Chimalizeni
- Queen Elizabeth Central Hospital and Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Terrie E Taylor
- Queen Elizabeth Central Hospital and Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Karl Seydel
- Queen Elizabeth Central Hospital and Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Hans C Ackerman
- Physiology Unit, Laboratory of Malaria and Vector Research, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
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Niizawa T, Sakuraba R, Kusaka T, Kurihara Y, Sugashi T, Kawaguchi H, Kanno I, Masamoto K. Spatiotemporal analysis of blood plasma and blood cell flow fluctuations of cerebral microcirculation in anesthetized rats. J Cereb Blood Flow Metab 2023; 43:138-152. [PMID: 36138557 PMCID: PMC9875347 DOI: 10.1177/0271678x221125743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 01/28/2023]
Abstract
Cerebral hemodynamics fluctuates spontaneously over broad frequency ranges. However, its spatiotemporal coherence of flow oscillations in cerebral microcirculation remains incompletely understood. The objective of this study was to characterize the spatiotemporal fluctuations of red blood cells (RBCs) and plasma flow in the rat cerebral microcirculation by simultaneously imaging their dynamic behaviors. Comparisons of changes in cross-section diameters between RBC and plasma flow showed dissociations in penetrating arterioles. The results indicate that vasomotion has the least effect on the lateral movement of circulating RBCs, resulting in variable changes in plasma layer thickness. Parenchymal capillaries exhibited slow fluctuations in RBC velocity (0.1 to 0.3 Hz), regardless of capillary diameter fluctuations (<0.1 Hz). Temporal fluctuations and the velocity of RBCs decreased significantly at divergent capillary bifurcations. The results indicate that a transit of RBCs generates flow resistance in the capillaries and that slow velocity fluctuations of the RBCs are subject to a number of bifurcations. In conclusion, the high-frequency oscillation of the blood flow is filtered at the bifurcation through the capillary networks. Therefore, a number of bifurcations in the cerebral microcirculation may contribute to the power of low-frequency oscillations.
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Affiliation(s)
- Tomoya Niizawa
- Faculty of Informatics and Engineering, University of
Electro-Communications, Tokyo, Japan
| | - Ruka Sakuraba
- Faculty of Informatics and Engineering, University of
Electro-Communications, Tokyo, Japan
| | - Tomoya Kusaka
- Faculty of Informatics and Engineering, University of
Electro-Communications, Tokyo, Japan
| | - Yuika Kurihara
- Faculty of Informatics and Engineering, University of
Electro-Communications, Tokyo, Japan
| | - Takuma Sugashi
- Faculty of Informatics and Engineering, University of
Electro-Communications, Tokyo, Japan
- Center for Neuroscience and Biomedical Engineering,
University of Electro-Communications, Tokyo, Japan
| | - Hiroshi Kawaguchi
- Human Informatics and Interaction Research Institute,
National Institute of Advanced Industrial Science and Technology
(AIST), Ibaraki, Japan
| | - Iwao Kanno
- Department of Functional Brain Imaging Research,
National Institute of Radiological Sciences, Chiba, Japan
| | - Kazuto Masamoto
- Faculty of Informatics and Engineering, University of
Electro-Communications, Tokyo, Japan
- Center for Neuroscience and Biomedical Engineering,
University of Electro-Communications, Tokyo, Japan
- Department of Functional Brain Imaging Research,
National Institute of Radiological Sciences, Chiba, Japan
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Hemodynamics and Tissue Optical Properties in Bimodal Infarctions Induced by Middle Cerebral Artery Occlusion. Int J Mol Sci 2022; 23:ijms231810318. [PMID: 36142225 PMCID: PMC9499323 DOI: 10.3390/ijms231810318] [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: 07/24/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
Various infarct sizes induced by middle cerebral artery occlusion (MCAO) generate inconsistent outcomes for stroke preclinical study. Monitoring cerebral hemodynamics may help to verify the outcome of MCAO. The aim of this study was to investigate the changes in brain tissue optical properties by frequency-domain near-infrared spectroscopy (FD-NIRS), and establish the relationship between cerebral hemodynamics and infarct variation in MCAO model. The rats were undergone transient MCAO using intraluminal filament. The optical properties and hemodynamics were measured by placing the FD-NIRS probes on the scalp of the head before, during, and at various time-courses after MCAO. Bimodal infarction severities were observed after the same 90-min MCAO condition. Significant decreases in concentrations of oxygenated hemoglobin ([HbO]) and total hemoglobin ([HbT]), tissue oxygenation saturation (StO2), absorption coefficient (μa) at 830 nm, and reduced scattering coefficient (μs’) at both 690 and 830 nm were detected during the occlusion in the severe infarction but not the mild one. Of note, the significant increases in [HbO], [HbT], StO2, and μa at both 690 and 830 nm were found on day 3; and increases in μs’ at both 690 and 830 nm were found on day 2 and day 3 after MCAO, respectively. The interhemispheric correlation coefficient (IHCC) was computed from low-frequency hemodynamic oscillation of both hemispheres. Lower IHCCs standing for interhemispheric desynchronizations were found in both mild and severe infarction during occlusion, and only in severe infarction after reperfusion. Our finding supports that sequential FD-NIRS parameters may associated with the severity of the infarction in MCAO model, and the consequent pathologies such as vascular dysfunction and brain edema. Further study is required to validate the potential use of FD-NIRS as a monitor for MCAO verification.
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Xie H, Xu G, Huo C, Li W, Zhao H, Lv Z, Li Z. Brain Function Changes Induced by Intermittent Sequential Pneumatic Compression in Patients With Stroke as Assessed by Functional Near-Infrared Spectroscopy. Phys Ther 2021; 101:6290099. [PMID: 34061206 DOI: 10.1093/ptj/pzab140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/08/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Intermittent sequential pneumatic compression (ISPC) can effectively promote cerebral perfusion and collateral blood supply in patients with stroke. However, the effects of ISPC on cerebral oscillations are still unclear. METHODS The tissue concentration of oxyhemoglobin and deoxyhemoglobin oscillations were measured by functional near-infrared spectroscopy under resting and ISPC conditions in 27 right-handed adult patients with stroke. Five characteristic frequency signals (I, 0.6-2 Hz; II, 0.145-0.6 Hz; III, 0.052-0.145 Hz; IV, 0.021-0.052 Hz; and V, 0.0095-0.021 Hz) were identified using the wavelet method. The wavelet amplitude (WA) and laterality index (LI) were calculated to describe the frequency-specific cortical activities. RESULTS The ISPC state of patients with ischemic stroke showed significantly increased WA values of the ipsilesional motor cortex (MC) in the frequency intervals III (F37 = 8.017), IV (F37 = 6.347), and V (F37 = 5.538). There was no significant difference in the WA values in the ISPC state compared with the resting state in patients with hemorrhagic stroke. Also, the LI values of the prefrontal cortex and MC in patients decreased more obviously in the ISPC state than in the resting state despite no significant difference. CONCLUSION The significantly increased WA values in the frequency intervals III, IV, and V in the MC of patients with ischemic stroke might be related to cortical activity in the MC in addition to increased cerebral perfusion. The decreased LI values in the prefrontal cortex and MC indicated that the ISPC may have had a positive effect on the functional rehabilitation of these regions. IMPACT This study provides a method for assessing the effects of ISPC on cerebral oscillations, and the results benefit the optimization of ISPC parameters in personalized treatment for the functional recovery of patients with stroke.
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Affiliation(s)
- Hui Xie
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Gongcheng Xu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Congcong Huo
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Wenhao Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Haihong Zhao
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Zeping Lv
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China.,Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, China
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Perioperative Dynamics of Intracranial B-waves of Blood Flow Velocity in the Basal Cerebral Arteries in Patients with Brain Arteriovenous Malformation. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021. [PMID: 33839820 DOI: 10.1007/978-3-030-59436-7_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Intracranial B-waves (8-30 mHz) of blood flow velocity (BFV) in the cerebral arteries are observed in various pathologies of the brain. Changes in B-waves of BFV in pathological arteriovenous shunting and "steal" syndrome remain poorly understood. The aim of this study was to evaluate the dynamics of the B-wave amplitude of BFV (BWA) in patients with an arteriovenous malformation (AVM) in the brain. In 38 such patients, cerebral autoregulation (CA) was assessed using a cuff test and transfer function analysis of the mean blood pressure (BP) and BFV in the basal cerebral arteries within the range of Mayer waves (80-120 mHz). BWA was calculated with spectral analysis. Reliable CA impairment was denoted on the AVM side as compared with the contralateral side prior to intervention. BWA was greater on the AVM side (4.5 ± 2.7 cm/s) than on the contralateral side (2.2 ± 1.4 cm/s, p < 0.05). After embolization, there was a reliable improvement (p < 0.05) in CA and a decrease in BWA on the AVM side (2.7 ± 1.8 cm/s). Thus, a considerable increase in BWA on the AVM side that is not induced by BP fluctuations may indicate additional compensation for blood flow under conditions of reduced perfusion pressure. This assumption is supported by a reduction in BWA after AVM embolization.
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Attarpour A, Ward J, Chen JJ. Vascular origins of low-frequency oscillations in the cerebrospinal fluid signal in resting-state fMRI: Interpretation using photoplethysmography. Hum Brain Mapp 2021; 42:2606-2622. [PMID: 33638224 PMCID: PMC8090775 DOI: 10.1002/hbm.25392] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
In vivo mapping of cerebrovascular oscillations in the 0.05–0.15 Hz remains difficult. Oscillations in the cerebrospinal fluid (CSF) represent a possible avenue for noninvasively tracking these oscillations using resting‐state functional MRI (rs‐fMRI), and have been used to correct for vascular oscillations in rs‐fMRI functional connectivity. However, the relationship between low‐frequency CSF and vascular oscillations remains unclear. In this study, we investigate this relationship using fast simultaneous rs‐fMRI and photoplethysmogram (PPG), examining the 0.1 Hz PPG signal, heart‐rate variability (HRV), pulse‐intensity ratio (PIR), and the second derivative of the PPG (SDPPG). The main findings of this study are: (a) signals in different CSF regions are not equivalent in their associations with vascular and tissue rs‐fMRI signals; (b) the PPG signal is maximally coherent with the arterial and CSF signals at the cardiac frequency, but coherent with brain tissue at ~0.2 Hz; (c) PIR is maximally coherent with the CSF signal near 0.03 Hz; and (d) PPG‐related vascular oscillations only contribute to ~15% of the CSF (and arterial) signal in rs‐fMRI. These findings caution against averaging all CSF regions when extracting physiological nuisance regressors in rs‐fMRI applications, and indicate the drivers of the CSF signal are more than simply cardiac. Our study is an initial attempt at the refinement and standardization of how the CSF signal in rs‐fMRI can be used and interpreted. It also paves the way for using rs‐fMRI in the CSF as a potential tool for tracking cerebrovascular health through, for instance, the potential relationship between PIR and the CSF signal.
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Affiliation(s)
- Ahmadreza Attarpour
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - James Ward
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - J Jean Chen
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
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7
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Bahrani AA, Kong W, Shang Y, Huang C, Smith CD, Powell DK, Jiang Y, Rayapati AO, Jicha GA, Yu G. Diffuse optical assessment of cerebral-autoregulation in older adults stratified by cerebrovascular risk. JOURNAL OF BIOPHOTONICS 2020; 13:e202000073. [PMID: 32533642 PMCID: PMC8824485 DOI: 10.1002/jbio.202000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/06/2020] [Accepted: 06/09/2020] [Indexed: 05/04/2023]
Abstract
Diagnosis of cerebrovascular disease (CVD) at early stages is essential for preventing sequential complications. CVD is often associated with abnormal cerebral microvasculature, which may impact cerebral-autoregulation (CA). A novel hybrid near-infrared diffuse optical instrument and a finger plethysmograph were used to simultaneously detect low-frequency oscillations (LFOs) of cerebral blood flow (CBF), oxy-hemoglobin concentration ([HbO2 ]), deoxy-hemoglobin concentration ([Hb]) and mean arterial pressure (MAP) in older adults before, during and after 70° head-up-tilting (HUT). The participants with valid data were divided based on Framingham risk score (FRS, 1-30 points) into low-risk (FRS ≤15, n = 13) and high-risk (FRS >15, n = 11) groups for developing CVD. The LFO gains were determined by transfer function analyses with MAP as the input, and CBF, [HbO2 ] and [Hb] as the outputs (CA ∝ 1/Gain). At resting-baseline, LFO gains in the high-risk group were relatively lower compared to the low-risk group. The lower baseline gains in the high-risk group may attribute to compensatory mechanisms to maintain stronger steady-state CAs. However, HUT resulted in smaller gain reductions in the high-risk group compared to the low-risk group, suggesting weaker dynamic CAs. LFO gains are potentially valuable biomarkers for early detection of CVD based on associations with CAs.
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Affiliation(s)
- Ahmed A. Bahrani
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Biomedical Engineering Department, Al-Khwarizmi College of Engineering, University of Baghdad, Baghdad, Iraq
| | - Weikai Kong
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
| | - Yu Shang
- Shanxi Provincial Key Laboratory for Biomedical Imaging and Big Data, North University of China, Shanxi, China
| | - Chong Huang
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
| | - Charles D. Smith
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Magnetic Resonance Imaging and Spectroscopy Center (MRISC), University of Kentucky, Lexington, Kentucky
- Department of Neurology, University of Kentucky, Lexington, Kentucky
| | - David K. Powell
- Magnetic Resonance Imaging and Spectroscopy Center (MRISC), University of Kentucky, Lexington, Kentucky
- Neuroscience Department, University of Kentucky, Lexington, Kentucky
| | - Yang Jiang
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Magnetic Resonance Imaging and Spectroscopy Center (MRISC), University of Kentucky, Lexington, Kentucky
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Abner O. Rayapati
- Department of Psychiatry, University of Kentucky, Lexington, Kentucky
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Magnetic Resonance Imaging and Spectroscopy Center (MRISC), University of Kentucky, Lexington, Kentucky
- Department of Neurology, University of Kentucky, Lexington, Kentucky
| | - Guoqiang Yu
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
- Correspondence: Guoqiang Yu, Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40506,
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Cross-frequency and iso-frequency estimation of functional corticomuscular coupling after stroke. Cogn Neurodyn 2020; 15:439-451. [PMID: 34040670 DOI: 10.1007/s11571-020-09635-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/21/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022] Open
Abstract
Functional corticomuscular coupling (FCMC) between the brain and muscles has been used for motor function assessment after stroke. Two types, iso-frequency coupling (IFC) and cross-frequency coupling (CFC), are existed in sensory-motor system for healthy people. However, in stroke, only a few studies focused on IFC between electroencephalogram (EEG) and electromyogram (EMG) signals, and no CFC studies have been found. Considering the intrinsic complexity and rhythmicity of the biological system, we first used the wavelet package transformation (WPT) to decompose the EEG and EMG signals into several subsignals with different frequency bands, and then applied transfer entropy (TE) to analyze the IFC and CFC relationship between each pair-wise subsignal. In this study, eight stroke patients and eight healthy people were enrolled. Results showed that both IFC and CFC still existed in stroke patients (EEG → EMG: 1:1, 3:2, 2:1; EMG → EEG: 1:1, 2:1, 2:3, 3:1). Compared with the stroke-unaffected side and healthy controls, the stroke-affected side yielded lower alpha, beta and gamma synchronization (IFC: beta; CFC: alpha, beta and gamma). Further analysis indicated that stroke patients yielded no significant difference of the FCMC between EEG → EMG and EMG → EEG directions. Our study indicated that alpha and beta bands were essential to concentrating and maintaining the motor capacities, and provided a new insight in understanding the propagation and function in the sensory-motor system.
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9
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Fani L, Bos D, Mutlu U, Portegies MLP, Zonneveld HI, Koudstaal PJ, Vernooij MW, Ikram MA, Ikram MK. Global Brain Perfusion and the Risk of Transient Ischemic Attack and Ischemic Stroke: The Rotterdam Study. J Am Heart Assoc 2020; 8:e011565. [PMID: 30905232 PMCID: PMC6509734 DOI: 10.1161/jaha.118.011565] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background The role of subtle disturbances of brain perfusion in the risk of transient ischemic attack (TIA) or ischemic stroke remains unknown. We examined the association between global brain perfusion and risk of TIA and ischemic stroke in the general population. Methods and Results Between 2005 and 2015, 5289 stroke‐free participants (mean age, 64.3 years; 55.6% women) from the Rotterdam Study underwent phase‐contrast brain magnetic resonance imaging at baseline to assess global brain perfusion. These participants were followed for incident TIA or ischemic stroke until January 1, 2016. We investigated associations between global brain perfusion (mL of blood flow/100 mL of brain/min) and risk of TIA and ischemic stroke using Cox regression models with adjustment for age, sex, and cardiovascular risk factors. Additionally, we investigated whether associations were modified by retinal vessel calibers, small and large vessel disease, blood pressure, and heart rate. During a median follow‐up of 7.2 years (36 103 person‐years), 137 participants suffered a TIA and another 108 an ischemic stroke. We found that lower global brain perfusion was associated with a higher risk of TIA, but not with the risk of ischemic stroke (adjusted hazard ratio, 95% CI, per standard deviation decrease of global brain perfusion: 1.29, 1.07–1.55 for TIA and adjusted hazard ratio of 1.06, 0.87–1.30 for ischemic stroke). Across strata of wider arteriolar retinal calibers, lower brain perfusion was more prominently associated with TIA, but not with ischemic stroke. Conclusions In a community‐dwelling population, impaired global brain perfusion increased the risk of TIA, but not of ischemic stroke.
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Affiliation(s)
- Lana Fani
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Daniel Bos
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands.,2 Department of Radiology and Nuclear Medicine Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Unal Mutlu
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Marileen L P Portegies
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Hazel I Zonneveld
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Peter J Koudstaal
- 3 Department of Neurology Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Meike W Vernooij
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands.,2 Department of Radiology and Nuclear Medicine Erasmus MC University Medical Center Rotterdam the Netherlands
| | - M Arfan Ikram
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
| | - M Kamran Ikram
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands.,3 Department of Neurology Erasmus MC University Medical Center Rotterdam the Netherlands
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10
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Tong Y, Yao JF, Chen JJ, Frederick BD. The resting-state fMRI arterial signal predicts differential blood transit time through the brain. J Cereb Blood Flow Metab 2019; 39:1148-1160. [PMID: 29333912 PMCID: PMC6547182 DOI: 10.1177/0271678x17753329] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have found that aperiodic, systemic low-frequency oscillations (sLFOs) are present in blood-oxygen-level-dependent (BOLD) data. These signals are in the same low frequency band as the "resting state" signal; however, they are distinct signals which represent non-neuronal, physiological oscillations. The same sLFOs are found in the periphery (i.e. finger tips) as changes in oxy/deoxy-hemoglobin concentration using concurrent near-infrared spectroscopy. Together, this evidence points toward an extra-cerebral origin of these sLFOs. If this is the case, it is expected that these sLFO signals would be found in the carotid arteries with time delays that precede the signals found in the brain. To test this hypothesis, we employed the publicly available MyConnectome dataset (a two-year longitudinal study of a single subject) to extract the sLFOs in the internal carotid arteries (ICAs) with the help of the T1/T2-weighted images. Significant, but negative, correlations were found between the LFO BOLD signals from the ICAs and (1) the global signal (GS), (2) the superior sagittal sinus, and (3) the jugulars. We found the consistent time delays between the sLFO signals from ICAs, GS and veins which coincide with the blood transit time through the cerebral vascular tree.
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Affiliation(s)
- Yunjie Tong
- 1 Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Jinxia Fiona Yao
- 2 Agricultural and Biological Engineering, Purdue University, West Lafayette, IN, USA
| | - J Jean Chen
- 3 Rotman Research Institute, Baycrest Centre, Canada; Department of Medical Biophysics, University of Toronto, Canada
| | - Blaise deB Frederick
- 4 Brain Imaging Center, McLean Hospital, Belmont, MA, USA.,5 Department of Psychiatry, Harvard University Medical School, Boston, MA, USA
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11
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Yang M, Yang Z, Yuan T, Feng W, Wang P. A Systemic Review of Functional Near-Infrared Spectroscopy for Stroke: Current Application and Future Directions. Front Neurol 2019; 10:58. [PMID: 30804877 PMCID: PMC6371039 DOI: 10.3389/fneur.2019.00058] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Survivors of stroke often experience significant disability and impaired quality of life. The recovery of motor or cognitive function requires long periods. Neuroimaging could measure changes in the brain and monitor recovery process in order to offer timely treatment and assess the effects of therapy. A non-invasive neuroimaging technique near-infrared spectroscopy (NIRS) with its ambulatory, portable, low-cost nature without fixation of subjects has attracted extensive attention. Methods: We conducted a comprehensive literature review in order to review the use of NIRS in stroke or post-stroke patients in July 2018. NCBI Pubmed database, EMBASE database, Cochrane Library and ScienceDirect database were searched. Results: Overall, we reviewed 66 papers. NIRS has a wide range of application, including in monitoring upper limb, lower limb recovery, motor learning, cortical function recovery, cerebral hemodynamic changes, cerebral oxygenation, as well as in therapeutic method, clinical researches, and evaluation of the risk for stroke. Conclusions: This study provides a preliminary evidence of the application of NIRS in stroke patients as a monitoring, therapeutic, and research tool. Further studies could give more emphasize on the combination of NIRS with other techniques and its utility in the prevention of stroke.
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Affiliation(s)
- Muyue Yang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Yang
- Core Facility of West China Hospital, Sichuan University, Chengdu, China
| | - Tifei Yuan
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Pu Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai, China
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12
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Chalia M, Dempsey LA, Cooper RJ, Lee CW, Gibson AP, Hebden JC, Austin T. Diffuse optical tomography for the detection of perinatal stroke at the cot side: a pilot study. Pediatr Res 2019; 85:1001-1007. [PMID: 30759451 PMCID: PMC6760550 DOI: 10.1038/s41390-018-0263-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/10/2018] [Accepted: 11/17/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Perinatal stroke is a potentially debilitating injury, often under-diagnosed in the neonatal period. We conducted a pilot study investigating the role of the portable, non-invasive brain monitoring technique, diffuse optical tomography (DOT), as an early detection tool for infants with perinatal stroke. METHODS Four stroke-affected infants were scanned with a DOT system within the first 3 days of life and compared to four healthy control subjects. Spectral power, correlation, and phase lag between interhemispheric low frequency (0.0055-0.3 Hz) hemoglobin signals were assessed. Optical data analyses were conducted with and without magnetic resonance imaging (MRI)-guided stroke localization to assess the efficacy of DOT when used without stroke anatomical information. RESULTS Interhemispheric correlations of both oxyhemoglobin and deoxyhemoglobin concentration were significantly reduced in the stroke-affected group within the very low (0.0055-0.0095 Hz) and resting state (0.01-0.08 Hz) frequencies (p < 0.003). There were no interhemispheric differences for spectral power. These results were observed even without MRI stroke localization. CONCLUSION This suggests that DOT and correlation-based analyses in the low-frequency range can potentially aid the early detection of perinatal stroke, prior to MRI acquisition. Additional methodological advances are required to increase the sensitivity and specificity of this technique.
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Affiliation(s)
- Maria Chalia
- 0000 0004 0383 8386grid.24029.3dNeonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - Laura A. Dempsey
- 0000000121901201grid.83440.3bDepartment of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Robert J. Cooper
- 0000000121901201grid.83440.3bDepartment of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Chuen-Wai Lee
- 0000 0004 0383 8386grid.24029.3dNeonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - Adam P. Gibson
- 0000000121901201grid.83440.3bDepartment of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Jeremy C. Hebden
- 0000000121901201grid.83440.3bDepartment of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT UK
| | - Topun Austin
- Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
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13
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Semenyutin VB, Asaturyan GA, Nikiforova AA, Aliev VA, Panuntsev GK, Iblyaminov VB, Savello AV, Patzak A. Predictive Value of Dynamic Cerebral Autoregulation Assessment in Surgical Management of Patients with High-Grade Carotid Artery Stenosis. Front Physiol 2017; 8:872. [PMID: 29163214 PMCID: PMC5673646 DOI: 10.3389/fphys.2017.00872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/17/2017] [Indexed: 01/20/2023] Open
Abstract
Dynamic cerebral autoregulation (DCA) capacity along with the degree of internal carotid artery (ICA) stenosis and characteristics of the plaque can also play an important role in selection of appropriate treatment strategy. This study aims to classify the patients with severe ICA stenosis according to preoperative state of DCA and to assess its dynamics after surgery. Thirty-five patients with severe ICA stenosis having different clinical type of disease underwent reconstructive surgery. DCA was assessed with transfer function analysis (TFA) by calculating phase shift (PS) between Mayer waves of blood flow velocity (BFV) and blood pressure (BP) before and after operation. In 18 cases, regardless of clinical type, preoperative PS on ipsilateral side was within the normal range and did not change considerably after surgery. In other 17 cases preoperative PS was reliably lower both in patients with symptomatic and asymptomatic stenosis. Surgical reconstruction led to restoration of impaired DCA evidenced by significant increase of PS in postoperative period. Our data suggest that regardless clinical type of disease various state of DCA may be present in patients with severe ICA stenosis. This finding can contribute to establishing the optimal treatment strategy, and first of all for asymptomatic patients. Patients with compromised DCA should be considered as ones with higher risk of stroke and first candidates for reconstructive surgery.
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Affiliation(s)
- Vladimir B Semenyutin
- Laboratory of Brain Circulation Pathology, Federal Almazov Medical Research Center, Saint-Petersburg, Russia
| | - Gregory A Asaturyan
- Laboratory of Brain Circulation Pathology, Federal Almazov Medical Research Center, Saint-Petersburg, Russia
| | - Anna A Nikiforova
- Laboratory of Brain Circulation Pathology, Federal Almazov Medical Research Center, Saint-Petersburg, Russia
| | - Vugar A Aliev
- Laboratory of Brain Circulation Pathology, Federal Almazov Medical Research Center, Saint-Petersburg, Russia.,Department of Neurosurgery, Municipal Hospital of Saint Martyr Elizabeth, Saint-Petersburg, Russia
| | - Grigory K Panuntsev
- Laboratory of Brain Circulation Pathology, Federal Almazov Medical Research Center, Saint-Petersburg, Russia
| | - Vadim B Iblyaminov
- Laboratory of Brain Circulation Pathology, Federal Almazov Medical Research Center, Saint-Petersburg, Russia
| | - Alexander V Savello
- Laboratory of Brain Circulation Pathology, Federal Almazov Medical Research Center, Saint-Petersburg, Russia
| | - Andreas Patzak
- Johannes-Mueller Institute of Physiology University Hospital Charite, Humboldt University of Berlin, Berlin, Germany
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14
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Goltsov A, Anisimova AV, Zakharkina M, Krupatkin AI, Sidorov VV, Sokolovski SG, Rafailov E. Bifurcation in Blood Oscillatory Rhythms for Patients with Ischemic Stroke: A Small Scale Clinical Trial using Laser Doppler Flowmetry and Computational Modeling of Vasomotion. Front Physiol 2017; 8:160. [PMID: 28386231 PMCID: PMC5362641 DOI: 10.3389/fphys.2017.00160] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
We describe application of spectral analysis of laser Doppler flowmetry (LDF) signals to investigation of cerebrovascular haemodynamics in patients with post-acute ischemic stroke (AIS) and cerebrovascular insufficiency. LDF was performed from 3 to 7 days after the onset of AIS on forehead in the right and left supraorbital regions in patients. Analysis of LDF signals showed that perfusion in the microvasculature in AIS patients was lower than that in patients with cerebrovascular insufficiency. As a result of wavelet analysis of the LDF signals we obtained activation of the vasomotion in the frequency range of myogenic oscillation of 0.1 Hz and predominantly nutritive regime microcirculation after systemic thrombolytic therapy of the AIS patients. In case of significant stroke size, myogenic activity, and nutritive pattern microhaemodynamics were reduced, in some cases non-nutritive pattern and/or venular stasis was revealed. Wavelet analysis of the LDF signals also showed asymmetry in wavelet spectra of the LDF signals obtained in stroke-affected and unaffected hemispheres in the AIS patients. A mechanism underlying the observed asymmetry was analyzed by computational modeling of vasomotion developed in Arciero and Secomb (2012). We applied this model to describe relaxation oscillation of arteriole diameter which is forced by myogenic oscillation induced by synchronous calcium oscillation in vascular smooth muscle cells. Calculation showed that vasomotion frequency spectrum at the low-frequency range (0.01 Hz) is reciprocally modulated by myogenic oscillation (0.1 Hz) that correlates with experimental observation of inter-hemispheric variation in the LDF spectrum.
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Affiliation(s)
- Alexey Goltsov
- Division of Science, School of Science, Engineering and Technology, Abertay University Dundee, UK
| | - Anastasia V Anisimova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, First City Hospital Moscow, Russia
| | - Maria Zakharkina
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, First City Hospital Moscow, Russia
| | - Alexander I Krupatkin
- Department of Functional Diagnostics, Priorov's Central Institute of Traumatology and Orthopedics Moscow, Russia
| | | | - Sergei G Sokolovski
- Optoelectronics and Biomedical Photonics Group, Photonics and Nanoscience Group, Aston Institute of Photonic Technologies, Aston University Birmingham, UK
| | - Edik Rafailov
- Optoelectronics and Biomedical Photonics Group, Photonics and Nanoscience Group, Aston Institute of Photonic Technologies, Aston University Birmingham, UK
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15
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Sood M, Besson P, Muthalib M, Jindal U, Perrey S, Dutta A, Hayashibe M. NIRS-EEG joint imaging during transcranial direct current stimulation: Online parameter estimation with an autoregressive model. J Neurosci Methods 2016; 274:71-80. [DOI: 10.1016/j.jneumeth.2016.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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16
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Oldag A, Neumann J, Goertler M, Hinrichs H, Heinze HJ, Kupsch A, Sweeney-Reed CM, Kopitzki K. Near-infrared spectroscopy and transcranial sonography to evaluate cerebral autoregulation in middle cerebral artery steno-occlusive disease. J Neurol 2016; 263:2296-2301. [PMID: 27544503 DOI: 10.1007/s00415-016-8262-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
The measurement of autoregulatory delay by near-infrared spectroscopy (NIRS) has been proposed as an alternative technique to assess cerebral autoregulation, which is routinely assessed via transcranial Doppler sonography (TCD) in most centers. Comparitive studies of NIRS and TCD, however, are largely missing. We investigated whether cerebrovascular reserve (CVR), as assessed via TCD, correlates with the delay of the autoregulatory response to changes in arterial blood pressure (ABP) as assessed by NIRS, i.e., if impaired upstream vasomotor reactivity is reflected by downstream cortical autoregulation. Twenty patients with unilateral high-grade steno-occlusion of the middle cerebral artery (MCA) underwent bilateral multichannel NIRS of the cortical MCA distributions over a period of 6 min while breathing at a constant rate of 6 cycles/min to induce stable oscillations in ABP. The phase shift φ between ABP and cortical blood oxygenation was calculated as a measure of autoregulatory latency. In a subgroup of 13 patients, CO2 reactivity of the MCAs was determined by TCD to assess CVR in terms of normalized autoregulatory response (NAR). Mean phase shift between ABP and blood oxygenation was significantly increased over the hemisphere ipsilateral to the steno-occlusion (n = 20, p = 0.042). The interhemispheric difference Δφ in phase shift was significantly larger in patients with markedly diminished or exhausted CVR (NAR < 10) than in patients with normal NAR values (NAR ≥ 10) (p = 0.007). Within the MCA core distribution territory, a strong correlation existed between Δφ and CO2 reactivity of the affected MCA (n = 13, r = -0.78, p = 0.011). NIRS may provide an alternative or supplementary approach to evaluate cerebral autoregulation in risk assessment of ischemic events in steno-occlusive disease of cerebral arteries, especially in patients with insufficient bone windows for TCD.
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Affiliation(s)
- Andreas Oldag
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Jens Neumann
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Michael Goertler
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Brenneckestrasse 6, 39118, Magdeburg, Germany
| | - Hermann Hinrichs
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Brenneckestrasse 6, 39118, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Brenneckestrasse 6, 39118, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Andreas Kupsch
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Catherine M Sweeney-Reed
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Klaus Kopitzki
- Clinic for Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany. .,Leibniz Institute for Neurobiology, Brenneckestrasse 6, 39118, Magdeburg, Germany.
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17
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Moreau F, Yang R, Nambiar V, Demchuk AM, Dunn JF. Near-infrared measurements of brain oxygenation in stroke. NEUROPHOTONICS 2016; 3:031403. [PMID: 26958577 PMCID: PMC4750462 DOI: 10.1117/1.nph.3.3.031403] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 01/13/2016] [Indexed: 05/17/2023]
Abstract
We investigated the feasibility of using frequency-domain near-infrared spectroscopy (fdNIRS) to study brain oxygenation in the first few hours of stroke onset. The OxiplexTS(®) fdNIRS system was used in this study. Using a standard probing protocol based on surface landmarks, we measured brain tHb and [Formula: see text] in healthy volunteers, cadavers, and acute stroke patients within 9 h of stroke onset and 3 days later. We obtained measurements from 11 controls, 5 cadavers, and 5 acute stroke patients. [Formula: see text] values were significantly lower in cadavers compared to the controls and stroke patients. Each stroke patient had at least one area with reduced [Formula: see text] on the stroke side compared to the contralateral side. The evolution of tHb and [Formula: see text] at 3 days differed depending on whether a large infarct occurred. This study shows the proof of principle that quantified measurements of brain oxygenation using NIRS could be used in the hectic environment of acute stroke management. It also highlights the current technical limitations and future challenges in the development of this unique bedside monitoring tool for stroke.
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Affiliation(s)
- François Moreau
- Université de Sherbrooke, Department of Medicine, CHUS-Hôpital Fleurimont 3001, 12e Avenue Nord, bureau 6501, Québec, Sherbrooke J1H 5N4, Canada
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 12th Floor, 1403-29th Street NW Calgary, Alberta T2N 2T9, Canada
- Address all correspondence to: François Moreau, E-mail:
| | - Runze Yang
- University of Calgary, Department of Radiology, Foothills Medical Centre, Room 812, North Tower, 1403-29th Street NW Calgary, Alberta T2N 2T9, Canada
- University of Calgary, Hotchkiss Brain Institute, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Vivek Nambiar
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 12th Floor, 1403-29th Street NW Calgary, Alberta T2N 2T9, Canada
- Amrita Institute Medical Sciences, Department of Neurology, Center of Neurosciences, Ponekkara, Kochi 682041, India
| | - Andrew M. Demchuk
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 12th Floor, 1403-29th Street NW Calgary, Alberta T2N 2T9, Canada
- University of Calgary, Hotchkiss Brain Institute, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Jeff F. Dunn
- University of Calgary, Department of Radiology, Foothills Medical Centre, Room 812, North Tower, 1403-29th Street NW Calgary, Alberta T2N 2T9, Canada
- University of Calgary, Hotchkiss Brain Institute, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
- University of Calgary, Experimental Imaging Center, TRW building, Basement level P2, Foothills Medical Centre, 1403-29th Street NW Calgary, Alberta T2N 2T9, Canada
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18
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Chernomordik V, Amyot F, Kenney K, Wassermann E, Diaz-Arrastia R, Gandjbakhche A. Abnormality of low frequency cerebral hemodynamics oscillations in TBI population. Brain Res 2016; 1639:194-9. [PMID: 26996413 PMCID: PMC9392959 DOI: 10.1016/j.brainres.2016.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/29/2016] [Accepted: 02/08/2016] [Indexed: 10/25/2022]
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19
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Medow MS, Del Pozzi AT, Messer ZR, Terilli C, Stewart JM. Altered oscillatory cerebral blood flow velocity and autoregulation in postural tachycardia syndrome. Front Physiol 2014; 5:234. [PMID: 25002851 PMCID: PMC4067089 DOI: 10.3389/fphys.2014.00234] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/03/2014] [Indexed: 11/13/2022] Open
Abstract
Decreased upright cerebral blood flow (CBF) with hyperpnea and hypocapnia is seen in a minority of patients with postural tachycardia syndrome (POTS). More often, CBF is not decreased despite upright neurocognitive dysfunction. This may result from time-dependent changes in CBF. We hypothesized that increased oscillations in CBF occurs in POTS (N = 12) compared to healthy controls (N = 9), and tested by measuring CBF velocity (CBFv) by transcranial Doppler ultrasound of the middle cerebral artery, mean arterial pressure (MAP) and related parameters, supine and during 70° upright tilt. Autospectra for mean CBFv and MAP, and transfer function analysis were obtained over the frequency range of 0.0078-0.4 Hz. Upright HR was increased in POTS (125 ± 8 vs. 86 ± 2 bpm), as was diastolic BP (74 ± 3 vs. 65 ± 3 mmHg) compared to control, while peripheral resistance, cardiac output, and mean CBFv increased similarly with tilt. Upright BP variability (BPV), low frequency (LF) power (0.04-0.13 Hz), and peak frequency of BPV were increased in POTS (24.3 ± 4.1, and 18.4 ± 4.1 mmHg(2)/Hz at 0.091 Hz vs. 11.8 ± 3.3, and 8.8 ± 2 mmHg(2)/Hz c at 0.071 Hz), as was upright overall CBFv variability, low frequency power and peak frequency of CBFv variability (29.3 ± 4.7, and 22.1 ± 2.7 [cm/s](2)/Hz at.092 Hz vs. 14.7 ± 2.6, and 6.7 ± 1.2 [cm/s](2)/Hz at 0.077Hz). Autospectra were sharply peaked in POTS. LF phase was decreased in POTS (-14 ± 4 vs. -25 ± 10 degrees) while upright. LF gain was increased (1.51 ± 0.09 vs. 0.86 ± 0.12 [cm/s]/ mmHg) while coherence was increased (0.96 ± 0.01 vs. 0.80 ± 0.04). Increased oscillatory BP in upright POTS patients is closely coupled to oscillatory CBFv over a narrow bandwidth corresponding to the Mayer wave frequency. Therefore combined increased oscillatory BP and increased LF gain markedly increases CBFv oscillations in a narrow bandwidth. This close coupling of CBF to MAP indicates impaired cerebral autoregulation that may underlie upright neurocognitive dysfunction in POTS.
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Affiliation(s)
- Marvin S Medow
- Departments of Pediatrics, The Center for Hypotension, New York Medical College Valhalla, NY, USA ; Departments of Physiology, New York Medical College Valhalla, NY, USA
| | - Andrew T Del Pozzi
- Departments of Pediatrics, The Center for Hypotension, New York Medical College Valhalla, NY, USA
| | - Zachary R Messer
- Departments of Pediatrics, The Center for Hypotension, New York Medical College Valhalla, NY, USA
| | - Courtney Terilli
- Departments of Pediatrics, The Center for Hypotension, New York Medical College Valhalla, NY, USA
| | - Julian M Stewart
- Departments of Pediatrics, The Center for Hypotension, New York Medical College Valhalla, NY, USA ; Departments of Physiology, New York Medical College Valhalla, NY, USA
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20
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Scholkmann F, Gerber U, Wolf M, Wolf U. End-tidal CO2: an important parameter for a correct interpretation in functional brain studies using speech tasks. Neuroimage 2012; 66:71-9. [PMID: 23099101 DOI: 10.1016/j.neuroimage.2012.10.025] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/21/2012] [Accepted: 10/16/2012] [Indexed: 12/30/2022] Open
Abstract
The aim was to investigate the effect of different speech tasks, i.e. recitation of prose (PR), alliteration (AR) and hexameter (HR) verses and a control task (mental arithmetic (MA) with voicing of the result on end-tidal CO2 (PETCO2), cerebral hemodynamics and oxygenation. CO2 levels in the blood are known to strongly affect cerebral blood flow. Speech changes breathing pattern and may affect CO2 levels. Measurements were performed on 24 healthy adult volunteers during the performance of the 4 tasks. Tissue oxygen saturation (StO2) and absolute concentrations of oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]) and total hemoglobin ([tHb]) were measured by functional near-infrared spectroscopy (fNIRS) and PETCO2 by a gas analyzer. Statistical analysis was applied to the difference between baseline before the task, 2 recitation and 5 baseline periods after the task. The 2 brain hemispheres and 4 tasks were tested separately. A significant decrease in PETCO2 was found during all 4 tasks with the smallest decrease during the MA task. During the recitation tasks (PR, AR and HR) a statistically significant (p<0.05) decrease occurred for StO2 during PR and AR in the right prefrontal cortex (PFC) and during AR and HR in the left PFC. [O2Hb] decreased significantly during PR, AR and HR in both hemispheres. [HHb] increased significantly during the AR task in the right PFC. [tHb] decreased significantly during HR in the right PFC and during PR, AR and HR in the left PFC. During the MA task, StO2 increased and [HHb] decreased significantly during the MA task. We conclude that changes in breathing (hyperventilation) during the tasks led to lower CO2 pressure in the blood (hypocapnia), predominantly responsible for the measured changes in cerebral hemodynamics and oxygenation. In conclusion, our findings demonstrate that PETCO2 should be monitored during functional brain studies investigating speech using neuroimaging modalities, such as fNIRS, fMRI to ensure a correct interpretation of changes in hemodynamics and oxygenation.
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Affiliation(s)
- F Scholkmann
- Institute of Complementary Medicine KIKOM, University of Bern, 3010 Bern, Switzerland; Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - U Gerber
- Institute of Complementary Medicine KIKOM, University of Bern, 3010 Bern, Switzerland
| | - M Wolf
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - U Wolf
- Institute of Complementary Medicine KIKOM, University of Bern, 3010 Bern, Switzerland.
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21
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Papademetriou MD, Tachtsidis I, Elliot MJ, Hoskote A, Elwell CE. Multichannel near infrared spectroscopy indicates regional variations in cerebral autoregulation in infants supported on extracorporeal membrane oxygenation. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:067008. [PMID: 22734786 DOI: 10.1117/1.jbo.17.6.067008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Assessing noninvasively cerebral autoregulation, the protective mechanism of the brain to maintain constant cerebral blood flow despite changes in blood pressure, is challenging. Infants on life support system (ECMO) for cardiorespiratory failure are at risk of cerebral autoregulation impairment and consequent neurological problems. We measured oxyhaemoglobin concentration (HbO(2)) by multichannel (12 channels) near-infrared spectroscopy (NIRS) in six infants during sequential changes in ECMO flow. Wavelet cross-correlation (WCC) between mean arterial pressure (MAP) and HbO(2) was used to construct a time-frequency representation of the concordance between the two signals to assess the nonstationary aspect of cerebral autoregulation and investigate regional variations. Group data showed that WCC increases with decreasing ECMO flow indicating higher concordance between MAP and HbO(2) and demonstrating loss of cerebral autoregulation at low ECMO flows. Statistically significant differences in WCC were observed between channels placed on the right and left scalp with channels on the right exhibiting higher values of WCC suggesting that the right hemisphere was more susceptible to disruption of cerebral autoregulation. Multichannel NIRS in conjunction with wavelet analysis methods can be used to assess regional variations in dynamic cerebral autoregulation with important clinical application in the management of critically ill children on life support systems.
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Affiliation(s)
- Maria D Papademetriou
- University College London, Medical Physics and Biomedical Engineering, London, United Kingdom.
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22
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Schytz HW, Hansen JM, Phillip D, Selb J, Boas DA, Ashina M. Nitric oxide modulation of low-frequency oscillations in cortical vessels in FHM--a NIRS study. Headache 2012; 52:1146-54. [PMID: 22352839 DOI: 10.1111/j.1526-4610.2012.02098.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The pathophysiological alterations in patients with familial hemiplegic migraine (FHM) are not yet fully known. The headache characteristics in patients with FHM mutations have been examined in a series of glyceryl trinitrate (GTN) provocation studies in FHM patients, but the cortical vascular response to GTN in FHM patients has never been investigated before. OBJECTIVE To investigate changes in spontaneous low-frequency oscillations (LFO) of cortical vessels in response to the nitric oxide donor GTN by near-infrared spectroscopy in FHM patients. METHODS Twenty-three FHM patients without known mutations and 9 healthy controls received a continuous intravenous infusion of GTN 0.5 µg/kg/minute over 20 minutes. Using near-infrared spectroscopy, we recorded oxygenated hemoglobin (oxyHb) LFO amplitude bilateral at the frontal cortex at baseline and 15 minutes and 40 minutes after start of the GTN infusion. RESULTS GTN changed oxyHb LFO amplitude in FHM patients (P = .002), but not in healthy controls (P = .121). Only in FHM patients with coexisting common migraine types did GTN infusion induced changes in LFO amplitudes (P < .001), where post-hoc analysis revealed an increase in LFO amplitude 15 minutes (P = .003) and 40 (P = .013) minutes after start of infusion compared with baseline. Interestingly, GTN infusion induced no changes in LFO amplitude in patients with a pure FHM phenotype (P = .695). CONCLUSION FHM patients with a mixed phenotype (coexisting common type of migraine) showed an increase in oxyHb LFO amplitude during GTN infusion, whereas FHM patients with pure phenotype showed no changes. These data suggest possible differences in frontal cortical nitric oxide vascular sensitivity between FHM patients with a mixed phenotype and patients with pure FHM.
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Affiliation(s)
- Henrik W Schytz
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Obrig H, Steinbrink J. Non-invasive optical imaging of stroke. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:4470-94. [PMID: 22006902 DOI: 10.1098/rsta.2011.0252] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The acute onset of a neurological deficit is the key clinical feature of stroke. In most cases, however, pathophysiological changes in the cerebral vasculature precede the event, often by many years. Persisting neurological deficits may also require long-term rehabilitation. Hence, stroke may be considered a chronic disease, and diagnostic and therapeutic efforts must include identification of specific risk factors, and the monitoring of and interventions in the acute and subacute stages, and should aim at a pathophysiologically based approach to optimize the rehabilitative effort. Non-invasive optical techniques have been experimentally used in all three stages of the disease and may complement the established diagnostic and monitoring tools. Here, we provide an overview of studies using the methodology in the context of stroke, and we sketch perspectives of how they may be integrated into the assessment of the highly dynamic pathophysiological processes during the acute and subacute stages of the disease and also during rehabilitation and (secondary) prevention of stroke.
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Affiliation(s)
- Hellmuth Obrig
- Department of Cognitive Neurology, University Hospital Leipzig, Liebigstraße 16, 04103 Leipzig, Germany.
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