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Chen H, Cui L, Chen S, Liu R, Pan X, Zhou F, Xing Y. Comparable dynamic cerebral autoregulation and neurovascular coupling of the posterior cerebral artery between healthy men and women. CNS Neurosci Ther 2024; 30:e14584. [PMID: 38421125 PMCID: PMC10851316 DOI: 10.1111/cns.14584] [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: 09/11/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS Most studies focus on dynamic cerebral autoregulation (dCA) in the middle cerebral artery (MCA), and few studies investigated neurovascular coupling (NVC) and dCA in the posterior cerebral artery (PCA). We investigated NVC and dCA of the PCA in healthy volunteers to identify sex differences. METHODS Thirty men and 30 age-matched women completed dCA and NCV assessments. The cerebral blood flow velocity (CBFV) and mean arterial pressure were evaluated using transcranial Doppler ultrasound and a servo-controlled plethysmograph, respectively. The dCA parameters were analyzed using transfer function analysis. The NCV was evaluated by eyes-open and eyes-closed (24 s each) periodically based on voice prompts. The eyes-open visual stimulation comprised silent reading of Beijing-related tourist information. RESULTS The PCA gain was lower than that of the MCA in all frequency ranges (all p < 0.05). Phase was consistent across the cerebrovascular territories. The cerebrovascular conductance index (CVCi) and mean CBFV (MV) of the PCA were significantly higher during the eyes-open than eyes-closed period (CVCi: 0.50 ± 0.12 vs. 0.38 ± 0.10; MV: 42.89 ± 8.49 vs. 32.98 ± 7.25, both p < 0.001). The PCA dCA and NVC were similar between the sexes. CONCLUSION We assessed two major mechanisms that maintain cerebral hemodynamic stability in healthy men and women. The visual stimulation-evoked CBFV of the PCA was significantly increased compared to that during rest, confirming the activation of NVC. Men and women have similar functions in PCA dCA and NCV.
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Affiliation(s)
- Hongxiu Chen
- Department of Vascular UltrasonographyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Diagnostic Center of Vascular UltrasoundBeijingChina
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina
| | - Liuping Cui
- Department of Vascular UltrasonographyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Diagnostic Center of Vascular UltrasoundBeijingChina
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina
| | - Songwei Chen
- Department of Vascular UltrasonographyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Diagnostic Center of Vascular UltrasoundBeijingChina
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina
| | - Ran Liu
- Department of Vascular UltrasonographyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Diagnostic Center of Vascular UltrasoundBeijingChina
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina
| | - Xijuan Pan
- Department of Vascular UltrasonographyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Diagnostic Center of Vascular UltrasoundBeijingChina
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina
| | - Fubo Zhou
- Department of Vascular UltrasonographyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Diagnostic Center of Vascular UltrasoundBeijingChina
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina
| | - Yingqi Xing
- Department of Vascular UltrasonographyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Beijing Diagnostic Center of Vascular UltrasoundBeijingChina
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina
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Ackland GL, Martin T, Joseph M, Dias P, Hameed R, Gutierrez del Arroyo A, Hewson R, Abbott TEF, Spooner O, Bhogal P. Transauricular nerve stimulation in acute ischaemic stroke requiring mechanical thrombectomy: Protocol for a phase 2A, proof-of-concept, sham-controlled randomised trial. PLoS One 2023; 18:e0289719. [PMID: 38134136 PMCID: PMC10745208 DOI: 10.1371/journal.pone.0289719] [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: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Labile blood pressure after acute ischaemic stroke requiring mechanical thrombectomy is independently associated with poor patient outcomes. OBJECTIVES This study protocol describes is designed to determine whether transauricular nerve stimulation, improves baroreflex sensitivity, reduces blood pressure variability in the first 24 hours after acute ischaemic stroke requiring mechanical thrombectomy. DESIGN: PHASE 2A, PROOF-OF-CONCEPT, SHAM-CONTROLLED RANDOMISED TRIAL Methods and Analysis: 36 individuals undergoing mechanical thrombectomy for acute ischaemic stroke with established hypertension aged >18 years will be randomly allocated to receive bilateral active or sham transauricular nerve stimulation for the duration of the mechanical thrombectomy procedure (AffeX-CT/001 investigational device). The intervention will be repeated for 1h the morning following the mechanical thrombectomy. Non-invasive blood pressure will be measured ≥2h for 24h after mechanical thrombectomy. Holter electrocardiographic monitoring will be recorded during transauricular nerve stimulation. Participants, clinicians and investigators will be masked to treatment allocations. The primary outcome will be the coefficient of variation of systolic blood pressure. Secondary outcomes include additional estimates of blood pressure variability and time/frequency-domain measures of autonomic cardiac modulation An adjusted sample size of 36 patients is required to have a 90% chance of detecting, as significant at the 5% level, a difference in the coefficient of variation in systolic blood pressure of 5±4mmHg between sham and active stimulation [assuming 5% non-compliance rate in each group]. Ethics: confirmed on 16 March 2023 by HRA and Health and Care Research Wales ethics committee (reference 23/WA/0013). DISCUSSION This study will provide proof-of-concept data that examines whether non-invasive autonomic neuromodulation can be used to favourably modify blood pressure and autonomic control after acute ischaemic stroke requiring mechanical thrombectomy. TRIAL REGISTRATION Trial registration number: NCT05417009.
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Affiliation(s)
- Gareth L. Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Tim Martin
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Mareena Joseph
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Priyanthi Dias
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Rizwan Hameed
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Ana Gutierrez del Arroyo
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Russ Hewson
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Tom E. F. Abbott
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Oliver Spooner
- Department of Stroke Medicine, London, Royal London Hospital, London, Barts Health NHS Trust, London, United Kingdom
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, Royal London Hospital, London, Barts Health NHS Trust, London, United Kingdom
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Hussein M, Ali M, Abdelghaffar M, Yassien A, Gomaa R, Assad R, Magdy R. Frequency, characteristics, and predictors of headache attributed to acute ischemic stroke. Rev Neurol (Paris) 2023; 179:1000-1007. [PMID: 37541931 DOI: 10.1016/j.neurol.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/09/2023] [Accepted: 03/05/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES Although headache is a common symptom in acute ischemic stroke, the clinical and radiological factors associated with its occurrence are controversial. This work aimed to determine the frequency, characteristics, and predictors of headache occurrence among patients with acute ischemic stroke. METHODS This cross-sectional study was conducted on 303 patients with acute ischemic stroke. The patients were submitted to detailed history taking, clinical and radiological assessment. A detailed analysis of headache was performed for the patients who experienced headache temporally related to stroke onset. RESULTS Diagnosis of headache attributed to the ischemic stroke was established in 129 (42.6%) patients; sentinel headache in 17.2% of patients, and headache at stroke onset in 25.4% of patients. The headache group had a significantly younger age (P=0.017), lower NIHSS score (P=0.042), higher frequency of pre-existing headache disorders (P=0.001), substance use disorder (P=0.021), and fever (P=0.036), and lower frequency of chronic hypertension (P=0.013) and small vessel disease (P=0.004) than non-headache group. Infarction involving posterior circulation was more frequent in headache than in non-headache groups (P=0.003). The presence of migraine, tension-type headache, other types of headache, fever and posterior circulation stroke increased the odds of headache by 27.4 (95%CI=8.0-94.4), 7.6 (95%CI=3.93-14.6), 26.2 (95%CI=8.0-85.8), 3.75 (95%CI=1.22-11.6) and 3.15 (95%CI=1.65-6.0) times, respectively, whereas, the presence of small vessel disease decreased the odds of headache by 0.51 (95%CI=0.279-0.95) times. CONCLUSION Pre-existing headache disorder, fever, and posterior circulation stroke were associated with headache occurrence in acute ischemic stroke patients.
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Affiliation(s)
- M Hussein
- Department of Neurology, Beni-Suef University, Beni-Suef. Egypt.
| | - M Ali
- Department of Neurology, Beni-Suef University, Beni-Suef. Egypt.
| | - M Abdelghaffar
- Department of Neurology, Fayoum University, Fayoum, Egypt.
| | - A Yassien
- Department of Critical care medicine, Beni-suef University, Beni-Suef. Egypt.
| | - R Gomaa
- Department of Neurology, Beni-Suef University, Beni-Suef. Egypt.
| | - R Assad
- Department of Radiology, Cairo University, Cairo, Egypt.
| | - R Magdy
- Department of Neurology, Cairo University, Cairo, Egypt.
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Laviv Y, Saraf D, Oxman L, Zvi IB. Supratentorial hemangioblastoma: correlation between phenotype, gender and vascular territory affected. Neurosurg Rev 2023; 46:281. [PMID: 37875641 DOI: 10.1007/s10143-023-02194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
Supratentorial hemangioblastomas are rare, vascular lesions. The presence of peri-tumoral cysts and edema has meaningful clinical, diagnostic and therapeutic implications. Nevertheless, the pathogenesis of both cyst and edema formation is not fully understood. This study sought to determine if the radiologic phenotype of supratentorial hemangioblastoma is affected by the different cerebral arterial circulations. Review of the English-language literature from 1973 to 2023 yielded 53 cases of parenchymal supratentorial hemangioblastomas eligible for analysis. Patients were divided by the vascular territorial distribution of the lesions: anterior circulation (n = 36) or posterior circulation (n = 17), and the groups were compared for demographic, clinical, radiologic and molecular variables. Univariate analyses yielded a significant difference between the groups in five variables. Cystic changes and "classic" radiological phenotype were associated with hemangioblastomas of the posterior circulation (OR = 0.19, p = 0.045 and OR = 0.287, p = 0.048, respectively), while female gender, significant peritumoral edema and purely solid phenotype were associated with hemangioblastomas of the anterior circulation (OR = 3.384, p = 0.045 and OR = 5.25, p = 0.05 and OR = 14.0, p = 0.015; respectively). On multivariate analysis, solid phenotype and female gender remained significantly associated with the anterior circulation (OR = 36.04, p = 0.014 and OR = 4.45, p = 0.045). The incidence of von-Hippel Lindau disease was higher in the anterior-circulation group. Cystic tumors were present in all females in the posterior-circulation group compared to 43.4% in the anterior-circulation group (OR = 20.714, 95% CI 1.061 to 404.122; p = 0.045). Based on historical cases of supratentorial hemangioblastoma, this study shows that different tumor phenotypes are associated with the different cerebral circulations. Gender was also associated with differences in tumor distribution and radiologic phenotype. These novel data may improve our understanding of unique vascular diseases of the central nervous system.
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Affiliation(s)
- Yosef Laviv
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - David Saraf
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Oxman
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Ben Zvi
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jin GY, Jin LL, Jin BX, Zheng J, He BJ, Li SJ. Neural control of cerebral blood flow: scientific basis of scalp acupuncture in treating brain diseases. Front Neurosci 2023; 17:1210537. [PMID: 37650106 PMCID: PMC10464620 DOI: 10.3389/fnins.2023.1210537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023] Open
Abstract
Scalp acupuncture (SA), as a modern acupuncture therapy in the treatment of brain diseases, especially for acute ischemic strokes, has accumulated a wealth of experience and tons of success cases, but the current hypothesized mechanisms of SA therapy still seem to lack significant scientific validity, which may not be conducive to its ultimate integration into mainstream medicine. This review explores a novel perspective about the mechanisms of SA in treating brain diseases based on its effects on cerebral blood flow (CBF). To date, abundant evidence has shown that CBF is significantly increased by stimulating specific SA points, areas or nerves innervating the scalp, which parallels the instant or long-term improvement of symptoms of brain diseases. Over time, the neural pathways that improve CBF by stimulating the trigeminal, the facial, and the cervical nerves have also been gradually revealed. In addition, the presence of the core SA points or areas frequently used for brain diseases can be rationally explained by the characteristics of nerve distribution, including nerve overlap or convergence in certain parts of the scalp. But such characteristics also suggest that the role of these SA points or areas is relatively specific and not due to a direct correspondence between the current hypothesized SA points, areas and the functional zones of the cerebral cortex. The above evidence chain indicates that the efficacy of SA in treating brain diseases, especially ischemic strokes, is mostly achieved by stimulating the scalp nerves, especially the trigeminal nerve to improve CBF. Of course, the mechanisms of SA in treating various brain diseases might be multifaceted. However, the authors believe that understanding the neural regulation of SA on CBF not only captures the main aspects of the mechanisms of SA therapy, but also facilitates the elucidation of other mechanisms, which may be of greater significance to further its clinical applications.
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Affiliation(s)
- Guan-Yuan Jin
- International Institute of Systems Medicine, Inc., Milwaukee, WI, United States
- Ace Acupuncture Clinic of Milwaukee, LLC, Milwaukee, WI, United States
| | - Louis Lei Jin
- The Woodlands Acupuncture and Herbal Clinic, The Woodlands, TX, United States
| | - Bonnie Xia Jin
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jin Zheng
- HCA Houston Healthcare Conroe, Conroe, TX, United States
| | - Belinda Jie He
- The Woodlands Acupuncture and Herbal Clinic, The Woodlands, TX, United States
| | - Shi-Jiang Li
- Medical College of Wisconsin, Milwaukee, WI, United States
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Stewart JM, Medow MS. Anticipatory central command on standing decreases cerebral blood velocity causing hypocapnia in hyperpneic postural tachycardia syndrome. J Appl Physiol (1985) 2023; 135:26-34. [PMID: 37227184 PMCID: PMC10281786 DOI: 10.1152/japplphysiol.00016.2023] [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: 01/10/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023] Open
Abstract
Fifty percent of patients with postural tachycardia syndrome (POTS) are hypocapnic during orthostasis related to initial orthostatic hypotension (iOH). We determined whether iOH drives hypocapnia in POTS by low BP or decreased cerebral blood velocity (CBv). We studied three groups; healthy volunteers (n = 32, 18 ± 3 yr) were compared with POTS, grouped by presence [POTS-low end-tidal CO2 (↓ETCO2), n = 26, 19 ± 2 yr] or absence [POTS-normal upright end-tidal carbon dioxide (nlCO2), n = 28, 19 ± 3 yr] of standing hypocapnia defined by end-tidal CO2 (ETCO2) ≤ 30 mmHg at steady-state, measuring middle cerebral artery CBv, heart rate (HR), and beat-to-beat blood pressure (BP). After 30 min supine, subjects stood for 5 min. Quantities were measured prestanding, at minimum CBv, minimum BP, peak HR, CBv recovery, BP recovery, minimum HR, steady-state, and 5 min. Baroreflex gain was estimated by α index. iOH occurred with similar frequency and minimum BP in POTS-↓ETCO2 and POTS-nlCO2. Minimum CBv was reduced significantly (P < 0.05) in POTS-↓ETCO2 (48 ± 3 cm/s) preceding hypocapnia compared with POTS-nlCO2 (61 ± 3 cm/s) or Control (60 ± 2 cm/s). The anticipatory increased BP was significantly larger (P < 0.05) in POTS (8 ± 1 mmHg vs. 2 ± 1) and began ∼8 s prestanding. HR increased in all subjects, CBv increased significantly (P < 0.05) in both POTS-nlCO2 (76 ± 2 to 85 ± 2 cm/s) and Control (75 ± 2 to 80 ± 2 cm/s) consistent with central command. CBv decreased in POTS-↓ETCO2 (76 ± 3 to 64 ± 3 cm/s) correlating with decreased baroreflex gain. Cerebral conductance [meanCBv/mean arterial blood pressure (MAP)] was reduced in POTS-↓ETCO2 throughout. Data support the hypothesis that excessively reduced CBv during iOH may intermittently reduce carotid body blood flow, sensitizing that organ and producing postural hyperventilation in POTS-↓ETCO2. Excessive fall in CBv occurs in part during prestanding central command and is a facet of defective parasympathetic regulation in POTS.NEW & NOTEWORTHY Dyspnea is frequent in postural tachycardia syndrome (POTS) and is associated with upright hyperpnea and hypocapnia that drives sinus tachycardia. It is initiated by an exaggerated reduction in cerebral conductance and decreased cerebral blood flow (CBF) that precedes the act of standing. This is a form of autonomically mediated "central command." Cerebral blood flow is further reduced by initial orthostatic hypotension common in POTS. Hypocapnia is maintained during the standing response and might account for persistent postural tachycardia.
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Affiliation(s)
- Julian M Stewart
- Department of Pediatrics, New York Medical College, Valhalla, New York, United States
- Department of Physiology, New York Medical College, Valhalla, New York, United States
| | - Marvin S Medow
- Department of Pediatrics, New York Medical College, Valhalla, New York, United States
- Department of Physiology, New York Medical College, Valhalla, New York, United States
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González-Hernández A, Marichal-Cancino BA, MaassenVanDenBrink A, Villalón CM. Serotonergic Modulation of Neurovascular Transmission: A Focus on Prejunctional 5-HT Receptors/Mechanisms. Biomedicines 2023; 11:1864. [PMID: 37509503 PMCID: PMC10377335 DOI: 10.3390/biomedicines11071864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
5-Hydroxytryptamine (5-HT), or serotonin, plays a crucial role as a neuromodulator and/or neurotransmitter of several nervous system functions. Its actions are complex, and depend on multiple factors, including the type of effector or receptor activated. Briefly, 5-HT can activate: (i) metabotropic (G-protein-coupled) receptors to promote inhibition (5-HT1, 5-HT5) or activation (5-HT4, 5-HT6, 5-HT7) of adenylate cyclase, as well as activation (5-HT2) of phospholipase C; and (ii) ionotropic receptor (5-HT3), a ligand-gated Na+/K+ channel. Regarding blood pressure regulation (and beyond the intricacy of central 5-HT effects), this monoamine also exerts direct postjunctional (on vascular smooth muscle and endothelium) or indirect prejunctional (on autonomic and sensory perivascular nerves) effects. At the prejunctional level, 5-HT can facilitate or preclude the release of autonomic (e.g., noradrenaline and acetylcholine) or sensory (e.g., calcitonin gene-related peptide) neurotransmitters facilitating hypertensive or hypotensive effects. Hence, we cannot formulate a specific impact of 5-HT on blood pressure level, since an increase or decrease in neurotransmitter release would be favoured, depending on the type of prejunctional receptor involved. This review summarizes and discusses the current knowledge on the prejunctional mechanisms involved in blood pressure regulation by 5-HT and its impact on some vascular-related diseases.
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Affiliation(s)
- Abimael González-Hernández
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Queretaro 76230, Mexico
| | - Bruno A Marichal-Cancino
- Departamento de Fisiología y Farmacología, Universidad Autónoma de Aguascalientes, Mexico City 20100, Mexico
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Carlos M Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Calzada de los Tenorios 235, Colonia Granjas-Coapa, Delegación Tlalpan, Mexico City 14330, Mexico
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Schubert R, Gaynullina D, Shvetsova A, Tarasova OS. Myography of isolated blood vessels: Considerations for experimental design and combination with supplementary techniques. Front Physiol 2023; 14:1176748. [PMID: 37168231 PMCID: PMC10165122 DOI: 10.3389/fphys.2023.1176748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
The study of the mechanisms of regulation of vascular tone is an urgent task of modern science, since diseases of the cardiovascular system remain the main cause of reduction in the quality of life and mortality of the population. Myography (isometric and isobaric) of isolated blood vessels is one of the most physiologically relevant approaches to study the function of cells in the vessel wall. On the one hand, cell-cell interactions as well as mechanical stretch of the vessel wall remain preserved in myography studies, in contrast to studies on isolated cells, e.g., cell culture. On the other hand, in vitro studies in isolated vessels allow control of numerous parameters that are difficult to control in vivo. The aim of this review was to 1) discuss the specifics of experimental design and interpretation of data obtained by myography and 2) highlight the importance of the combined use of myography with various complementary techniques necessary for a deep understanding of vascular physiology.
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Affiliation(s)
- Rudolf Schubert
- Physiology, Institute of Theoretical Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- *Correspondence: Rudolf Schubert,
| | - Dina Gaynullina
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | | | - Olga S. Tarasova
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
- State Research Center of the Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
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9
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Robertson CE, Benarroch EE. The anatomy of head pain. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:41-60. [PMID: 38043970 DOI: 10.1016/b978-0-12-823356-6.00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Pain-sensitive structures in the head and neck, including the scalp, periosteum, meninges, and blood vessels, are innervated predominantly by the trigeminal and upper cervical nerves. The trigeminal nerve supplies most of the sensation to the head and face, with the ophthalmic division (V1) providing innervation to much of the supratentorial dura mater and vessels. This creates referral patterns for pain that may be misleading to clinicians and patients, as described by studies involving awake craniotomies and stimulation with electrical and mechanical stimuli. Most brain parenchyma and supratentorial vessels refer pain to the ipsilateral V1 territory, and less commonly the V2 or V3 region. The upper cervical nerves provide innervation to the posterior scalp, while the periauricular region and posterior fossa are territories with shared innervation. Afferent fibers that innervate the head and neck send nociceptive input to the trigeminocervical complex, which then projects to additional pain processing areas in the brainstem, thalamus, hypothalamus, and cortex. This chapter discusses the pain-sensitive structures in the head and neck, including pain referral patterns for many of these structures. It also provides an overview of peripheral and central nervous system structures responsible for transmitting and interpreting these nociceptive signals.
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Affiliation(s)
- Carrie E Robertson
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.
| | - Eduardo E Benarroch
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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Dumais F, Caceres MP, Janelle F, Seifeldine K, Arès-Bruneau N, Gutierrez J, Bocti C, Whittingstall K. eICAB: A novel deep learning pipeline for Circle of Willis multiclass segmentation and analysis. Neuroimage 2022; 260:119425. [PMID: 35809887 DOI: 10.1016/j.neuroimage.2022.119425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/22/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The accurate segmentation, labeling and quantification of cerebral blood vessels on MR imaging is important for basic and clinical research, yet results are not generalizable, and often require user intervention. New methods are needed to automate this process. PURPOSE To automatically segment, label and quantify Circle of Willis (CW) arteries on Magnetic Resonance Angiography images using deep convolutional neural networks. MATERIALS AND METHODS MRA images were pooled from three public and private databases. A total of 116 subjects (mean age 56 years ± 21 [standard deviation]; 72 women) were used to make up the training set (N=101) and the testing set (N=15). In each image, fourteen arterial segments making up or surrounding the CW were manually annotated and validated by a clinical expert. Convolutional neural network (CNN) models were trained on a training set to be finally combined in an ensemble to develop eICAB. Model performances were evaluated using (1) quantitative analysis (dice score on test set) and (2) qualitative analysis (external datasets, N=121). The reliability was assessed using multiple MRAs of healthy participants (ICC of vessel diameters and volumes on test-retest). RESULTS Qualitative analysis showed that eICAB correctly predicted the large, medium and small arteries in 99±0.4%, 97±1% and 88±7% of all images, respectively. For quantitative assessment, the average dice score coefficients for the large (ICAs, BA), medium (ACAs, MCAs, PCAs-P2), and small (AComm, PComm, PCAs-P1) vessels were 0.76±0.07, 0.76±0.08 and 0.41±0.27, respectively. These results were similar and, in some cases, statistically better (p<0.05) than inter-expert annotation variability and robust to image SNR. Finally, test-retest analysis showed that the model yielded high diameter and volume reliability (ICC=0.99). CONCLUSION We have developed a quick and reliable open-source CNN-based method capable of accurately segmenting and labeling the CW in MRA images. This method is largely independent of image quality. In the future, we foresee this approach as a critical step towards fully automated analysis of MRA databases in basic and clinical research.
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Affiliation(s)
- Félix Dumais
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada.
| | - Marco Perez Caceres
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Félix Janelle
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Kassem Seifeldine
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Noémie Arès-Bruneau
- Department of Medecine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Christian Bocti
- Department of Medecine, Université de Sherbrooke, Sherbrooke, Québec, Canada; Research Center on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada; Department of Neurology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Kevin Whittingstall
- Department of Radiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
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11
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O'Brien NF, Fonseca Y, Johnson HC, Postels D, Birbeck GL, Chimalizeni Y, Seydel KB, Bernard Gushu M, Phiri T, June S, Chetcuti K, Vidal L, Goyal MS, Taylor TE. Mechanisms of Transcranial Doppler Ultrasound phenotypes in paediatric cerebral malaria remain elusive. Malar J 2022; 21:196. [PMID: 35729574 PMCID: PMC9210743 DOI: 10.1186/s12936-022-04163-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cerebral malaria (CM) results in significant paediatric death and neurodisability in sub-Saharan Africa. Several different alterations to typical Transcranial Doppler Ultrasound (TCD) flow velocities and waveforms in CM have been described, but mechanistic contributors to these abnormalities are unknown. If identified, targeted, TCD-guided adjunctive therapy in CM may improve outcomes. Methods This was a prospective, observational study of children 6 months to 12 years with CM in Blantyre, Malawi recruited between January 2018 and June 2021. Medical history, physical examination, laboratory analysis, electroencephalogram, and magnetic resonance imaging were undertaken on presentation. Admission TCD results determined phenotypic grouping following a priori definitions. Evaluation of the relationship between haemodynamic, metabolic, or intracranial perturbations that lead to these observed phenotypes in other diseases was undertaken. Neurological outcomes at hospital discharge were evaluated using the Paediatric Cerebral Performance Categorization (PCPC) score. Results One hundred seventy-four patients were enrolled. Seven (4%) had a normal TCD examination, 57 (33%) met criteria for hyperaemia, 50 (29%) for low flow, 14 (8%) for microvascular obstruction, 11 (6%) for vasospasm, and 35 (20%) for isolated posterior circulation high flow. A lower cardiac index (CI) and higher systemic vascular resistive index (SVRI) were present in those with low flow than other groups (p < 0.003), though these values are normal for age (CI 4.4 [3.7,5] l/min/m2, SVRI 1552 [1197,1961] dscm-5m2). Other parameters were largely not significantly different between phenotypes. Overall, 118 children (68%) had a good neurological outcome. Twenty-three (13%) died, and 33 (19%) had neurological deficits. Outcomes were best for participants with hyperaemia and isolated posterior high flow (PCPC 1–2 in 77 and 89% respectively). Participants with low flow had the least likelihood of a good outcome (PCPC 1–2 in 42%) (p < 0.001). Cerebral autoregulation was significantly better in children with good outcome (transient hyperemic response ratio (THRR) 1.12 [1.04,1.2]) compared to a poor outcome (THRR 1.05 [0.98,1.02], p = 0.05). Conclusions Common pathophysiological mechanisms leading to TCD phenotypes in non-malarial illness are not causative in children with CM. Alternative mechanistic contributors, including mechanical factors of the cerebrovasculature and biologically active regulators of vascular tone should be explored.
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Affiliation(s)
- Nicole F O'Brien
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43502, USA.
| | - Yudy Fonseca
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43502, USA
| | - Hunter C Johnson
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43502, USA
| | - Douglas Postels
- Department of Neurology, George Washington University/Children's National Medical Center, Washington, DC, USA
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY, USA.,University Teaching Hospitals Children's Hospital, Lusaka, Zambia
| | - Yamikani Chimalizeni
- Department of Pediatrics and Child Health, Kamuzu University of Health Sciences, Chichiri, Blantyre 3, Malawi
| | - Karl B Seydel
- Dept of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Montfort Bernard Gushu
- Queen Elizabeth Central Hospital, The Blantyre Malaria Project, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Tusekile Phiri
- Queen Elizabeth Central Hospital, The Blantyre Malaria Project, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Sylvester June
- Queen Elizabeth Central Hospital, The Blantyre Malaria Project, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Karen Chetcuti
- Department of Pediatrics and Child Health, Kamuzu University of Health Sciences, Chichiri, Blantyre 3, Malawi
| | - Lorenna Vidal
- Department of Radiology, Division of Neuroradiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Manu S Goyal
- Washington University School of Medicine, St. Louis, MO, USA
| | - Terrie E Taylor
- Dept of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
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12
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Triplett JD, Kutlubaev MA, Kermode AG, Hardy T. Posterior reversible encephalopathy syndrome (PRES): diagnosis and management. Pract Neurol 2022; 22:183-189. [PMID: 35046115 DOI: 10.1136/practneurol-2021-003194] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/31/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) may present with diverse clinical symptoms including visual disturbance, headache, seizures and impaired consciousness. MRI shows oedema, usually involving the posterior subcortical regions. Triggering factors include hypertension, pre-eclampsia/eclampsia, renal failure, cytotoxic agents and autoimmune conditions. The mechanism underlying PRES is not certain, but endothelial dysfunction is implicated. Treatment is supportive and involves correcting the underlying cause and managing associated complications, such as seizures. Although most patients recover, PRES is not always reversible and may be associated with considerable morbidity and even mortality.
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Affiliation(s)
- James D Triplett
- Neurology, Concord Hospital, Concord, New South Wales, Australia
| | | | - Allan G Kermode
- Perron Institute, University of Western Australia, Perth, Western Australia, Australia.,CMMIT, Murdoch University, Murdoch, Western Australia, Australia
| | - Todd Hardy
- Neurology, Concord Hospital, Concord, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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13
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Abdelhaleem NF, Mohamed YE. Effect of sphenopalatine ganglion block on intracranial pressure and cerebral venous outflow oxygenation during craniotomy for supratentorial brain tumours. Anaesth Crit Care Pain Med 2021; 41:101013. [PMID: 34954221 DOI: 10.1016/j.accpm.2021.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/06/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative intracranial pressure (ICP) control continues to be a challenge for anaesthetists during craniotomies. Although many standard brain-dehydrating protocols are available, they may be ineffective in certain surgical situations and may result in harm either to the systemic or cerebral circulation. Sphenopalatine ganglion block (SPGB) can reverse the vasodilatory effects of anaesthesia during craniotomy. METHODS This prospective randomised study was carried from June 2020 to February 2021. Fifty-two patients were randomly allocated into two groups, the block group (B) and the non-block control group (Non). Twenty-six patients were enrolled in the (B) group and received a bilateral transnasal SPG block with 2% lidocaine using a hallow culture swab prior to anaesthesia induction. Intraoperative monitoring was performed using standard American Society of Anesthesiologists (ASA) monitors in addition to invasive monitoring using intra-arterial cannulas and jugular venous bulb catheters. Subdural ICP monitors were also employed. The arterio-jugular oxygen difference in mmol/l (AjvDO2) was then calculated. Mean flow velocity cm/s (MFV) and pulsatility index (PI) were monitored in both groups using Transcranial Doppler. Haemodynamic data were recorded every 30 min from induction of anaesthesia until the closure of the dura. RESULTS There was a significant difference in ICP prior to the dural opening between the block group (B), mean ± sd 7.58 ± 1.47, and the non-block group (Non), mean ± sd (11.69 ± 1.72), p-value < 0.001. There was no significant difference in MFV between (B) group, mean ± sd 72.65 ± 2.28 and (Non) group, mean ± sd 71.19 ± 3.09 before intubation (baseline values). While there was a significant difference after intubation between block group, mean ± sd 72.12 ± 1.77 and non - block group, mean ± sd 74.62 ± 5.07, p-value = 0.02. There was an insignificant difference between (B) and (Non) groups before intubation regarding PI values, while PI was significantly higher in (B) group than the (Non) group after intubation where mean ± sd was 1.17 ± 0.05 versus 0.96 ± 0.09, respectively, p-value = 0.001. There was no significant difference regarding cerebral oxygenation between the groups. CONCLUSIONS SPGB can control factors that increase CBF during anaesthesia by the block of parasympathetic vasodilatory fibres to the arterial system in the anterior cerebral circulation, while neither hindering cerebral venous drainage nor impairing cerebral oxygenation, as it gives no supply to cerebral veins and does not affect basal CBF. Additionally, it does not affect systemic circulation.
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Affiliation(s)
- Naglaa Fathy Abdelhaleem
- Anaesthesia and Surgical Intensive Care department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt.
| | - Youssef Essam Mohamed
- Neurosurgery department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
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14
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Koep JL, Taylor CE, Coombes JS, Bond B, Ainslie PN, Bailey TG. Autonomic control of cerebral blood flow: fundamental comparisons between peripheral and cerebrovascular circulations in humans. J Physiol 2021; 600:15-39. [PMID: 34842285 DOI: 10.1113/jp281058] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/25/2021] [Indexed: 01/12/2023] Open
Abstract
Understanding the contribution of the autonomic nervous system to cerebral blood flow (CBF) control is challenging, and interpretations are unclear. The identification of calcium channels and adrenoreceptors within cerebral vessels has led to common misconceptions that the function of these receptors and actions mirror those of the peripheral vasculature. This review outlines the fundamental differences and complex actions of cerebral autonomic activation compared with the peripheral circulation. Anatomical differences, including the closed nature of the cerebrovasculature, and differential adrenoreceptor subtypes, density, distribution and sensitivity, provide evidence that measures on peripheral sympathetic nerve activity cannot be extrapolated to the cerebrovasculature. Cerebral sympathetic nerve activity seems to act opposingly to the peripheral circulation, mediated at least in part by changes in intracranial pressure and cerebral blood volume. Additionally, heterogeneity in cerebral adrenoreceptor distribution highlights region-specific autonomic regulation of CBF. Compensatory chemo- and autoregulatory responses throughout the cerebral circulation, and interactions with parasympathetic nerve activity are unique features to the cerebral circulation. This crosstalk between sympathetic and parasympathetic reflexes acts to ensure adequate perfusion of CBF to rising and falling perfusion pressures, optimizing delivery of oxygen and nutrients to the brain, while attempting to maintain blood volume and intracranial pressure. Herein, we highlight the distinct similarities and differences between autonomic control of cerebral and peripheral blood flow, and the regional specificity of sympathetic and parasympathetic regulation within the cerebrovasculature. Future research directions are outlined with the goal to further our understanding of autonomic control of CBF in humans.
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Affiliation(s)
- Jodie L Koep
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Chloe E Taylor
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Jeff S Coombes
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Bert Bond
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| | - Tom G Bailey
- Physiology and Ultrasound Laboratory in Science and Exercise, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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15
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Tamayo A, Siepmann T. Regulation of Blood Flow in the Cerebral Posterior Circulation by Parasympathetic Nerve Fibers: Physiological Background and Possible Clinical Implications in Patients With Vertebrobasilar Stroke. Front Neurol 2021; 12:660373. [PMID: 34777191 PMCID: PMC8585859 DOI: 10.3389/fneur.2021.660373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/23/2021] [Indexed: 01/14/2023] Open
Abstract
Posterior circulation involves the vertebrobasilar arteries, which supply oxygen and glucose to vital human brainstem structures and other areas. This complex circulatory- perfusion system is not homogenous throughout the day; rather, its hemodynamic changes rely on physiological demands, ensuring brainstem perfusion. This dynamic autoregulatory pattern maintains cerebral perfusion during blood pressure changes. Accumulative evidence suggests that activity within the autonomic nervous system is involved in the regulation of cerebral blood flow. Neither the sympathetic nor parasympathetic nervous systems work independently. Functional studies have shown a tight and complicated cross talk between these systems. In pathological processes where sympathetic stimulation is present, systemic vasoconstriction is followed, representing the most important CNS parasympathetic trigger that will promote local vasodilation. Stroke is a clear example of this process. The posterior circulation is affected in 30% of strokes, causing high morbidity and mortality outcomes. Currently, the management of ischemic stroke is focused on thrombolytic treatment and endovascular thrombectomy within an overall tight 4.5 to 6 h ischemic time window. Therefore, the autonomic nervous system could represent a potential therapeutic target to modulate reperfusion after cerebral ischemia through vasodilation, which could potentially decrease infarct size and increase the thrombolytic therapeutic ischemic window. In addition, shifting the autonomic nervous system balance toward its parasympathetic branch has shown to enhance neurogenesis and decrease local inflammation. Regretfully, the vast majority of animal models and human research on neuromodulation during brain ischemia have been focused on anterior circulation with disappointing results. In addition, the source of parasympathetic inputs in the vertebrobasilar system in humans is poorly understood, substantiating a gap and controversy in this area. Here, we reviewed current available literature regarding the parasympathetic vascular function and challenges of its stimulation in the vertebrobasilar system.
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Affiliation(s)
- Arturo Tamayo
- The Max Rady Faculty of Health Sciences, Department of Medicine, Section of Neurology, WRHA, Winnipeg and Brandon Regional Health Centre, University of Manitoba, Winnipeg, MB, Canada.,Department of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Timo Siepmann
- Department of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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16
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Yartsev VN. Effect of Nephrectomy on Arterial Reactivity in Spontaneously Hypertensive Rats. J EVOL BIOCHEM PHYS+ 2021. [DOI: 10.1134/s0022093021050124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Stoyell-Conti FF, Chabbra A, Puthentharayil J, Rigatto K, Speth RC. Chronic administration of pharmacological doses of angiotensin 1-7 and iodoangiotensin 1-7 has minimal effects on blood pressure, heart rate, and cognitive function of spontaneously hypertensive rats. Physiol Rep 2021; 9:e14812. [PMID: 33904655 PMCID: PMC8077095 DOI: 10.14814/phy2.14812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular diseases are the principal cause of death worldwide, with hypertension being the most common cardiovascular disease risk factor. High blood pressure (BP) is also associated with an increased risk of poor cognitive performance and dementia including Alzheimer's disease. Angiotensin 1–7 (Ang 1‐7), a product of the renin‐angiotensin system (RAS), exhibits central and peripheral actions to reduce BP. Recent data from our lab reveals that the addition of a non‐radioactive iodine molecule to the tyrosine in position 4 of Ang 1‐7 (iodoAng 1‐7) makes it ~1000‐fold more potent than Ang 1‐7 in competing for the 125I‐Ang 1‐7 binding site (Stoyell‐Conti et al., 2020). Moreover, the addition of the non‐radioactive iodine molecule increases (~4‐fold) iodoAng 1‐7’s ability to bind to the AT1 receptor (AT1R), the primary receptor for Ang II. Preliminary data indicates that iodoAng 1‐7 can also compete for the 125I‐Ang IV binding site with a low micromolar IC50. Thus, our aims were to compare the effects of chronic treatment of the Spontaneously Hypertensive Rat (SHR) with iodoAng 1‐7 (non‐radioactive iodine isotope) and Ang 1‐7 on arterial pressure, heart rate, and cognitive function. For this study, male SHRs were divided into three groups and treated with Saline, Ang 1‐7, or iodoAng 1‐7 administrated subcutaneously using a 28‐day osmotic mini pump. Systolic BP was measured non‐invasively by the tail‐cuff technique. Cognitive function was assessed by Y‐Maze test and novel object recognition (NOR) test. We have demonstrated in SHRs that subcutaneous administration of high doses of iodoAng 1‐7 prevented the increase in heart rate with age, while Ang 1‐7 showed a trend toward preventing the increase in heart rate, possibly by improving baroreflex control of the heart. Conversely, neither Ang 1‐7 nor iodoAng 1‐7 administered subcutaneously affected BP nor cognitive function.
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Affiliation(s)
- Filipe F Stoyell-Conti
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA.,Surgery Department, University of Miami, Miami, FL, USA
| | - Alesa Chabbra
- Halmos College of Natural Science & Oceanography, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Joseph Puthentharayil
- Halmos College of Natural Science & Oceanography, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Katya Rigatto
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.,Laboratório de Fisiologia Translacional, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Robert C Speth
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Pharmacology and Physiology, College of Medicine, Georgetown University, Washington, DC, USA
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18
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Reehal N, Cummings S, Mullen MT, Baker WB, Kung D, Tackett W, Favilla CG. Differentiating Dynamic Cerebral Autoregulation Across Vascular Territories. Front Neurol 2021; 12:653167. [PMID: 33833734 PMCID: PMC8021764 DOI: 10.3389/fneur.2021.653167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Transcranial Doppler is commonly used to calculate cerebral autoregulation, but measurements are typically restricted to a single cerebral artery. In exploring topographic heterogeneity, this study reports the first thorough comparison of autoregulation in all major cerebral vessels. Methods: In forty healthy adults, flow velocity was monitored in the anterior, middle, and posterior cerebral arteries, and synchronized with arterial blood pressure. A transfer function analysis provided characteristics of autoregulation by quantifying the relationship between blood pressure and cerebral blood flow velocity. Results: Phase, which quantifies the time course of autoregulation, was similar in all vessels. Gain, which quantifies the magnitude of hemodynamic regulation, was lower in posterior cerebral artery, indicative of tighter regulation. However, after adjusting for baseline flow differences in each vascular territory, normalized gain was similar in all vessels. Conclusions: Discriminating dynamic cerebral autoregulation between cerebrovascular territories is feasible with a transcranial doppler based approach. In the posterior cerebral artery of healthy volunteers, absolute flow is more tightly regulated, but relative flow regulation is consistent across cerebrovascular territories. Significance: The methodology can be applied to focal disease states such as stroke or posterior reversible encephalopathy syndrome, in which the topographic distribution of autoregulation may be particularly critical.
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Affiliation(s)
- Navpreet Reehal
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Stephanie Cummings
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Wesley B Baker
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - David Kung
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - William Tackett
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher G Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
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19
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Huang X, Ngaenklangdon S, He J, Gao X. Traditional Chinese Medicine's liver yang ascendant hyperactivity pattern of essential hypertension and its treatment approaches: A narrative review. Complement Ther Clin Pract 2021; 43:101354. [PMID: 33706064 DOI: 10.1016/j.ctcp.2021.101354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/24/2022]
Abstract
"Liver yang ascendant hyperactivity" (SF52), as termed by WHO, is a commonly observed pattern of essential hypertension (EH), herein referred to as EH-SF52. This paper summarizes the Traditional Chinese Medicine (TCM) perspectives, biomedical findings, and TCM managements for EH-SF52 in modern times. EH-SF52 is generally identified as an EH individual presenting with headache, dizziness, poor sleep quality, tinnitus, facial flushing, fatigue, signs of mild dehydration, and whom are highly irritable individuals with a tendency to overthink, be competitive, or be aggressive. The proposed EH-SF52 model features a state of autonomic imbalance and vascular changes that accounts for the above symptoms. TCM managements for EH-SF52 includes Chinese herbal medication, acupuncture, qigong, taichi, massage, food therapy, as well as lifestyle changes, which targets symptomatic alleviation and blood pressure reduction in a multi-mechanistic manner. An increasing shift towards integrated practice of TCM and western medicine in EH-SF52 requires effective communication between both disciplines.
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Affiliation(s)
- Xuhua Huang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Sakhorn Ngaenklangdon
- Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; Faculty of Traditional Chinese Medicine, Nakhonratchasima College, Thailand
| | - Jun He
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
| | - Xiumei Gao
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
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20
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Chen YC, Lu BZ, Shu YC, Sun YT. Spatiotemporal Dynamics of Cerebral Vascular Permeability in Type 2 Diabetes-Related Cerebral Microangiopathy. Front Endocrinol (Lausanne) 2021; 12:805637. [PMID: 35087478 PMCID: PMC8786705 DOI: 10.3389/fendo.2021.805637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS Diabetes-related cerebral microangiopathy can manifest as cerebral small vessel disease (CSVD) and exhibit cognitive decline. To find the early change of function in advance, this study examined the spatiotemporal dynamics of cerebral vascular permeability (Ktrans) in the progression of type 2 diabetes mellitus (T2DM). METHODS Ktrans was cross-sectionally measured in T2DM and non-diabetes groups with or without CSVD using dynamic contrast-enhanced MRI (DCE-MRI). RESULTS In all patients with T2DM, the Ktrans of white matter (WM) was increased, whereas the Ktrans of gray matter (GM) was increased only in T2DM with CSVD. The involvement of WM was earlier than GM and was before the CSVD features could be visualized on MRI. Among the commonly available four CSVD items of MRI, microbleeds were the most sensitive, indicating the increased permeability in all patients. Increased Ktrans in T2DM was more associated with moderate WM hyperintensity but less with the presence of lacunae or multiple perivascular spaces, in contrast to patients without diabetes. The differential correlation suggested distinct mechanisms underlying diabetes-related CSVD and other CSVDs. CONCLUSIONS This study highlights the early development of cerebral microangiopathy with increased BBB leakage in T2DM, before the CSVD features can be visualized on MRI. The results may increase the proactivity of clinicians in recognizing the subsequent neurological comorbidities.
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Affiliation(s)
- Ying-Chen Chen
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Radiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - Bing-Ze Lu
- Department of Mathematics, College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Shu
- Department of Mathematics, College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Medical Genomics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Yuan-Ting Sun,
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Aalkjær C, Nilsson H, De Mey JGR. Sympathetic and Sensory-Motor Nerves in Peripheral Small Arteries. Physiol Rev 2020; 101:495-544. [PMID: 33270533 DOI: 10.1152/physrev.00007.2020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Small arteries, which play important roles in controlling blood flow, blood pressure, and capillary pressure, are under nervous influence. Their innervation is predominantly sympathetic and sensory motor in nature, and while some arteries are densely innervated, others are only sparsely so. Innervation of small arteries is a key mechanism in regulating vascular resistance. In the second half of the previous century, the physiology and pharmacology of this innervation were very actively investigated. In the past 10-20 yr, the activity in this field was more limited. With this review we highlight what has been learned during recent years with respect to development of small arteries and their innervation, some aspects of excitation-release coupling, interaction between sympathetic and sensory-motor nerves, cross talk between endothelium and vascular nerves, and some aspects of their role in vascular inflammation and hypertension. We also highlight what remains to be investigated to further increase our understanding of this fundamental aspect of vascular physiology.
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Affiliation(s)
| | - Holger Nilsson
- Department Physiology, Gothenburg University, Gothenburg, Sweden
| | - Jo G R De Mey
- Deptartment Pharmacology and Personalized Medicine, Maastricht University, Maastricht, The Netherlands
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22
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Matsuo N, Matsuo S, Nakamura Y, Ezomo FO, Kawai Y. Regulatory effects of cervical sympathetic trunk and renal sympathetic nerve activities on cerebral blood flow during head-down postural rotations. Auton Neurosci 2020; 229:102738. [PMID: 33197695 DOI: 10.1016/j.autneu.2020.102738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022]
Abstract
This study attempts to clarify the neural control of cerebral blood flow (CBF) during head-down postural rotation, which induces a cephalad fluid shift in urethane-anesthetized rats. The animals were placed on a table, tilted to a 45° head-down position over 5 s and maintained in that position. Head-down rotation (HDR) induced a transient decrease (8 ± 3 mm Hg; mean ± SE) in mean arterial blood pressure (ABP) at 7.3 ± 0.3 s after the onset of HDR. The pressure returned to the pre-HDR level within 1 min in the head-down position. Pretreatment with hexamethonium bromide suppressed the HDR-elicited decrease in ABP, suggesting that the decrease in ABP was induced by the suppression of autonomic neural outflow. The administration of phenoxybenzamine (PB), an α-adrenergic antagonist, also eliminated the HDR-elicited decrease in ABP, suggesting that this decrease was elicited by the suppression of α-adrenergic vascular tone. To test sympathetic outflow during HDR, renal sympathetic nerve activity (RSNA) and cervical sympathetic trunk (CST) activity (CSTA) were recorded. RSNA was transiently suppressed at 2.3 ± 0.4 s after HDR onset, followed by a decrease in ABP, suggesting that this decrease was, at least in part, induced by the suppression of sympathetic nerves. CSTA did not change significantly during HDR. These results suggest that HDR suppresses sympathetic nerves in the lower body rather than in the head, which might result in a decrease in ABP. To test the effect of the decrease in ABP due to sympathetic activity on CBF during HDR, changes in CBF during HDR were measured. CBF did not change significantly during HDR in the control group after the administration of an α-receptor blocker or after denervation of the CSTs. These results suggest that the impact of the CSTs on CBF is likely to be limited by a rapid increase in CBF due to HDR-elicited cephalad fluid shift and that CBF autoregulation proceeds through an alternative mechanism involving the myogenic properties of cerebral vessels.
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Affiliation(s)
- Noriko Matsuo
- Division of Adaptation Physiology, Department of Physiology, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Satoshi Matsuo
- Division of Adaptation Physiology, Department of Physiology, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago 683-8503, Japan.
| | - Yosuke Nakamura
- Division of Adaptation Physiology, Department of Physiology, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Felix Ojeiru Ezomo
- Division of Adaptation Physiology, Department of Physiology, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Yasuaki Kawai
- Division of Adaptation Physiology, Department of Physiology, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago 683-8503, Japan
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23
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R P, Gupta D, Shetty N, Bhushan AK, Haskar K, Gogineni S, Mehta A, Javali M, Acharya PT, Srinivasa R. Transcranial Doppler for Monitoring and Evaluation of Idiopathic Intracranial Hypertension. J Neurosci Rural Pract 2020; 11:309-314. [PMID: 32405187 PMCID: PMC7214091 DOI: 10.1055/s-0040-1710086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, characterized by features of raised intracranial pressure (ICP). Existing literature is inconclusive about the role of transcranial Doppler (TCD) in the management of IIH. Objective To study the TCD changes in IIH patients, pre- and post-cerebrospinal fluid (CSF) drainage. Materials and Methods This was a prospective study, conducted between July 2017 and December 2019, in a tertiary care referral center in South India. Sixteen consecutive patients, suspected to have IIH, underwent magnetic resonance imaging ofthe brain, a baseline TCD, and lumbar puncture with CSF drainage and pressure monitoring. Post-CSF drainage, TCD was repeated and mean flow velocities, peak systolic velocities, end-diastolic velocities, and pulsatility index (PI), in the middle cerebral artery (MCA), vertebral artery, and basilar artery (BA) were noted. Thirteen patients had elevated CSF pressure, and fulfilled the diagnostic criteria for IIH. These patients were included in the final analysis and pre- and post-CSF drainage TCD blood flow velocities and PI were compared. Results The mean age of study participants was 29.92 ± 6.92 years. There was a significant reduction in the cerebral flow velocities in bilateral MCA, after CSF drainage and normalization of ICP. Flow velocities in posterior circulation and PI in MCA, PCA, and BA showed an insignificant reduction. Two patients, who did not show any reduction in flow velocities after CSF drainage, developed optic atrophy on follow-up. Conclusion TCD-derived systolic blood flow velocities can be used in the management and follow-up of patients with IIH.
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Affiliation(s)
- Pradeep R
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Dhananjay Gupta
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Nikith Shetty
- Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India
| | | | - Krishna Haskar
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Sujana Gogineni
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
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Masai K, Ueda Y, Naito H, Tsukahara K, Aokage T, Fujisaki N, Yamamoto H, Nakao A. Atypical case of posterior reversible encephalopathy syndrome related to late onset postpartum eclampsia: A case report. Medicine (Baltimore) 2019; 98:e15187. [PMID: 31008940 PMCID: PMC6494391 DOI: 10.1097/md.0000000000015187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Eclampsia, an obstetric emergency frequently seen in pregnant or puerperal women, is a risk factor for posterior reversible encephalopathy syndrome (PRES). Most cases of eclampsia occur postpartum. We report a woman with PRES associated with eclampsia 10 weeks post-delivery, the latest onset ever reported. PATIENT CONCERNS A 23-year-old healthy woman presented headache and nausea 10 weeks after delivery. Two days later, she generalized tonic-clonic seizure. Her brain MRI presented the foci which is typical of PRES. DIAGNOSIS The patient was diagnosed as PRES associated with eclampsia. INTERVENTIONS The patient received levetiracetam and edaravone. OUTCOMES Her clinical course was uneventful and she fully recovered without neurological complications LESSONS:: The possible diagnosis of late onset postpartum eclampsia, even weeks post-delivery, should be considered, since initiation of early treatment averts severe complications and decreases mortality. Sharing our experience may increase awareness of PRES induced by late-onset postpartum eclampsia.
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25
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Rots ML, de Borst GJ, van der Toorn A, Moll FL, Pennekamp CWA, Dijkhuizen RM, Bleys RLAW. Effect of bilateral carotid occlusion on cerebral hemodynamics and perivascular innervation: An experimental rat model. J Comp Neurol 2019; 527:2263-2272. [PMID: 30840325 PMCID: PMC6767706 DOI: 10.1002/cne.24672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
We aimed to investigate the effect of chronic cerebral hypoperfusion on cerebral hemodynamics and perivascular nerve density in a rat model. Bilateral common carotid artery (CCA) ligation (n = 24) or sham‐operation (n = 24) was performed with a 1‐week interval. A subgroup (ligated n = 6; sham‐operated n = 3) underwent magnetic resonance imaging (MRI) before the procedures and 2 and 4 weeks after the second procedure. After termination, carotids were harvested for assessment of complete ligation and nerve density in cerebral arteries that were stained for the general neural marker PGP 9.5 and sympathetic marker TH by computerized image analysis. Five rats were excluded because of incomplete ligation. MRI‐based tortuosity of the posterior communicating artery (Pcom), first part of the posterior cerebral artery (P1) and basilar artery was observed in the ligated group, as well as an increased volume (p = 0.05) and relative signal intensity in the basilar artery (p = 0.04; sham‐group unchanged). Immunohistochemical analysis revealed that compared to sham‐operated rats, ligated rats had increased diameters of all intracircular segments and the extracircular part of the internal carotid artery (p < 0.05). Ligated rats showed a higher general nerve density compared to controls in P1 (10%, IQR:8.7–10.5 vs. 6.6%, IQR:5.5–7.4, p = 0.003) and Pcom segments (6.4%, IQR:5.8–6.5 vs. 3.2%, IQR:2.4–4.3, p = 0.003) and higher sympathetic nerve density in Pcom segments (3.7%, IQR:2.8–4.8 vs. 1.7%, IQR:1.3–2.2, p = 0.02). Bilateral CCA occlusion resulted in redistribution of blood flow to posteriorly located cerebral arteries with remarkable changes in morphology and perivascular nerve density, suggesting a functional role for perivascular nerves in cerebral autoregulation.
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Affiliation(s)
- M L Rots
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - G J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A van der Toorn
- Center for Image Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - F L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - C W A Pennekamp
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R M Dijkhuizen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Falvo MJ, Lindheimer JB, Serrador JM. Dynamic cerebral autoregulation is impaired in Veterans with Gulf War Illness: A case-control study. PLoS One 2018; 13:e0205393. [PMID: 30321200 PMCID: PMC6188758 DOI: 10.1371/journal.pone.0205393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 09/25/2018] [Indexed: 02/03/2023] Open
Abstract
Neurological dysfunction has been reported in Gulf War Illness (GWI), including abnormal cerebral blood flow (CBF) responses to physostigmine challenge. However, it is unclear whether the CBF response to normal physiological challenges and regulation is similarly dysfunctional. The goal of the present study was to evaluate the CBF velocity response to orthostatic stress (i.e., sit-to-stand maneuver) and increased fractional concentration of carbon dioxide. 23 cases of GWI (GWI+) and 9 controls (GWI) volunteered for this study. Primary variables of interest included an index of dynamic autoregulation and cerebrovascular reactivity. Dynamic autoregulation was significantly lower in GWI+ than GWI- both for autoregulatory index (2.99±1.5 vs 4.50±1.5, p = 0.017). In addition, we observed greater decreases in CBF velocity both at the nadir after standing (-18.5±6.0 vs -9.8±4.9%, p = 0.001) and during steady state standing (-5.7±7.1 vs -1.8±3.2%, p = 0.042). In contrast, cerebrovascular reactivity was not different between groups. In our sample of Veterans with GWI, dynamic autoregulation was impaired and consistent with greater cerebral hypoperfusion when standing. This reduced CBF may contribute to cognitive difficulties in these Veterans when upright.
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Affiliation(s)
- Michael J. Falvo
- War Related Illness and Injury Study Center, Department of Veterans Affairs, East Orange, New Jersey, United States of America
- Department of Pharmacology, Physiology and Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
| | - Jacob B. Lindheimer
- William S. Middleton Memorial Veterans Hospital, Department of Veterans Affairs, Madison, Wisconsin, United States of America
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jorge M. Serrador
- War Related Illness and Injury Study Center, Department of Veterans Affairs, East Orange, New Jersey, United States of America
- Department of Pharmacology, Physiology and Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey, United States of America
- Department of Cardiovascular Electronics, National University of Ireland Galway, Galway, Connacht, IRE
- * E-mail:
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Roloff EVL, Walas D, Moraes DJA, Kasparov S, Paton JFR. Differences in autonomic innervation to the vertebrobasilar arteries in spontaneously hypertensive and Wistar rats. J Physiol 2018; 596:3505-3529. [PMID: 29797726 PMCID: PMC6092310 DOI: 10.1113/jp275973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/03/2018] [Indexed: 01/14/2023] Open
Abstract
KEY POINTS Essential hypertension is associated with hyperactivity of the sympathetic nervous system and hypoperfusion of the brainstem area controlling arterial pressure. Sympathetic and parasympathetic innervation of vertebrobasilar arteries may regulate blood perfusion to the brainstem. We examined the autonomic innervation of these arteries in pre-hypertensive (PHSH) and hypertensive spontaneously hypertensive (SH) rats relative to age-matched Wistar rats. Our main findings were: (1) an unexpected decrease in noradrenergic sympathetic innervation in PHSH and SH compared to Wistar rats despite elevated sympathetic drive in PHSH rats; (2) a dramatic deficit in cholinergic and peptidergic parasympathetic innervation in PHSH and SH compared to Wistar rats; and (3) denervation of sympathetic fibres did not alter vertebrobasilar artery morphology or arterial pressure. Our results support a compromised vasodilatory capacity in PHSH and SH rats compared to Wistar rats, which may explain their hypoperfused brainstem. ABSTRACT Neurogenic hypertension may result from brainstem hypoperfusion. We previously found remodelling (decreased lumen, increased wall thickness) in vertebrobasilar arteries of juvenile, pre-hypertensive spontaneously hypertensive (PHSH) and adult spontaneously hypertensive (SH) rats compared to age-matched normotensive rats. We tested the hypothesis that there would be a greater density of sympathetic to parasympathetic innervation of vertebrobasilar arteries in SH versus Wistar rats irrespective of the stage of development and that sympathetic denervation (ablation of the superior cervical ganglia bilaterally) would reverse the remodelling and lower blood pressure. Contrary to our hypothesis, immunohistochemistry revealed a decrease in the innervation density of noradrenergic sympathetic fibres in adult SH rats (P < 0.01) compared to Wistar rats. Unexpectedly, there was a 65% deficit in parasympathetic fibres, as assessed by both vesicular acetylcholine transporter (α-VAChT) and vasoactive intestinal peptide (α-VIP) immunofluorescence (P < 0.002) in PHSH rats compared to age-matched Wistar rats. Although the neural activity of the internal cervical sympathetic branch, which innervates the vertebrobasilar arteries, was higher in PHSH relative to Wistar rats, its denervation had no effect on the vertebrobasilar artery morphology or persistent effect on arterial pressure in SH rats. Our neuroanatomic and functional data do not support a role for sympathetic nerves in remodelling of the vertebrobasilar artery wall in PHSH or SH rats. The remodelling of vertebrobasilar arteries and the elevated activity in the internal cervical sympathetic nerve coupled with their reduced parasympathetic innervation suggests a compromised vasodilatory capacity in PHSH and SH rats that could explain their brainstem hypoperfusion.
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Affiliation(s)
- Eva v. L. Roloff
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
| | - Dawid Walas
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
| | - Davi J. A. Moraes
- Department of PhysiologySchool of Medicine of Ribeirão PretoUniversity of São PauloRibeirão PretoSP 14049–900Brazil
| | - Sergey Kasparov
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
| | - Julian F. R. Paton
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
- Department of PhysiologyFaculty of Medical and Health SciencesThe University of Auckland85 Park RoadGraftonAuckland1142New Zealand
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Serrador JM, Freeman R. Enhanced Cholinergic Activity Improves Cerebral Blood Flow during Orthostatic Stress. Front Neurol 2017; 8:103. [PMID: 28373858 PMCID: PMC5357636 DOI: 10.3389/fneur.2017.00103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
Abstract
Cerebral blood flow (CBF) and consequently orthostatic tolerance when upright depends on dilation of the cerebral vasculature in the face of reduced perfusion pressure associated with the hydrostatic gradient. However, it is still unclear if cholinergic activation plays a role in this dilation. To determine if enhancing central cholinergic activity with the centrally acting acetylcholinesterase inhibitor, physostigmine would increase CBF when upright compared to the peripherally acting acetylcholinesterase inhibitor, neostigmine, or saline. We performed a randomized double-blind dose-ranging study that took place over 3 days in a hospital-based research lab. Eight healthy controls (six women and two men, mean age, 26 years; range 21–33) were given infusions of physostigmine, neostigmine, or saline on three different days. Five-minute tilts were repeated at baseline (no infusion), Dose 1 (0.2 μg/kg/min physostigmine; 0.1 μg/kg/min neostigmine) and Dose 2 (0.6 μg/kg/min physostigmine or 0.3 μg/kg/min neostigmine), and placebo (0.9% NaCl). Cerebral blood velocity, beat-to-beat blood pressure, and end-tidal CO2 were continuously measured during tilts. Physostigmine (0.6 μg/kg/min) resulted in higher cerebral blood velocity during tilt (90.5 ± 1.5%) than the equivalent neostigmine (85.5 ± 2.6%) or saline (84.8 ± 1.7%) trials (P < 0.05). This increase occurred despite a greater postural hypocapnia, suggesting physostigmine had a direct vasodilatory effect on the cerebral vasculature. Cerebral hypoperfusion induced by repeated tilts was eliminated by infusion of physostigmine not neostigmine. In conclusion, this study provides the first evidence that enhancement of central, not peripheral, cholinergic activity attenuates the physiological decrease in CBF seen during upright tilt. These data support the need for further research to determine if enhancing central cholinergic activity may improve symptoms in patients with symptomatic orthostatic intolerance.
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Affiliation(s)
- Jorge M Serrador
- Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Cardiovascular Electronics, National University of Ireland Galway, Galway, Ireland
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
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Phillips AA, Hansen A, Krassioukov AV. In with the new and out with the old: enter multivariate wavelet decomposition, exit transfer function. Am J Physiol Heart Circ Physiol 2016; 311:H735-7. [PMID: 27473940 DOI: 10.1152/ajpheart.00512.2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Aaron A Phillips
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada; and
| | - Alex Hansen
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada
| | - Andrei V Krassioukov
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada; and GF Strong Rehabilitation Centre, Vancouver Health Authority, Vancouver, Canada
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