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Li G, Lin B, Yang F. Low-/Negative-Pressure Hydrocephalus: To Understand the Formation Mechanism from the Perspective of Clinicians. J Neurol Surg A Cent Eur Neurosurg 2024; 85:492-500. [PMID: 38688300 DOI: 10.1055/s-0044-1785671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Low-/negative-pressure hydrocephalus (LPH/NePH) is uncommon in clinical practice, and doctors are unfamiliar with it. LPH/NePH is frequently caused by other central nervous system diseases, and patients are frequently misdiagnosed with other types of hydrocephalus, resulting in delayed treatment. LPH/NePH therapy evolved to therapeutic measures based on "external ventricular drainage below atmospheric pressure" as the number of patients with LPH/NePH described in the literature has increased. However, the mechanism of LPH/NePH formation is unknown. Thus, understanding the process of LPH/NePH development is the most important step in improving diagnosis and treatment capability. Based on case reports of LPH/NePH, we reviewed theories of transcortical pressure difference, excessive cerebral venous drainage, brain viscoelastic changes, and porous elastic sponges.
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Affiliation(s)
- Guangzhao Li
- Department of Neurosurgery, The First People's Hospital of Hefei, Hefei, Anhui, Peoples' Republic of China
| | - Bin Lin
- Department of Neurosurgery, The First People's Hospital of Hefei, Hefei, Anhui, Peoples' Republic of China
| | - Fei Yang
- Department of Neurosurgery, The First People's Hospital of Hefei, Hefei, Anhui, Peoples' Republic of China
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Fargen KM, Midtlien JP, Belanger K, Hepworth EJ, Hui FK. The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series. Neurosurgery 2024; 95:400-407. [PMID: 38477595 DOI: 10.1227/neu.0000000000002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/05/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral venous outflow disorders (CVDs) secondary to internal jugular vein (IJV) stenosis are becoming an increasingly recognized cause of significant cognitive and functional impairment in patients. There are little published data on IJV stenting for this condition. This study aims to report on procedural success. METHODS A single-center retrospective analysis was performed on patients with CVD that underwent IJV stenting procedures. RESULTS From 2019 to 2023, 29 patients with CVD underwent a total of 33 IJV stenting procedures. Most patients (20; 69%) had an underlying connective tissue disorder diagnosis. The mean age of the included patients was 36.3 years (SD 12.4), 24 were female (82.8%), and all were Caucasian except for 2 patients (27; 93.0%). Twenty-eight procedures (85%) involved isolated IJV stenting under conscious sedation, whereas 5 procedures (15%) involved IJV stenting and concomitant transverse sinus stenting under general anesthesia. Thirteen (39%) patients underwent IJV stenting after open IJV decompression and styloidectomy. Three patients had stents placed for stenosis below the C1 tubercle, one of which was for carotid compression. Periprocedural complications occurred in 11 (33%), including intracardiac stent migration in 1 patient, temporary shoulder pain/weakness in 5 (15%), and persistent and severe shoulder pain/weakness in 2 patients (6%). Approximately 75% of patients demonstrated improvement after stenting although only 12 patients (36%) had durable improvement over a mean follow-up of 4.5 months (range 6 weeks-3.5 years). CONCLUSION Our experience, along with early published studies, suggests that there is significant promise to IJV revascularization techniques in these patients; however, stenting carries a high complication rate, and symptom recurrence is common. Most neurointerventionalists should not be performing IJV stenting unless they have experience with these patients and understand technical nuances (stent sizing, anatomy, patient selection), which can maximize benefit and minimize risk.
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Affiliation(s)
- Kyle M Fargen
- Departments of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem , North Carolina , USA
| | - Jackson P Midtlien
- Departments of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem , North Carolina , USA
| | - Katherine Belanger
- Departments of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem , North Carolina , USA
| | - Edward J Hepworth
- Division of Otolaryngology, Skull Base, Head & Neck Surgery, Sinus Solutions at Veros Clinical Services, Denver , Colorado , USA
| | - Ferdinand K Hui
- Division of Neurointerventional Surgery, Neuroscience Institute, Queen's Medical Center, Honolulu , Hawaii , USA
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Cohen JN, Hedge ET, Greaves DK, Robertson AD, Nahas H, Yu ACH, Petersen LG, Au JS. Characterization of internal jugular vein region-specific distension and flow patterns during progressive volume shifting. J Appl Physiol (1985) 2024; 137:32-41. [PMID: 38813612 DOI: 10.1152/japplphysiol.00162.2024] [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: 03/04/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Blood volume shifts during postural adjustment lead to irregular distension of the internal jugular vein (IJV). In microgravity, distension may contribute to flow stasis and thromboembolism, though the regional implications and associated risk remain unexplored. We characterized regional differences in IJV volume distension and flow complexity during progressive head-down tilt (HDT) (0°, -6°, -15°, -30°) using conventional ultrasound and vector flow imaging. We also evaluated low-pressure thigh cuffs (40 mmHg) as a fluid shifting countermeasure during -6° HDT. Total IJV volume expanded 139 ± 95% from supine position (4.6 ± 2.7 mL) to -30° HDT (10.3 ± 5.0 mL). Blood flow profiles had greater vector uniformity at the cranial IJV region (P < 0.01) and became more dispersed with increasing tilt (P < 0.01). Qualitatively, flow was more uniform throughout the IJV during its early flow cycle phase and more disorganized during late flow phase. This disorganized flow was accentuated closer to the vessel wall, near the caudal region, and during greater HDT. Low-pressure thigh cuffs during -6° HDT decreased IJV volume at the cranial region (-12 ± 15%; P < 0.01) but not the caudal region (P = 0.20), although flow uniformity was unchanged (both regions, P > 0.25). We describe a distensible IJV accommodating large volume shifts along its length. Prominent flow dispersion was primarily found at the caudal region, suggesting multidirectional blood flow. Thigh cuffs appear effective for decreasing IJV volume but effects on flow complexity are minor. Flow complexity along the vessel length is likely related to IJV distension during chronic volume shifting and may be a precipitating factor for flow stasis and future thromboembolism risk.NEW & NOTEWORTHY The internal jugular vein (IJV) facilitates cerebral outflow and is sensitive to volume shifts. Concerns about IJV expansion and fluid flow behavior in astronauts have surfaced following thromboembolism reports. Our study explored regional volume distension and blood flow complexity in the IJV during progressive volume shifting. We observed stepwise volume distension and increasing flow dispersion with head-down tilting across all regions. Flow dispersion may pose a risk of future thromboembolism during prolonged volume shifts.
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Affiliation(s)
- Jeremy N Cohen
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Eric T Hedge
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Danielle K Greaves
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew D Robertson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Hassan Nahas
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Alfred C H Yu
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Lonnie G Petersen
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Jason S Au
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Mizutani K, Miyauchi T, Yamada Y, Yamada M, Yokoyama Y, Kosugi K, Yoshida K, Akiyama T, Toda M, Jinzaki M. Exploration of postural effects on the external jugular and diploic venous system using upright computed tomography scanning. Neuroradiology 2024; 66:963-971. [PMID: 38613702 DOI: 10.1007/s00234-024-03357-4] [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: 01/23/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Few studies have investigated the influence of posture on the external jugular and diploic venous systems in the head and cranial region. In this study, we aimed to investigate the effects of posture on these systems using upright computed tomography (CT) scanning. METHODS This study retrospectively analysed an upright CT dataset from a previous prospective study. In each patient, the diameters of the vessels in three external jugular tributaries and four diploic veins were measured using CT digital subtraction venography in both supine and sitting positions. RESULTS Amongst the 20 cases in the original dataset, we eventually investigated 19 cases due to motion artifacts in 1 case. Compared with the supine position, most of the external jugular tributaries collapsed, and the average size significantly decreased in the sitting position (decreased by 22-49% on average). In contrast, most of the diploic veins, except the occipital diploic veins, tended to increase or remain unchanged (increased by 12-101% on average) in size in the sitting position compared with the supine position. However, the changes in the veins associated with this positional shift were not uniform; in approximately 5-30% of the cases, depending on each vein, an opposite trend was observed. CONCLUSION Compared to the supine position, the contribution of external jugular tributaries to head venous drainage decreased in the sitting position, whilst most diploic veins maintained their contribution. These results could enhance our understanding of the physiology and pathophysiology of the head region in upright and sitting positions.
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Affiliation(s)
- Katsuhiro Mizutani
- Department of Neurosurgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - Tsubasa Miyauchi
- Department of Neurosurgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, School of Medicine, Keio University, Shinjuku, Tokyo, Japan.
| | - Minoru Yamada
- Department of Radiology, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - Keisuke Yoshida
- Department of Neurosurgery, Mihara Memorial Hospital, Isezaki, Gumma, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
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Fargen KM, Midtlien JP, Margraf C, Kiritsis NR, Chang E, Hui F. Dynamic internal jugular vein venography: a descriptive study in 89 patients with suspected cerebral venous outflow disorders. J Neurointerv Surg 2024:jnis-2024-021734. [PMID: 38782567 DOI: 10.1136/jnis-2024-021734] [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: 03/14/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Internal jugular vein (IJV) stenosis has recently been recognized as a plausible source of symptom etiology in patients with cerebral venous outflow disorders (CVD). Diagnosis and determining surgical candidacy remains difficult due to a poor understanding of IJV physiology and positional symptom exacerbation often reported by these patients. METHODS A retrospective single-center chart review was conducted on adult patients who underwent diagnostic cerebral venography with rotational IJ venography from 2022 to 2024. Patients were divided into three groups for further analysis based on symptoms and diagnostic criteria: presumed jugular stenosis, near-healthy venous outflow, and idiopathic intracranial hypertension. RESULTS Eighty-nine patients were included in the study. Most commonly, ipsilateral rotation resulted in ipsilateral IJV stenosis and gradient development at C4-6 and contralateral stenosis and gradient appearance in the contralateral IJV at C1, with stenosis and gradient development in bilateral IJVs at C1-3 bilaterally during chin flexion. In all patients, 93.3% developed at least moderate dynamic stenosis of at least one IJV, more than two-thirds (69.7%) developed either severe or occlusive stenosis during rightward and leftward rotation, and 81.8% developed severe or occlusive stenosis with head flexion. Dynamic gradients of at least 4 mmHg were seen in 68.5% of patients, with gradients of at least 8 mmHg in 31.5% and at least 10 mmHg in 12.4%. CONCLUSION This study is the first to document dynamic changes in IJV caliber and gradients in different head positions, offering insights into the complex nature of venous outflow and its impact on CVD.
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Affiliation(s)
- Kyle M Fargen
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jackson P Midtlien
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Connor Margraf
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Nicholas R Kiritsis
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Emily Chang
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ferdinand Hui
- Division of Neurointerventional Surgery, Neuroscience Institute, Queen's Medical Center, Honolulu, HI, USA
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Norager NH, Lilja-Cyron A, Riedel CS, Holst AV, Pedersen SH, Juhler M. Intracranial pressure following surgery of an unruptured intracranial aneurysm-a model for normal intracranial pressure in humans. Fluids Barriers CNS 2024; 21:44. [PMID: 38773608 PMCID: PMC11110356 DOI: 10.1186/s12987-024-00549-1] [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: 02/07/2024] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE Optimizing the treatment of several neurosurgical and neurological disorders relies on knowledge of the intracranial pressure (ICP). However, exploration of normal ICP and intracranial pressure pulse wave amplitude (PWA) values in healthy individuals poses ethical challenges, and thus the current documentation remains scarce. This study explores ICP and PWA values for healthy adults without intracranial pathology expected to influence ICP. METHODS Adult patients (age > 18 years) undergoing surgery for an unruptured intracranial aneurysm without any other neurological co-morbidities were included. Patients had a telemetric ICP sensor inserted, and ICP was measured in four different positions: supine, lateral recumbent, standing upright, and 45-degree sitting, at day 1, 14, 30, and 90 following the surgery. RESULTS ICP in each position did not change with time after surgery. Median ICP was 6.7 mmHg and median PWA 2.1 mmHg in the supine position, while in the upright standing position median ICP was - 3.4 mmHg and median PWA was 1.9 mmHg. After standardization of the measurements from the transducer site to the external acoustic meatus, the median ICPmidbrain was 8.3 mmHg in the supine position and 1.2 mmHg in the upright standing position. CONCLUSION Our study provides insights into normal ICP dynamics in healthy adults following a uncomplicated surgery for an unruptured aneurysm. These results suggest a slightly wider normal reference range for invasive intracranial pressure than previously suggested, and present the first normal values for PWA in different positions. Further studies are, however, essential to enhance our understanding of normal ICP. Trial registration The study was preregistered at www. CLINICALTRIALS gov (NCT03594136) (11 July 2018).
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Affiliation(s)
- Nicolas Hernandez Norager
- Clinic of Neurosurgery, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Copenhagen East, Denmark.
| | - Alexander Lilja-Cyron
- Clinic of Neurosurgery, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Copenhagen East, Denmark
| | - Casper Schwartz Riedel
- Clinic of Neurosurgery, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Copenhagen East, Denmark
| | - Anders Vedel Holst
- Clinic of Neurosurgery, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Copenhagen East, Denmark
| | - Sarah Hornshoej Pedersen
- Clinic of Neurosurgery, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Copenhagen East, Denmark
| | - Marianne Juhler
- Clinic of Neurosurgery, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Copenhagen East, Denmark
- Clinic of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
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Park JH, Park I, Yoon J, Sim Y, Kim J, Lee SK, Joo B. Mesial temporal atrophy in preoperative MRI rather than steep Trendelenburg position is associated with postoperative delirium in patients undergoing a major urologic surgery. Int Urol Nephrol 2024; 56:1543-1550. [PMID: 38091174 DOI: 10.1007/s11255-023-03898-2] [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: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 04/09/2024]
Abstract
PURPOSE To investigate whether steep Trendelenburg in a major urologic surgery is associated with postoperative delirium, and to examine other potential clinical and radiologic factors predictive of postoperative delirium. METHODS 182 patients who received a major urologic surgery and underwent a 3.0-T brain MRI scan within 1 year prior to the date of surgery were retrospectively enrolled. Preoperative brain MRIs were used to analyze features related to small vessel disease burden and mesial temporal atrophy. Presence of a significant mesial temporal atrophy was defined as Scheltens' scale ≥ 2. Patients' clinico-demographic data and MRI features were used to identify significant predictors of postoperative delirium using the logistic regression analysis. Independent predictors found significant in the univariate analysis were further evaluated in the multivariate analysis. RESULTS Incidence of postoperative delirium was 6.0%. Patients with postoperative delirium had lower body mass index (21.3 vs. 25.0 kg/m2, P = 0.003), prolonged duration of anesthesia (362.7 vs. 224.7 min, P < 0.001) and surgery (302.2 vs. 174.5 min, P < 0.001), and had more significant mesial temporal atrophy (64% vs. 30%, P = 0.046). In the univariate analysis, female sex, type of surgery (radical prostatectomy over cystectomy), prolonged duration of anesthesia (≥ 6 h), and presence of a significant mesial temporal atrophy were significant predictors (all P-values < 0.050), but only the presence of significant mesial temporal atrophy was significant in the multivariate analysis [odds ratio (OR), 3.69; 95% CI 0.99-13.75; P = 0.046]. CONCLUSION Steep Trendelenburg was not associated with postoperative delirium. Significant mesial temporal atrophy (Scheltens' scale ≥ 2) in preoperative brain MRI was predictive of postoperative delirium. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Jae Hyon Park
- Department of Radiology, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Insun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jongjin Yoon
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yongsik Sim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinhyun Kim
- Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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van Zandwijk JK, Simmering JA, Schuurmann RCL, Simonis FFJ, Ten Haken B, de Vries JPPM, Geelkerken RH. Position- and posture-dependent vascular imaging-a scoping review. Eur Radiol 2024; 34:2334-2351. [PMID: 37672051 PMCID: PMC10957623 DOI: 10.1007/s00330-023-10154-9] [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: 01/16/2023] [Revised: 07/17/2023] [Accepted: 07/29/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES Position- and posture-dependent deformation of the vascular system is a relatively unexplored field. The goal of this scoping review was to create an overview of existing vascular imaging modalities in different body positions and postures and address the subsequent changes in vascular anatomy. METHODS Scopus, Medline, and Cochrane were searched for literature published between January 1, 2000, and June 30, 2022, incorporating the following categories: image modality, anatomy, orientation, and outcomes. RESULTS Out of 2446 screened articles, we included 108. The majority of papers used ultrasound (US, n = 74) in different body positions and postures with diameter and cross-sectional area (CSA) as outcome measures. Magnetic resonance imaging (n = 22) and computed tomography (n = 8) were less frequently used but allowed for investigation of other geometrical measures such as vessel curvature and length. The venous system proved more sensitive to postural changes than the arterial system, which was seen as increasing diameters of veins below the level of the heart when going from supine to prone to standing positions, and vice versa. CONCLUSIONS The influence of body positions and postures on vasculature was predominantly explored with US for vessel diameter and CSA. Posture-induced deformation and additional geometrical features that may be of interest for the (endovascular) treatment of vascular pathologies have been limitedly reported, such as length and curvature of an atherosclerotic popliteal artery during bending of the knee after stent placement. The most important clinical implications of positional changes are found in diagnosis, surgical planning, and follow-up after stent placement. CLINICAL RELEVANCE STATEMENT This scoping review presents the current state and opportunities of position- and posture-dependent imaging of vascular structures using various imaging modalities that are relevant in the fields of clinical diagnosis, surgical planning, and follow-up after stent placement. KEY POINTS • The influence of body positions and postures on the vasculature was predominantly investigated with US for vessel diameter and cross-sectional area. • Research into geometrical deformation, such as vessel length and curvature adaptation, that may be of interest for the (endovascular) treatment of vascular pathologies is limited in different positions and postures. • The most important clinical implications of postural changes are found in diagnosis, surgical planning, and follow-up after stent placement.
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Affiliation(s)
- Jordy K van Zandwijk
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
- Magnetic Detection & Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Jaimy A Simmering
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Richte C L Schuurmann
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F J Simonis
- Magnetic Detection & Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Bennie Ten Haken
- Magnetic Detection & Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert H Geelkerken
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Dai L, Li S, Yang T, Wei H, Song R, Meng X, Yuan X, Jiao Z, Wu T, Shi H. Investigating the effects of tilting the postural drainage lithotripsy system on cerebral blood flow, intracranial pressure, heart rate, and blood pressure. World J Urol 2024; 42:89. [PMID: 38376590 PMCID: PMC10879416 DOI: 10.1007/s00345-024-04777-w] [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: 04/25/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
PURPOSE To investigate the effect of the postural drainage lithotripsy system developed by our experimental team on the vital signs of patient with urinary stones during the stone removal process. METHODS Four groups of 15 subjects (0°, 10°, 40°, and 70°) were subjected to different angles of head-down tilt to measure middle cerebral artery blood flow velocity (MCAv), cerebrovascular conductance coefficient (CVCi), intracranial pressure (nICP), heart rate (HR), and mean arterial blood pressure (MAP). RESULTS As the angle of HDT changed, MCAv values, nICP values, CVCi values, HR values, and MAP values changed significantly (all P ≤ 0.001), and the difference was statistically significant. During 10°HDT, despite a slight increase in nICP, the other measurements remained stable. During 40°HDT, only the MCAv values did not change significantly, whereas the rest of the measures were significantly altered. During 70°HDT, all indicators changed significantly. CONCLUSIONS The significant alterations in cerebral blood flow, intracranial pressure, and hemodynamics induced during the treatment of renal residual fragments with postural drainage should be used with caution in individuals with cerebrovascular accidents. CHINA CLINICAL TRIALS REGISTRY ChiCTR2300070671; Registration date: 2023-04-18.
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Affiliation(s)
- Liangliang Dai
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Shihui Li
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Tao Yang
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Hanping Wei
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Rijin Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xianghu Meng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiaoliang Yuan
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Zhimin Jiao
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Tingchun Wu
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Honglei Shi
- Department of Urology, Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213004, China.
- Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China.
- Wujin Hospital Affiliated With Jiangsu University, Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China.
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Khawari S, Al-Mohammad A, Pandit A, Moncur E, Bancroft MJ, Tariq K, Cowley P, Watkins L, Toma A. ICP during head movement: significance of the venous system. Acta Neurochir (Wien) 2023; 165:3243-3247. [PMID: 37191723 DOI: 10.1007/s00701-023-05620-8] [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: 05/30/2022] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND It is thought that the internal jugular veins (IJV) are the primary route for cranial venous outflow in supine position and the vertebral venous plexus when upright. Previous studies have noted a greater increase in intracranial pressure (ICP) when subjects turn their head in one direction compared to the other, but no clear cause had been investigated. We hypothesised that in the supine position, head turning and consequently obstructing the IJV draining the dominant transverse sinus (TVS) would lead to a greater rise in ICP compared to turning to the non-dominant side. METHODS A prospective study in a large-volume neurosurgical centre. Patients undergoing continuous ICP monitoring as part of their standard clinical management were recruited. Immediate ICP was measured in different head positions (neutral, rotated to the right and left) when supine, seated, and standing. TVS dominance was established by consultant radiologist report on venous imaging. RESULTS Twenty patients were included in the study, with a median age of 44 years. Venous system measurements revealed 85% right-sided vs 15% left-sided dominance. Immediate ICP rose more when head turning from neutral to the dominant TVS (21.93mmHg ± 4.39) vs non-dominant side (16.66mmHg ± 2.71) (p= <0.0001). There was no significant relationship in the sitting (6.08mmHg ± 3.86 vs 4.79mmHg ± 3.81, p = 0.13) or standing positions (8.74mmHg ± 4.30 vs 6.76mmHg ± 4.14, p =0.07). CONCLUSION This study has provided further evidence that the transverse venous sinus to internal jugular system pathway is the likely primary venous drainage when supine; and quantified its effect when head turning on ICP. It may guide patient-specific nursing care and advice.
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Affiliation(s)
- Sogha Khawari
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Alaa Al-Mohammad
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Anand Pandit
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Matthew James Bancroft
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Kanza Tariq
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Peter Cowley
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laurence Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ahmed Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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11
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Govind A, Kenchaiah R, Dubbal R, Gupta M, Meghana BK, Saravanan A, Kulanthaivelu K, Ramakrishnan S, Kulkarni GB. Mastoid fluid signal in acute cerebral venous thrombosis is is associated with increased clot burden. J Clin Neurosci 2023; 117:54-60. [PMID: 37769407 DOI: 10.1016/j.jocn.2023.09.007] [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: 06/12/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Mastoid air cell abnormalities in the form of hyperintense T2 fluid signal have been reported in cases of acute Cerebral Venous Thrombosis (CVT) without otologic infection and have been hypothesized to be a result of venous congestion rather than infectious mastoiditis. The aim of this study was to investigate a link between the spectrum of mastoid abnormalities and clot burden in patients with acute CVT. METHODS A retrospective study of adult patients admitted to the National Institute of Mental Health and Neurosciences between 2016 and 2023 who were diagnosed with acute CVT and had no clinical evidence of active or recent ear infections was conducted. Pre- and post-contrast MR Images were analyzed to identify the dural sinuses and/or cerebral veins involved and the presence of fluid signal in the mastoid. Fluid signal in the mastoid was graded from 0 to 3 as described by Shah et al- no fluid signal (grade 0), thin curvilinear hyperintensities (grade 1), thick crescenteric hyperintensities (grade 2), and complete hyperintensity (grade 3). Clot Burden Score (CBS) was calculated by assigning one point for each sinus involved, one point for extension of thrombus into the intracranial Internal Jugular Vein (IJV), one point for thrombosis of cortical veins and one point for thrombosis of deep cerebral veins. RESULTS A total of 89 patients with acute CVT were included in the final analysis. Median time from presentation to MRI was 2 days (range 0-13). 51 patients (57.3%) had fluid signal in the mastoid air cells on T2-weighted images, of whom 33 showed mucosal contrast enhancement. Higher grade of fluid signal in the mastoid was present ipsilateral to the side of venous thrombosis in 59 out of 60 patients with posterior fossa CVT. CBS was significantly different between patients with different grades of fluid signal (p = 0.002). Grade 2-3 fluid signal was associated with higher clot burden (CBS > 3) in both the entire study population (n = 89) - OR = 8.281, 95 %CI: 2.758-24.866 (p < 0.001) and among patients with posterior fossa CVT - OR = 4.375, 95 %CI: 1.320-14.504 (p = 0.016). Among patients with posterior fossa CVT, grade 2-3 fluid signal was associated with left sided transverse and/or sigmoid sinus thrombosis - OR = 5.600, 95 %CI: 1.413-22.188 (p = 0.014), and extension of thrombosis into the IJV - OR = 4.606, 95 %CI: 1.162-18.262 (p = 0.030). CONCLUSION T2 fluid signal in the mastoid is associated with venous congestion in adults with acute CVT without evidence of otologic infection. Moderate-to-severe T2 fluid signal in the mastoid air cells is associated with increased clot burden.
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Affiliation(s)
- Alok Govind
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Raghavendra Kenchaiah
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Rohin Dubbal
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Manisha Gupta
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - B K Meghana
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Akshaya Saravanan
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India.
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Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio 2023; 41:403-406. [PMID: 37565696 DOI: 10.1080/08869634.2023.2243756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Larry Z Lockerman
- Clinical Instructor Orofacial Pain, Department of Oral Pathology, Oral Medicine, Maxillofacial Imaging, Tel Aviv University School Dental Medicine, Israel
| | - Ross Hauser
- Medical Director, Caring Medical Florida & the Hauser Neck Center, Fort Myers, FL, USA
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Podgoršak A, Trimmel NE, Flürenbrock F, Oertel MF, Arras M, Weisskopf M, Schmid Daners M. Influence of head-over-body and body-over-head posture on craniospinal, vascular, and abdominal pressures in an acute ovine in-vivo model. Fluids Barriers CNS 2023; 20:58. [PMID: 37533133 PMCID: PMC10394828 DOI: 10.1186/s12987-023-00458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Optimal shunt-based hydrocephalus treatments are heavily influenced by dynamic pressure behaviors between proximal and distal ends of shunt catheters. Posture-dependent craniospinal, arterial, venous, and abdominal dynamics thereby play an essential role. METHODS An in-vivo ovine trial (n = 6) was conducted to evaluate communication between craniospinal, arterial, venous, and abdominal dynamics. Tilt-testing was performed between -13° and + 13° at 10-min intervals starting and ending at 0° prone position. Mean pressure, pulse pressure, and Pearson correlation (r) to the respective angle were calculated. Correlations are defined as strong: |r|≥ 0.7, mild: 0.3 <|r|< 0.7, and weak: |r|≤ 0.3. Transfer functions (TFs) between the arterial and adjacent compartments were derived. RESULTS Strong correlations were observed between posture and: mean carotid/femoral arterial (r = - 0.97, r = - 0.87), intracranial, intrathecal (r = - 0.98, r = 0.94), jugular (r = - 0.95), abdominal cranial, dorsal, caudal, and intravesical pressure (r = - 0.83, r = 0.84, r = - 0.73, r = 0.99) while mildly positive correlation exists between tilt and central venous pressure (r = 0.65). Only dorsal abdominal pulse pressure yielded a significant correlation to tilt (r = 0.21). TFs followed general lowpass behaviors with resonant peaks at 4.2 ± 0.4 and 11.5 ± 1.5 Hz followed by a mean roll-off of - 15.9 ± 6.0 dB/decade. CONCLUSIONS Tilt-tests with multi-compartmental recordings help elucidate craniospinal, arterial, venous, and abdominal dynamics, which is essential to optimize shunt-based therapy. Results motivate hydrostatic influences on mean pressure, with all pressures correlating to posture, with little influence on pulse pressure. TF results quantify the craniospinal, arterial, venous, and abdominal compartments as compliant systems and help pave the road for better quantitative models of the interaction between the craniospinal and adjacent spaces.
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Affiliation(s)
- Anthony Podgoršak
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nina Eva Trimmel
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Flürenbrock
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Margarete Arras
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Miriam Weisskopf
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Tucci M, Chaiyamoon A, Suwannakhan A, Cardona JJ, Comert A, Iwanaga J, Dumont AS, Tubbs RS. A Novel Direct Pathway of Dural Venous Outflow from the Basilar Venous Plexus via the Diploic Space of the Clivus. World Neurosurg 2023; 175:e1182-e1185. [PMID: 37121502 DOI: 10.1016/j.wneu.2023.04.093] [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: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The internal jugular vein (IJV) is the pre-eminent outflow of the dural venous sinuses (DVS) in the supine position, while the vertebral venous plexus (VVP) dominates venous outflow in the upright position. Emissary veins can also be an accessory pathway for this venous egress. To our knowledge, alternative dural venous sinus directly drainage via the diploic space has not been previously reported in the literature. METHODS Ten fresh frozen adult cadavers underwent exposure of the basilar venous plexus. The entire plexus, still adhered to the underlying clivus, was removed with its underlying bone and submitted for histological examination following decalcification (Masson Trichrome, 5 μm slices). RESULTS All specimens were found to have direct communication between the basilar venous plexus and underlying diploic space of the clivus i.e., no intermediate clival emissary vein. These were concentrated near the midline and were more numerous over the clivus near the junction of the occipital and sphenoid bones. The endothelium of the venous sinus was continuous at the opening into the diploic space and these openings ranged in size from 500 to 750 μm (mean 650 μm). CONCLUSIONS An improved understanding of the cerebral venous drainage can assist clinicians and surgeons in recognizing normal, pathologic, and variant anatomy in this region. Based on our study, direct venous sinus (DVS) to diploic space drainage offers an additional pathway for venous egress from the intracranium. Therefore, removal of the dura over the clivus during various skull base procedures might be associated with increased venous bleeding from the basilar venous plexus on its deep surface where it interfaces with the clivus.
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Affiliation(s)
- Marissa Tucci
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen, Thailand.
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand; In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ayhan Comert
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; University of Queensland, Brisbane, Australia
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15
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Sagirov AF, Sergeev TV, Shabrov AV, Yurov AY, Guseva NL, Agapova EA. Postural influence on intracranial fluid dynamics: an overview. J Physiol Anthropol 2023; 42:5. [PMID: 37055862 PMCID: PMC10100470 DOI: 10.1186/s40101-023-00323-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023] Open
Abstract
This review focuses on the effects of different body positions on intracranial fluid dynamics, including cerebral arterial and venous flow, cerebrospinal fluid (CSF) hydrodynamics, and intracranial pressure (ICP). It also discusses research methods used to quantify these effects. Specifically, the implications of three types of body positions (orthostatic, supine, and antiorthostatic) on cerebral blood flow, venous outflow, and CSF circulation are explored, with a particular emphasis on cerebrovascular autoregulation during microgravity and head-down tilt (HDT), as well as posture-dependent changes in cerebral venous and CSF flow, ICP, and intracranial compliance (ICC). The review aims to provide a comprehensive analysis of intracranial fluid dynamics during different body positions, with the potential to enhance our understanding of intracranial and craniospinal physiology.
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Affiliation(s)
- Arlan Faritovich Sagirov
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia.
| | - Timofey Vladimirovich Sergeev
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Aleksandr Vladimirovich Shabrov
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Andrey Yur'evich Yurov
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Nadezhda Leonidovna Guseva
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
| | - Elizaveta Aleksandrovna Agapova
- Department of Ecological Physiology, Federal State Budgetary Scientific Institution "Institute of Experimental Medicine", 12 Academic Pavlov St, Saint-Petersburg, 197022, Russia
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CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence. Eur Radiol 2023; 33:4464-4471. [PMID: 36648550 DOI: 10.1007/s00330-022-09352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate the imaging features of unilateral pulsatile tinnitus (PT) with jugular bulb wall dehiscence (JBWD). METHODS Computerized tomography angiography images of unilateral PT patients were reviewed between 2019 and 2021. Thirty-one symptomatic JBWD patients without sigmoid sinus wall dehiscence (SSWD) were included. Thirty-eight patients with SSWD were used as the control group. The prevalence of JBWD was calculated. The area and height of the jugular bulb, the extent of dehiscence, the presence of jugular bulb diverticulum, posterior condylar emissary vein (PCEV), oblique occipital sinus (OOS), venous outflow laterality (VOL), the degree of transverse sinus stenosis (TSS), and the pituitary height to sella turcica ratio were compared between the two groups. RESULTS The prevalence of JBWD was 12.1%, and JBWD was established as a causative diagnosis in 5.0% of unilateral PT patients. There were no statistical differences in the gender, symptomatic side, or VOL between the two groups. The area of the jugular bulb was larger and the height was higher (parea < 0.001, pheight = 0.005). The prevalence of jugular bulb diverticulum was higher in the JBWD group (p = 0.002). The degree of symptomatic TSS was less severe (p < 0.001), and the prevalence of bilateral TSS was lower in the JBWD group (p < 0.001). The pituitary height to sella turcica ratio was greater (p = 0.004), the prevalence of PCEV (p = 0.014) was lower, and OOS (p = 0.015) was greater in the JBWD group. CONCLUSIONS The correlating factors of PT with JBWD and PT with SSWD are significantly different. These findings can further facilitate early and efficient PT treatment. KEY POINTS • The incidence of jugular bulb dehiscence (JBWD) accounted for approximately 12.1% in pulsatile tinnitus (PT) patients, and JBWD was established as a causative diagnosis in 5.0% of PT patients. • PT required large blood flows and abnormal flow patterns, whether in JBWD or sigmoid sinus wall dehiscence groups. • JBWD causing PT has some unique characteristic findings on CT.
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Sattur MG, Amans M, Fargen KM, Huisman TAGM, Brinjikji W, Hui F, Shingala A, Vosler PS, Pereira VM, Hepworth E, Dehdashti AR, Patsalides A, Lo SFL, Spiotta AM. Angiographic Evaluation of Cranial Venous Outflow Patterns in Patients With and Without Idiopathic Intracranial Hypertension. Oper Neurosurg (Hagerstown) 2023; 24:e29-e35. [PMID: 36227195 DOI: 10.1227/ons.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Several collateral venous pathways exist to assist in cranial venous drainage in addition to the internal jugular veins. The important extrajugular networks (EJN) are often readily identified on diagnostic cerebral angiography. However, the angiographic pattern of venous drainage through collateral EJN has not been previously compared among patients with and without idiopathic intracranial hypertension (IIH). OBJECTIVE To quantify EJN on cerebral angiography among patients both with and without IIH and to determine whether there is a different EJN venous drainage pattern in patients with IIH. METHODS Retrospective imaging review of 100 cerebral angiograms (50 IIH and 50 non-IIH patients) and medical records from a single academic medical center was performed by 2 independent experienced neuroendovascular surgeons. Points were assigned to EJN flow from 0 to 6 using an increasing scale (with each patient's dominant internal jugular vein standardized to 5 points to serve as the internal reference). Angiography of each patient included 11 separately graded extrajugular networks for internal carotid and vertebral artery injections. RESULTS Patients in the IIH group had statistically significant greater flow in several of the extrajugular networks. Therefore, they preferentially drained through EJN compared with the non-IIH group. Right transverse-sigmoid system was most often dominant in both groups, yet there was a significantly greater prevalence of codominant sinus pattern on posterior circulation angiograms. CONCLUSION Patients with IIH have greater utilization of EJN compared with patients without IIH. Whether this is merely an epiphenomenon or possesses actual cause-effect relationships needs to be determined with further studies.
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Affiliation(s)
- Mithun G Sattur
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Matthew Amans
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Kyle Michael Fargen
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas, USA
| | | | - Ferdinand Hui
- Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
| | - Aakash Shingala
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Peter S Vosler
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Departments of Surgery and Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ed Hepworth
- Department of Otolaryngology, ImmunoE Research Centers, Centennial, Colorado, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Athos Patsalides
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Alejandro M Spiotta
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Adachi U, Toi S, Hosoya M, Hoshino T, Seki M, Yoshizawa H, Tsutsumi Y, Maruyama K, Kitagawa K. Association of Age-Related Spontaneous Internal Jugular Vein Reflux with Cognitive Impairment and Incident Dementia. J Alzheimers Dis 2023; 96:1221-1230. [PMID: 37927264 DOI: 10.3233/jad-230771] [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] [Indexed: 11/07/2023]
Abstract
BACKGROUND It remains unclear whether changes in the venous circulation contribute to cognitive decline. OBJECTIVE This study aimed to clarify whether the spontaneous jugular vein reflux (JVR) is associated with cognitive impairment and incident dementia. METHODS Patients with any evidence of cerebral vessel disease on magnetic resonance imaging (MRI) were consecutively enrolled between October 2015 to July 2019. We employed carotid duplex sonography to measure the internal jugular vein (IJV). The subjects were classified into two groups based on the degree of JVR on either side: none, mild (JVR(-) group) and moderate, severe (JVR (+) group) JVR. They underwent both the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Japanese (MoCA-J) global tests. Their cognitive status was prospectively assessed until March 2023. RESULTS 302 patients with an MMSE score ≥24 underwent duplex sonography of the IJV. Among them, 91 had spontaneous JVR on either side. Both MMSE and MoCA-J were significantly lower in patients with JVR (+) group than in the JVR (-) group. After the adjustment for risk factors and MRI findings, intergroup differences in MoCA-J remained significant. Among the cognitive subdomains, median executive function and memory scores were significantly lower in the JVR (+) group than in the JVR (-) group. During the median 5.2-year follow-up, 11 patients with incident dementia were diagnosed. Patients with severe JVR were significantly more likely to be diagnosed with dementia (log-rank test, p = 0.031). CONCLUSIONS Spontaneous IJV reflux especially severe JVR, was associated with global cognitive function, and potentially with incident dementia.
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Affiliation(s)
- Utako Adachi
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Neurology, Toda General Hospital, Toda, Japan
| | - Sono Toi
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Megumi Hosoya
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Misa Seki
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hiroshi Yoshizawa
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | | | - Kenji Maruyama
- Department of Neurology, Toda General Hospital, Toda, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
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A Preliminary Study on the Siphon Mechanism in Giraffe ( Giraffa camelopardalis). Animals (Basel) 2022; 12:ani12233348. [PMID: 36496868 PMCID: PMC9740075 DOI: 10.3390/ani12233348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022] Open
Abstract
Adult giraffes reach heights of 4.5 m with a heart-to-head distance of over 2 m, making cranial blood supply challenging. Ultrasound confirmed that the giraffe jugular vein collapses during head movement from ground level to fully erect, negating the possibility of a siphon mechanism in the neck. We showed that a short-length siphon structure over a simulated head-to-heart distance for a giraffe significantly influences flow in a collapsible tube. The siphon structure is determined according to brain case measurements. The short-length siphon structure in a shorter-necked ostrich showed no significant increase in flow. The shorter head-to-heart distance might be the reason for the lack of effect in ostriches. A siphon mechanism situated in the cranium is certainly possible, with a significant effect exerted on the amount of pressure the heart must generate to allow adequate cranial blood perfusion in a long-necked giraffe. The study validated that a cranial-bound siphon structure can operate and will be of significant value for adequate cranial blood perfusion in long-necked species such as giraffes and might also have existed in extinct species of long-necked dinosaurs.
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Amelard R, Flannigan N, Patterson CA, Heigold H, Hughson RL, Robertson AD. Assessing jugular venous compliance with optical hemodynamic imaging by modulating intrathoracic pressure. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:116005. [PMID: 36385200 PMCID: PMC9668675 DOI: 10.1117/1.jbo.27.11.116005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
SIGNIFICANCE The internal jugular veins (IJV) are critical cerebral venous drainage pathways that are affected by right heart function. Cardiovascular disease and microgravity can alter central venous pressure (CVP) and venous return, which may contribute to increased intracranial pressure and decreased cardiac output. Assessing jugular venous compliance may provide insight into cerebral drainage and right heart function, but monitoring changes in vessel volume is challenging. AIM We investigated the feasibility of quantifying jugular venous compliance from jugular venous attenuation (JVA), a noncontact optical measurement of blood volume, along with CVP from antecubital vein cannulation. APPROACH CVP was progressively increased through a guided graded Valsalva maneuver, increasing mouth pressure by 2 mmHg every 2 s until a maximum expiratory pressure of 20 mmHg. JVA was extracted from a 1-cm segment between the clavicle and midneck. The contralateral IJV cross-sectional area (CSA) was measured with ultrasound to validate changes in the vessel size. Compliance was calculated using both JVA and CSA between four-beat averages over the duration of the maneuver. RESULTS JVA and CSA were strongly correlated (median and interquartile range) over the Valsalva maneuver across participants (r = 0.986, [0.983, 0.987]). CVP more than doubled on average between baseline and peak strain (10.7 ± 4.4 vs. 25.8 ± 5.4 cmH2O; p < 0.01). JVA and CSA increased nonlinearly with CVP, and both JVA- and CSA-derived compliance decreased progressively from baseline to peak strain (49% and 56% median reduction, respectively), with no significant difference in compliance reduction between the two measures (Z = - 1.24, p = 0.21). Pressure-volume curves showed a logarithmic relationship in both CSA and JVA. CONCLUSIONS Optical jugular vein assessment may provide new ways to assess jugular distention and cardiac function.
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Affiliation(s)
- Robert Amelard
- University Health Network, KITE-Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Nyan Flannigan
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | | | - Hannah Heigold
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- University of Waterloo, Waterloo, Ontario, Canada
| | | | - Andrew D. Robertson
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- University of Waterloo, Waterloo, Ontario, Canada
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van Zandwijk JK, Kuijer KM, Stassen CM, ten Haken B, Simonis FF. Internal Jugular Vein Geometry Under Multiple Inclination Angles with 3D Low-Field MRI in Healthy Volunteers. J Magn Reson Imaging 2022; 56:1302-1308. [PMID: 35322920 PMCID: PMC9790417 DOI: 10.1002/jmri.28182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cerebral venous pathways are subjected to geometrical and patency changes due to body position. The internal jugular veins (IJVs) are the main venous drainage pathway in supine position. Their patency and geometry should be evaluated under different body inclination angles over a three-dimensional (3D) volume in the healthy situation to better understand pathological cases. PURPOSE To investigate whether positional changes in the body can affect the geometrical properties and patency of the venous system. STUDY TYPE Prospective. POPULATION 15 healthy volunteers, of which seven males and median age 22 years in a range of 19-59. FIELD STRENGTH/SEQUENCE A 0.25-T tiltable MRI system was used to scan volunteers in 90° (sitting position), 69°, 45°, 21°, and 0° (supine position) in the transverse plane with the top at vertebra C2. A gradient echo sequence was used. ASSESSMENT Three observers assessed IJVs on patency and created automatic centerlines from which diameter and patency were analysed perpendicular to the vessel at every 4 mm starting at the level of C2. STATISTICAL TESTS A Student's t test was used to find statistical difference (p < 0.05) in average IJV diameters per inclination angle. RESULTS The amount of fully collapsed IJVs increased from 33% to 93% (left IJV) and 14% to 80% (right IJV) when increasing the inclination angle from 0° to 90°. In both IJVs, the mean diameter (±SD) of the open vessels was significantly higher at 0° than 90° with 6.3 ± 0.5 mm vs. 4.4 ± 0.1 mm (left IJV) and 6.6 ± 0.6 mm vs. 4.3 ± 0.4 mm (right IJV). DATA CONCLUSION Tiltable low-field MRI can be used to assess IJV geometry and its associated venous pathways in 3D under multiple inclination angles. Next to a higher amount of collapsed vessels, the average diameter of noncollapsed vessels decreases with increasing inclination angles for both left and right IJVs. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Jordy K. van Zandwijk
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands,Department of Vascular SurgeryMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Koen M. Kuijer
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands
| | - Chrit M. Stassen
- Department of RadiologyZiekenhuisgroep TwenteHengeloThe Netherlands
| | - Bernard ten Haken
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands
| | - Frank F.J. Simonis
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands
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22
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Lopes DN, Marques LC, Cunha KS. Editorial for "Internal Jugular Vein Geometry Under Multiple Inclination Angles with 3D Low-Field MRI in Healthy Volunteers". J Magn Reson Imaging 2022; 56:1309-1310. [PMID: 35324051 DOI: 10.1002/jmri.28178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Danielle Nobre Lopes
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
| | - Letícia Côgo Marques
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
| | - Karin Soares Cunha
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
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23
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Menegatti E, Proto A, Paternò G, Gadda G, Gianesini S, Raisi A, Pagani A, Piva T, Zerbini V, Mazzoni G, Grazzi G, Taibi A, Zamboni P, Mandini S. The Effect of Submaximal Exercise on Jugular Venous Pulse Assessed by a Wearable Cervical Plethysmography System. Diagnostics (Basel) 2022; 12:diagnostics12102407. [PMID: 36292096 PMCID: PMC9600745 DOI: 10.3390/diagnostics12102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
The jugular venous pulse (JVP) is a one of the crucial parameters of efficient cardiovascular function. Nowadays, limited data are available regarding the response of JVP to exercise because of its complex and/or invasive assessment procedure. The aim of the present work is to test the feasibility of a non-invasive JVP plethysmography system to monitor different submaximal exercise condition. Twenty (20) healthy subjects (13M/7F mean age 25 ± 3, BMI 21 ± 2) underwent cervical strain-gauge plethysmography, acquired synchronously with the electrocardiogram, while they were carrying out different activities: stand supine, upright, and during the execution of aerobic exercise (2 km walking test) and leg-press machine exercise (submaximal 6 RM test). Peaks a and x of the JVP waveform were investigated since they reflect the volume of cardiac filling. To this aim, the Δax parameter was introduced, representing the amplitude differences between a and x peaks. Significant differences in the values of a, x, and Δax were found between static and exercise conditions (p < 0.0001, p < 0.0001, p < 0.0001), respectively. Particularly, the Δax value for the leg press was approximately three times higher than the supine, and during walking was even nine times higher. The exercise monitoring by means of the novel JVP plethysmography system is feasible during submaximal exercise, and it provides additional parameters on cardiac filling and cerebral venous drainage to the widely used heartbeat rate value.
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Affiliation(s)
- Erica Menegatti
- Department of Environmental Science and Prevention, University of Ferrara, 44123 Ferrara, Italy
| | - Antonino Proto
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-974375
| | - Gianfranco Paternò
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Giacomo Gadda
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrea Raisi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Anselmo Pagani
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Valentina Zerbini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Gianni Mazzoni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Giovanni Grazzi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL 60612, USA
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
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Liu L, Wu Y, Zhang K, Meng R, Duan J, Zhou C, Ji X. Anatomy imaging and hemodynamics research on the cerebral vein and venous sinus among individuals without cranial sinus and jugular vein diseases. Front Neurosci 2022; 16:999134. [PMID: 36238084 PMCID: PMC9551167 DOI: 10.3389/fnins.2022.999134] [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: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
In recent years, imaging technology has allowed the visualization of intracranial and extracranial vascular systems. However, compared with the cerebral arterial system, the relative lack of image information, individual differences in the anatomy of the cerebral veins and venous sinuses, and several unique structures often cause neurologists and radiologists to miss or over-diagnose. This increases the difficulty of the clinical diagnosis and treatment of cerebral venous system diseases. This review focuses on applying different imaging methods to the normal anatomical morphology of the cerebral venous system and special structural and physiological parameters, such as hemodynamics, in people without cranial sinus and jugular vein diseases and explores its clinical significance. We hope this study will reinforce the importance of studying the cerebral venous system anatomy and imaging data and will help diagnose and treat systemic diseases.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yan Wu
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kaiyuan Zhang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chen Zhou
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- *Correspondence: Chen Zhou,
| | - Xunming Ji
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- Xunming Ji,
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25
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Klarica M, Radoš M, Erceg G, Jurjević I, Petošić A, Virag Z, Orešković D. Cerebrospinal fluid micro-volume changes inside the spinal space affect intracranial pressure in different body positions of animals and phantom. Front Mol Neurosci 2022; 15:931091. [PMID: 36187355 PMCID: PMC9518230 DOI: 10.3389/fnmol.2022.931091] [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: 04/28/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Interpersonal differences can be observed in the human cerebrospinal fluid pressure (CSFP) in the cranium in an upright body position, varying from positive to subatmospheric values. So far, these changes have been explained by the Monroe–Kellie doctrine according to which CSFP should increase or decrease if a change in at least one of the three intracranial volumes (brain, blood, and CSF) occurs. According to our hypothesis, changes in intracranial CSFP can occur without a change in the volume of intracranial fluids. To test this hypothesis, we alternately added and removed 100 or 200 μl of fluid from the spinal CSF space of four anesthetized cats and from a phantom which, by its dimensions and biophysical characteristics, imitates the cat cerebrospinal system, subsequently comparing CSFP changes in the cranium and spinal space in both horizontal and vertical positions. The phantom was made from a rigid “cranial” part with unchangeable volume, while the “spinal” part was made of elastic material whose modulus of elasticity was in the same order of magnitude as those of spinal dura. When a fluid volume (CSF or artificial CSF) was removed from the spinal space, both lumbar and cranial CSFP pressures decreased by 2.0–2.5 cm H2O for every extracted 100 μL. On the other hand, adding fluid volume to spinal space causes an increase in both lumbar and cranial CSFP pressures of 2.6–3.0 cm H2O for every added 100 μL. Results observed in cats and phantoms did not differ significantly. The presented results on cats and a phantom suggest that changes in the spinal CSF volume significantly affect the intracranial CSFP, but regardless of whether we added or removed the CSF volume, the hydrostatic pressure difference between the measuring sites (lateral ventricle and lumbar subarachnoid space) was always constant. These results suggest that intracranial CSFP can be increased or decreased without significant changes in the volume of intracranial fluids and that intracranial CSFP changes in accordance with the law of fluid mechanics.
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Affiliation(s)
- Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
- *Correspondence: Marijan Klarica
| | - Milan Radoš
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Gorislav Erceg
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivana Jurjević
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Antonio Petošić
- Department of Electroacoustics, Faculty of Electrical Engineering and Computing University of Zagreb, Zagreb, Croatia
| | - Zdravko Virag
- Department of Fluid Mechanics, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruder Bošković Institute, Zagreb, Croatia
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26
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Dierickx I, Kremer C, Bruckers L, Ghossein-Doha C, Gyselaers W. Characteristics of the Maternal Jugular Venous Pulse Waveform by Combined Doppler-Electrocardiogram Assessment. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:895-900. [PMID: 35246340 DOI: 10.1016/j.ultrasmedbio.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
Standardized combined Doppler-electrocardiogram assessment was performed longitudinally at three different locations of internal jugular veins between 12 wk of gestation and 6 wk postnatally in 24 uncomplicated pregnancies. All images were classified as typical or non-typical based on the presence of the physiologic deflections A, X, H and C. Linear mixed models with random intercepts of typical images were used to investigate gestational changes in venous pulse transit time and venous impedance index. Unequivocal identification of venous pulse transit time and venous impedance index was possible in 2617 of 3798 (69%) and 2234 of 3798 (59%) images, respectively. The best identification rate (80%, 1018/1266) was at the right distal internal jugular vein. Venous pulse transit time increased with gestational age at all locations; venous impedance index decreased at the right sided internal jugular vein. Maternal jugular venous pulse waveform by combined Doppler-electrocardiogram allows unequivocal identification of A-deflection and calculation of venous pulse transit time and venous impedance index in around two-thirds of assessments, with the highest success rate at the right distal internal jugular vein. Gestational evolutions of venous pulse transit time and venous impedance index are similar to those reported at the level of renal interlobar and hepatic veins.
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Affiliation(s)
- Inge Dierickx
- Department of Obstetrics and Gynaecology, Sint Lucas Ziekenhuis, Gent, Belgium; Department of Physiology, Hasselt University, Hasselt, Belgium.
| | - Cécile Kremer
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Liesbeth Bruckers
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Chahinda Ghossein-Doha
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wilfried Gyselaers
- Department of Physiology, Hasselt University, Hasselt, Belgium; Department of Obstetrics and Gynecology, Ziekenhuis Oost Limburg, Genk, Belgium
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27
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Kato T, Kurazumi T, Konishi T, Takko C, Ogawa Y, Iwasaki KI. Effects of -10° and -30° head-down tilt on cerebral blood velocity, dynamic cerebral autoregulation, and noninvasively estimated intracranial pressure. J Appl Physiol (1985) 2022; 132:938-946. [PMID: 35201934 PMCID: PMC8993530 DOI: 10.1152/japplphysiol.00283.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 12/03/2022] Open
Abstract
Steady-state cerebral blood flow (CBF) and dynamic cerebral autoregulation are reportedly maintained during -10° head-down tilt (HDT) despite slight increases in intracranial pressure (ICP). However, the higher ICP during -30° HDT may alter steady-state CBF and dynamic cerebral autoregulation. The present study hypothesized that steady-state CBF and dynamic cerebral autoregulation would be altered by higher ICP during -30° HDT than during 0° and -10° HDT. Seventeen healthy participants were positioned horizontal (0°) and in -10° HDT and -30° HDT for 10 min in random order on separate days. The arterial blood pressure waveform was obtained using a finger blood pressure device and the cerebral blood velocity waveform in the middle cerebral artery was obtained using transcranial Doppler sonography (TCD) for the last 6 min in each position. ICP was estimated using noninvasive ICP (nICP) based on TCD. Dynamic cerebral autoregulation was evaluated by spectral and transfer function analysis. Although nICP was significantly higher during -30° HDT (12.4 mmHg) than during -10° HDT (8.9 mmHg), no significant differences in steady-state mean cerebral blood velocity or transfer function gain in any frequency ranges were seen among all angles of HDT. Counter to our hypothesis, the present results suggest that steady-state CBF and dynamic cerebral autoregulation may be preserved during short-term -30° HDT despite the higher ICP compared with that during -10° HDT.NEW & NOTEWORTHY This appears to be the first study to evaluate steady-state cerebral blood flow (CBF), dynamic cerebral autoregulation, and intracranial pressure (ICP) during -30° head-down tilt (HDT) compared with those during -10° HDT using noninvasive measurements. The results suggest that steady-state CBF and dynamic cerebral autoregulation are preserved despite the higher ICP during short-term -30° HDT compared with -10° HDT.
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Affiliation(s)
- Tomokazu Kato
- Division of Hygiene, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takuya Kurazumi
- Division of Hygiene, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Toru Konishi
- Division of Hygiene, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
- Air Staff Office, Japan Air Self-Defense Force, Tokyo, Japan
| | - Chiharu Takko
- Division of Hygiene, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yojiro Ogawa
- Division of Hygiene, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ken-Ichi Iwasaki
- Division of Hygiene, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
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28
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Kramer LA, Hasan KM, Gabr RE, Macias BR, Marshall-Goebel K, Laurie SS, Hargens AR. Cerebrovascular Effects of Lower Body Negative Pressure at 3T MRI: Implications for Long-Duration Space Travel. J Magn Reson Imaging 2022; 56:873-881. [PMID: 35119781 DOI: 10.1002/jmri.28102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Optic disc edema develops in most astronauts during long-duration spaceflight. It is hypothesized to result from weightlessness-induced venous congestion of the head and neck and is an unresolved health risk of space travel. PURPOSE Determine if short-term application of lower body negative pressure (LBNP) could reduce internal jugular vein (IJV) expansion associated with the supine posture without negatively impacting cerebral perfusion or causing IJV flow stasis. STUDY TYPE Prospective. SUBJECTS Nine healthy volunteers (six women). FIELD STRENGTH/SEQUENCE 3T/cine two-dimensional phase-contrast gradient echo; pseudo-continuous arterial spin labeling single-shot gradient echo echo-planar. ASSESSMENT The study was performed with two sequential conditions in randomized order: supine posture and supine posture with 25 mmHg LBNP (LBNP25 ). LBNP was achieved by enclosing the lower extremities in a semi-airtight acrylic chamber connected to a vacuum. Heart rate, bulk cerebrovasculature flow, IJV cross-sectional area, fractional IJV outflow relative to arterial inflow, and cerebral perfusion were assessed in each condition. STATISTICAL TESTS Paired t-tests were used to compare measurement means across conditions. Significance was defined as P < 0.05. RESULTS LBNP25 significantly increased heart rate from 64 ± 9 to 71 ± 8 beats per minute and significantly decreased IJV cross-sectional area, IJV outflow fraction, cerebral arterial flow rate, and cerebral arterial stroke volume from 1.28 ± 0.64 to 0.56 ± 0.31 cm2 , 0.75 ± 0.20 to 0.66 ± 0.28, 780 ± 154 to 708 ± 137 mL/min and 12.2 ± 2.8 to 9.7 ± 1.7 mL/cycle, respectively. During LBNP25 , there was no significant change in gray or white matter cerebral perfusion (P = 0.26 and P = 0.24 respectively) and IJV absolute mean peak flow velocity remained ≥4 cm/sec in all subjects. DATA CONCLUSION Short-term application of LBNP25 reduced IJV expansion without decreasing cerebral perfusion or inducing IJV flow stasis. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Larry A Kramer
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Khader M Hasan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Refaat E Gabr
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Brandon R Macias
- Cardiovascular and Vision Laboratory, NASA Johnson Space Center, Houston, Texas, USA
| | | | | | - Alan R Hargens
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, USA
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29
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Li W, Wang B, Wang Y, Liu X, Feng W, Liu T, Sun Z, Liu Y, Liu S, Fan Y. Variations of human cerebral and ocular blood flow during exposure to multi-axial accelerations : A mathematical modeling study. Med Biol Eng Comput 2022; 60:471-486. [PMID: 34997405 DOI: 10.1007/s11517-021-02472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
Human hemodynamic responses during exposure to multi-axial acceleration was a relatively new topic in the fields of acceleration physiology. This study aimed to focus on these responses, especially variations of blood perfusion to brain and eyes, through mathematical modeling. A mathematical model was established using lumped parameter methods, containing compartments of four heart chambers, systemic arteries and veins, circulation of typical systemic organs, and some compartments for pulmonary circulation, together with autonomic regulation considered. This model was firstly validated by using experimental data from experiment of posture change and centrifuge tests of +Gz accelerations, and then applied to analyze human hemodynamic responses to typical multi-axial accelerations. Validation results demonstrated the mathematical model could generate reasonable responses of human cardiovascular system during posture change and exposure to +Gz accelerations. Simulation results of hemodynamic responses to multi-axial accelerations depicted Gy induced significant differences of blood flow to the left and right eyes. And some contour maps were generated based on these results, which provided a quick way to estimate blood flow variations in brain and eyes during exposure to different accelerations. Graphical Abstract This study aimed to focus on variations of blood perfusion to brain and eyes during exposure to typical multi-axial accelerations through mathematical modeling. This model was firstly validated by using experimental data from experiment of posture change and centrifuge tests of +Gz accelerations, and then applied to analyze human hemodynamic responses to typical multi-axial accelerations. Simulation results of hemodynamic responses to multi-axial accelerations depicted Gy induced significant differences of blood flow to the left and right eyes. And contour maps that generated based on these results provided a quick way to estimate blood flow variations in brain and eyes during exposure to different accelerations.
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Affiliation(s)
- Weipeng Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Bitian Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Yawei Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
| | - Xiaoyu Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Wentao Feng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Tianya Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
- College of Veterinary Medicine, China Agricultural University, Beijing, 100083, People's Republic of China
| | - Zhujun Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Yu Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Songyang Liu
- Air Force Special Medical Center, Beijing, 100142, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
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30
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Harris KM, Weber T, Greaves D, Green DA, Goswami N, Petersen LG. Going against the flow: are venous thromboembolism and impaired cerebral drainage critical risks for spaceflight? J Appl Physiol (1985) 2022; 132:270-273. [PMID: 34672768 PMCID: PMC8759966 DOI: 10.1152/japplphysiol.00425.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Katie M. Harris
- 1Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Tobias Weber
- 2European Astronaut Centre, European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany,3KBR GmbH, Cologne, Germany
| | - Danielle Greaves
- 4Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - David Andrew Green
- 2European Astronaut Centre, European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany,3KBR GmbH, Cologne, Germany,5Centre of Human & Applied Physiological Sciences, King’s College London, London, United Kingdom
| | - Nandu Goswami
- 6Division of Physiology, Otto Löwi Research Center for Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - Lonnie G. Petersen
- 7Department of Mechanical and Aerospace Engineering, University of California, San Diego, California,8Department of Radiology, University of California, San Diego, California
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van der Ster BJP, Kim YS, Westerhof BE, van Lieshout JJ. Central Hypovolemia Detection During Environmental Stress-A Role for Artificial Intelligence? Front Physiol 2021; 12:784413. [PMID: 34975538 PMCID: PMC8715014 DOI: 10.3389/fphys.2021.784413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
The first step to exercise is preceded by the required assumption of the upright body position, which itself involves physical activity. The gravitational displacement of blood from the chest to the lower parts of the body elicits a fall in central blood volume (CBV), which corresponds to the fraction of thoracic blood volume directly available to the left ventricle. The reduction in CBV and stroke volume (SV) in response to postural stress, post-exercise, or to blood loss results in reduced left ventricular filling, which may manifest as orthostatic intolerance. When termination of exercise removes the leg muscle pump function, CBV is no longer maintained. The resulting imbalance between a reduced cardiac output (CO) and a still enhanced peripheral vascular conductance may provoke post-exercise hypotension (PEH). Instruments that quantify CBV are not readily available and to express which magnitude of the CBV in a healthy subject should remains difficult. In the physiological laboratory, the CBV can be modified by making use of postural stressors, such as lower body "negative" or sub-atmospheric pressure (LBNP) or passive head-up tilt (HUT), while quantifying relevant biomedical parameters of blood flow and oxygenation. Several approaches, such as wearable sensors and advanced machine-learning techniques, have been followed in an attempt to improve methodologies for better prediction of outcomes and to guide treatment in civil patients and on the battlefield. In the recent decade, efforts have been made to develop algorithms and apply artificial intelligence (AI) in the field of hemodynamic monitoring. Advances in quantifying and monitoring CBV during environmental stress from exercise to hemorrhage and understanding the analogy between postural stress and central hypovolemia during anesthesia offer great relevance for healthy subjects and clinical populations.
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Affiliation(s)
- Björn J. P. van der Ster
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yu-Sok Kim
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Berend E. Westerhof
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Johannes J. van Lieshout
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, The Medical School, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
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32
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Claassen JAHR, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev 2021; 101:1487-1559. [PMID: 33769101 PMCID: PMC8576366 DOI: 10.1152/physrev.00022.2020] [Citation(s) in RCA: 304] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Brain function critically depends on a close matching between metabolic demands, appropriate delivery of oxygen and nutrients, and removal of cellular waste. This matching requires continuous regulation of cerebral blood flow (CBF), which can be categorized into four broad topics: 1) autoregulation, which describes the response of the cerebrovasculature to changes in perfusion pressure; 2) vascular reactivity to vasoactive stimuli [including carbon dioxide (CO2)]; 3) neurovascular coupling (NVC), i.e., the CBF response to local changes in neural activity (often standardized cognitive stimuli in humans); and 4) endothelium-dependent responses. This review focuses primarily on autoregulation and its clinical implications. To place autoregulation in a more precise context, and to better understand integrated approaches in the cerebral circulation, we also briefly address reactivity to CO2 and NVC. In addition to our focus on effects of perfusion pressure (or blood pressure), we describe the impact of select stimuli on regulation of CBF (i.e., arterial blood gases, cerebral metabolism, neural mechanisms, and specific vascular cells), the interrelationships between these stimuli, and implications for regulation of CBF at the level of large arteries and the microcirculation. We review clinical implications of autoregulation in aging, hypertension, stroke, mild cognitive impairment, anesthesia, and dementias. Finally, we discuss autoregulation in the context of common daily physiological challenges, including changes in posture (e.g., orthostatic hypotension, syncope) and physical activity.
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Affiliation(s)
- Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- >National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Frank M Faraci
- Departments of Internal Medicine, Neuroscience, and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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33
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Maissen G, Narula G, Strässle C, Willms J, Muroi C, Keller E. Functional relationship of arterial blood pressure, central venous pressure and intracranial pressure in the early phase after subarachnoid hemorrhage. Technol Health Care 2021; 30:591-604. [PMID: 34459427 DOI: 10.3233/thc-212956] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intracranial pressure (ICP) and arterial blood pressure (ABP) are related to each other through cerebral autoregulation. Central venous pressure (CVP) is often measured to estimate cardiac filling pressures as an approximate measure for the volume status of a patient. Prior modelling efforts have formalized the functional relationship between CVP, ICP and ABP. However, these models were used to explain short segments of data during controlled experiments and have not yet been used to explain the slowly evolving ICP increase that occurs typically in patients after aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE To analyze the functional relationship between ICP, ABP and CVP recorded from SAH patients in the first five days after aneurysm. METHODS Two methods were used to elucidate this relationship on the running average of the signals: First, using Spearman correlation coefficients calculated over 30 min segments Second, for each patient, linear state space models of ICP as the output and ABP and CVP as inputs were estimated. RESULTS The mean and variance of the data and the correlation coefficients between ICP-ABP and ICP-CVP vary over time as the patient progresses through their stay in the ICU. On average, after an SAH event, the models show that a) ABP is the bigger driver of changes in ICP than CVP and that increasing ABP leads to reduction in ICP and (b) increasing CVP leads to an increase in ICP. CONCLUSIONS Finding a) agrees with the hypothesis that patients with subarachnoid hemorrhage have defective autoregulation, and b) agrees with the positive correlation observed between central venous pressure and intracranial pressure in the literature.
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Gergelé L, Manet R. Postural Regulation of Intracranial Pressure: A Critical Review of the Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:339-342. [PMID: 33839871 DOI: 10.1007/978-3-030-59436-7_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mechanisms underlying postural regulation of ICP remain unclear. METHOD Literature review in Medline 1900-2019 with search terms "Intracranial pressure," "Posture," "Jugular vein," "Collapse," "Regulation," "Physiology," resulting in 40 selected papers. RESULTS Postural transition from supine to sitting position results in a biphasic decrease of ICP: a fast decrease during phase 1 (low tilt) followed by a stabilization during phase 2 (higher tilt/erect). Two main factors have been proposed to explain this decrease: (a) Fast CSF transfers from the non-distensible cranial compartment to the distensible spinal compartment during phase 1; the maximal spinal expansion corresponds to phase 2; (b) The gravitational effect within the venous system is transferred to the CSF system according to Davson's equation, modulated by jugular collapse that would be responsible for the stabilization of ICP decrease in phase 2. DISCUSSION The impact of CSF transfers, from the cranial to spinal compartment, on postural regulation of ICP, has been well documented. Although they are sophisticated, models that support the major influence of jugular collapse likely underestimate the role of the vertebral venous plexus in cerebral venous outflow in the upright position. Moreover, Davson's equation supports slow CSF transfer from subarachnoid spaces to the venous system (a few mL/min) and thus cannot explain fast postural modulation of ICP (in a few seconds). Further data are thus needed to better understand postural regulation of ICP.
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Affiliation(s)
- Laurent Gergelé
- Department of Intensive Care, Ramsay Générale de Santé, Hôpital Privé de la Loire, Saint Etienne, France
| | - Romain Manet
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France.
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35
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Lan M, Phillips SD, Archambault-Leger V, Chepko AB, Lu R, Anderson AP, Masterova KS, Fellows AM, Halter RJ, Buckey JC. Proposed mechanism for reduced jugular vein flow in microgravity. Physiol Rep 2021; 9:e14782. [PMID: 33931957 PMCID: PMC8087922 DOI: 10.14814/phy2.14782] [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: 12/07/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 12/03/2022] Open
Abstract
Internal jugular flow is reduced in space compared with supine values, which can be associated with internal jugular vein (IJV) thrombosis. The mechanism is unknown but important to understand to prevent potentially serious vein thromboses on long duration flights. We used a novel, microgravity‐focused numerical model of the cranial vascular circulation to develop hypotheses for the reduced flow. This model includes the effects of removing hydrostatic gradients and tissue compressive forces – unique effects of weightlessness. The IJV in the model incorporates sensitivity to transmural pressure across the vein, which can dramatically affect resistance and flow in the vein. The model predicts reduced IJV flow in space. Although tissue weight in the neck is reduced in weightlessness, increasing transmural pressure, this is more than offset by the reduction in venous pressure produced by the loss of hydrostatic gradients and tissue pressures throughout the body. This results in a negative transmural pressure and increased IJV resistance. Unlike the IJV, the walls of the vertebral plexus are rigid; transmural pressure does not affect its resistance and so its flow increases in microgravity. This overall result is supported by spaceflight measurements, showing reduced IJV area inflight compared with supine values preflight. Significantly, this hypothesis suggests that interventions that further decrease internal IJV pressure (such as lower body negative pressure), which are not assisted by other drainage mechanisms (e.g. gravity), might lead to stagnant flow or IJV collapse with reduced flow, which could increase rather than decrease the risk of venous thrombosis.
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Affiliation(s)
- Mimi Lan
- Thayer School of Engineering at Dartmouth, Hanover, NH, USA
| | | | | | | | | | | | | | | | - Ryan J Halter
- Thayer School of Engineering at Dartmouth, Hanover, NH, USA
| | - Jay C Buckey
- Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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36
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Harms MPM, Finucane C, Pérez-Denia L, Juraschek SP, van Wijnen VK, Lipsitz LA, van Lieshout JJ, Wieling W. Systemic and cerebral circulatory adjustment within the first 60 s after active standing: An integrative physiological view. Auton Neurosci 2021; 231:102756. [PMID: 33385733 PMCID: PMC8103784 DOI: 10.1016/j.autneu.2020.102756] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023]
Abstract
Transient cardiovascular and cerebrovascular responses within the first minute of active standing provide the means to assess autonomic, cardiovascular and cerebrovascular regulation using a real-world everyday stimulus. Traditionally, these responses have been used to detect autonomic dysfunction, and to identify the hemodynamic correlates of patient symptoms and attributable causes of (pre)syncope and falls. This review addresses the physiology of systemic and cerebrovascular adjustment within the first 60 s after active standing. Mechanical factors induced by standing up cause a temporal mismatch between cardiac output and vascular conductance which leads to an initial blood pressure drops with a nadir around 10 s. The arterial baroreflex counteracts these initial blood pressure drops, but needs 2-3 s to be initiated with a maximal effect occurring at 10 s after standing while, in parallel, cerebral autoregulation buffers these changes within 10 s to maintain adequate cerebral perfusion. Interestingly, both the magnitude of the initial drop and these compensatory mechanisms are thought to be quite well-preserved in healthy aging. It is hoped that the present review serves as a reference for future pathophysiological investigations and epidemiological studies. Further experimental research is needed to unravel the causal mechanisms underlying the emergence of symptoms and relationship with aging and adverse outcomes in variants of orthostatic hypotension.
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Affiliation(s)
- Mark P M Harms
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ciáran Finucane
- Department of Medical Physics & Bioengineering, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Laura Pérez-Denia
- Department of Medical Physics & Bioengineering, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Stephen P Juraschek
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Veera K van Wijnen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Johannes J van Lieshout
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; School of Life Sciences, The Medical School, MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, Queen's Medical Centre, Nottingham, United Kingdom
| | - Wouter Wieling
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Mohammadyari P, Gadda G, Taibi A. Modelling physiology of haemodynamic adaptation in short-term microgravity exposure and orthostatic stress on Earth. Sci Rep 2021; 11:4672. [PMID: 33633331 PMCID: PMC7907254 DOI: 10.1038/s41598-021-84197-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular haemodynamics alters during posture changes and exposure to microgravity. Vascular auto-remodelling observed in subjects living in space environment causes them orthostatic intolerance when they return on Earth. In this study we modelled the human haemodynamics with focus on head and neck exposed to different hydrostatic pressures in supine, upright (head-up tilt), head-down tilt position, and microgravity environment by using a well-developed 1D-0D haemodynamic model. The model consists of two parts that simulates the arterial (1D) and brain-venous (0D) vascular tree. The cardiovascular system is built as a network of hydraulic resistances and capacitances to properly model physiological parameters like total peripheral resistance, and to calculate vascular pressure and the related flow rate at any branch of the tree. The model calculated 30.0 mmHg (30%), 7.1 mmHg (78%), 1.7 mmHg (38%) reduction in mean blood pressure, intracranial pressure and central venous pressure after posture change from supine to upright, respectively. The modelled brain drainage outflow percentage from internal jugular veins is 67% and 26% for supine and upright posture, while for head-down tilt and microgravity is 65% and 72%, respectively. The model confirmed the role of peripheral veins in regional blood redistribution during posture change from supine to upright and microgravity environment as hypothesized in literature. The model is able to reproduce the known haemodynamic effects of hydraulic pressure change and weightlessness. It also provides a virtual laboratory to examine the consequence of a wide range of orthostatic stresses on human haemodynamics.
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Affiliation(s)
- Parvin Mohammadyari
- Department of Physics and Earth Sciences, University of Ferrara, 44122, Ferrara, Italy
| | - Giacomo Gadda
- National Institute for Nuclear Physics (INFN), Section of Ferrara, 44122, Ferrara, Italy.
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, 44122, Ferrara, Italy
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Tarumi T, Yamabe T, Fukuie M, Zhu DC, Zhang R, Ogoh S, Sugawara J. Brain blood and cerebrospinal fluid flow dynamics during rhythmic handgrip exercise in young healthy men and women. J Physiol 2021; 599:1799-1813. [PMID: 33481257 DOI: 10.1113/jp281063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/12/2021] [Indexed: 01/06/2023] Open
Abstract
KEY POINTS The cerebral fluid response to exercise, including the arterial and venous cerebral blood flow (CBF) and cerebrospinal fluid (CSF), currently remains unknown. We used time-resolved phase-contrast magnetic resonance imaging to assess changes in CBF and CSF flow dynamics during moderate-intensity rhythmic handgrip (RHG) exercise in young healthy men and women. Our data demonstrated that RHG increases the cerebral arterial inflow and venous outflow while decreasing the pulsatile CSF flow during RHG. Furthermore, changes in blood stroke volume at the measured arteries, veins, and sinuses and CSF stroke volume at the cerebral aqueduct were positively correlated with each other during RHG. Male and female participants exhibited distinct blood pressure responses to RHG, but their cerebral fluid responses were similar. These results collectively suggest that RHG influences both CBF and CSF flow dynamics in a way that is consistent with the Monro-Kellie hypothesis to maintain intracranial volume-pressure homeostasis in young healthy adults. ABSTRACT Cerebral blood flow (CBF) increases during exercise, but its impact on cerebrospinal fluid (CSF) flow remains unknown. This study investigated CBF and CSF flow dynamics during moderate-intensity rhythmic handgrip (RHG) exercise in young healthy men and women. Twenty-six participants (12 women) underwent the RHG and resting control conditions in random order. Participants performed 3 sets of RHG, during which cine phase-contrast magnetic resonance imaging (PC-MRI) was performed to measure blood stroke volume (SV) and flow rate in the internal carotid (ICA) and vertebral (VA) arteries, the internal jugular vein (IJV), the superior sagittal (SSS) and straight sinuses (SRS), and CSF SV and flow rate in the cerebral aqueduct of Sylvius. Blood pressure, end-tidal CO2 (EtCO2 ), heart rate (HR), and respiratory rate were simultaneously measured during cine PC-MRI scans. Compared with control conditions, RHG showed significant elevations of HR, mean arterial pressure, and respiratory rate with a mild reduction of EtCO2 (all P < 0.05). RHG decreased blood SV in the measured arteries, veins, and sinuses and CSF SV in the aqueduct (all P < 0.05). Conversely, RHG increased blood flow in the ICA, VA, and IJV (all P < 0.05). At the aqueduct, RHG decreased the absolute CSF flow rate (P = 0.0307), which was calculated as a sum of the caudal and cranial CSF flow rates. Change in the ICA SV was positively correlated with changes in the IJV, SSS, SRS, and aqueductal SV during RHG (all P < 0.05). These findings demonstrate a close coupling between the CBF and CSF flow dynamics during RHG in young healthy adults.
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Affiliation(s)
- Takashi Tarumi
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA
| | - Takayuki Yamabe
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Marina Fukuie
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, Michigan, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Saitama, Japan
| | - Jun Sugawara
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
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39
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Kim YS, van der Ster BJP, Brassard P, Secher NH, van Lieshout JJ. Cerebral vs. Cardiovascular Responses to Exercise in Type 2 Diabetic Patients. Front Physiol 2021; 11:583155. [PMID: 33519500 PMCID: PMC7844205 DOI: 10.3389/fphys.2020.583155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/23/2020] [Indexed: 12/17/2022] Open
Abstract
The human brain is constantly active and even small limitations to cerebral blood flow (CBF) may be critical for preserving oxygen and substrate supply, e.g., during exercise and hypoxia. Exhaustive exercise evokes a competition for the supply of oxygenated blood between the brain and the working muscles, and inability to increase cardiac output sufficiently during exercise may jeopardize cerebral perfusion of relevance for diabetic patients. The challenge in diabetes care is to optimize metabolic control to slow progression of vascular disease, but likely because of a limited ability to increase cardiac output, these patients perceive aerobic exercise to be more strenuous than healthy subjects and that limits the possibility to apply physical activity as a preventive lifestyle intervention. In this review, we consider the effects of functional activation by exercise on the brain and how it contributes to understanding the control of CBF with the limited exercise tolerance experienced by type 2 diabetic patients. Whether a decline in cerebral oxygenation and thereby reduced neural drive to working muscles plays a role for "central" fatigue during exhaustive exercise is addressed in relation to brain's attenuated vascular response to exercise in type 2 diabetic subjects.
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Affiliation(s)
- Yu-Sok Kim
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Björn J. P. van der Ster
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Niels H. Secher
- Department of Anesthesia, The Copenhagen Muscle Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Johannes J. van Lieshout
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, United Kingdom
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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40
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Carpenter K, Decater T, Iwanaga J, Maulucci CM, Bui CJ, Dumont AS, Tubbs RS. Revisiting the Vertebral Venous Plexus-A Comprehensive Review of the Literature. World Neurosurg 2020; 145:381-395. [PMID: 33049379 DOI: 10.1016/j.wneu.2020.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
The venous drainage of the vertebral and paravertebral regions is important for a better understanding of hematogenous disease spread. Moreover, the spine surgeon must be well acquainted with this anatomy to minimize intraoperative and postoperative complications. A comprehensive review of the vertebral venous plexus (Batson plexus) was performed with a concentration on the clinical and surgical correlations of this venous network.
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Affiliation(s)
- Kennedy Carpenter
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Tess Decater
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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41
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Lloyd RA, Butler JE, Gandevia SC, Ball IK, Toson B, Stoodley MA, Bilston LE. Respiratory cerebrospinal fluid flow is driven by the thoracic and lumbar spinal pressures. J Physiol 2020; 598:5789-5805. [PMID: 32990956 DOI: 10.1113/jp279458] [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] [Received: 12/18/2019] [Accepted: 09/22/2020] [Indexed: 01/20/2023] Open
Abstract
KEY POINTS Respiration plays a key role in the circulation of cerebrospinal fluid (CSF) around the central nervous system. During inspiration increased venous return from the cranium is believed to draw CSF rostrally. However, this mechanism does not explain why CSF has also been observed to move caudally during inspiration. We show that during inspiration decreased intrathoracic pressure draws venous blood from the cranium and lumbar spine towards the thorax. We also show that the abdominal pressure was associated with rostral CSF displacement. However, a caudal shift of cervical CSF was seen with low abdominal pressure and comparably negative intrathoracic pressures. These results suggest that the effects of epidural blood flow within the spinal canal need to be considered, as well as the cranial blood volume balance, to understand respiratory-related CSF flow. These results may prove useful for the treatment of CSF obstructive pathology and understanding the behaviour of intrathecal drug injections. ABSTRACT It is accepted that during inspiration, cerebrospinal fluid (CSF) flows rostrally to compensate for decreased cranial blood volume, caused by venous drainage due to negative intrathoracic pressure. However, this mechanism does not explain observations of caudal CSF displacement during inspiration. Determining the drivers of respiratory CSF flow is crucial for understanding the pathophysiology of CSF flow disorders. To quantify the influence of respiration on CSF flow, real-time phase-contrast magnetic resonance imaging (MRI) was used to record CSF and blood flow, while healthy subjects (5:5 M:F, 25-50 years) performed either a brief expiratory or inspiratory effort between breaths. Transverse images were taken perpendicular to the spinal canal in the middle of the C3 and L2 vertebrae. The same manoeuvres were then performed after a nasogastric pressure catheter was used to measure the intrathoracic and abdominal pressures. During expiratory-type manoeuvres that elevated abdominal and intrathoracic pressures, epidural blood flow into the spinal canal increased and CSF was displaced rostrally. With inspiratory manoeuvres, the negative intrathoracic pressure drew venous blood from C3 and L2 towards the thoracic spinal canal, and cervical CSF was displaced both rostrally and caudally, despite the increased venous drainage. Regression analysis showed that rostral displacement of CSF at both C3 (adjusted R2 = 0.53; P < 0.001) and L2 (adjusted R2 = 0.38; P < 0.001) were associated with the abdominal pressure. However, with low abdominal pressure and comparably negative intrathoracic pressure, cervical CSF flowed caudally. These findings suggest that changes in both the cranial and spinal pressures need to be considered to understand respiratory CSF flow.
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Affiliation(s)
- Robert A Lloyd
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Iain K Ball
- Philips Australia & New Zealand, Sydney, NSW, Australia
| | - Barbara Toson
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Marcus A Stoodley
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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Ogoh S, Washio T, Paton JFR, Fisher JP, Petersen LG. Gravitational effects on intracranial pressure and blood flow regulation in young men: a potential shunting role for the external carotid artery. J Appl Physiol (1985) 2020; 129:901-908. [PMID: 32816640 DOI: 10.1152/japplphysiol.00369.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We sought to determine whether gravity-induced changes in intracranial pressure influence cerebral blood flow regulation. Accordingly, nine young healthy men were studied while supine (0°) and during mild changes in hydrostatic pressure induced by head-up tilt at +20° and +10° (HUT+20 and HUT+10) and head-down tilt at -20° and -10° (HDT-20, HDT-10). Blood flows were measured in the internal and external carotid and vertebral arteries (ICA, ECA, and VA). Intraocular pressure (IOP) was measured as an indicator of hydrostatic changes in intracranial pressure. A posture change from HUT+20 to HDT-20 increased IOP by +5.1 ± 1.9 mmHg (P < 0.001) and ECA blood flow (from 61.7 ± 26.1 to 87.6 ± 46.4 mL/min, P = 0.004) but did not affect ICA (P = 0.528) or VA (P = 0.101) blood flow. The increase in ECA flow correlated with the tilt angle and resultant changes in intracranial pressures (by IOP), thus indicating a passive hydrostatic gravitational dependence (r = 0.371, P = 0.012). On the contrary, ICA flow remained constant and thus well protected against moderate orthostatic stress. When ICA flow was corrected for the gravitational changes in intracranial pressures (by IOP), it demonstrated the same magnitude of gravitational dependence as ECA. These findings suggest that passive hydrostatic increases in intracranial pressure outbalance the concurrent increase in arterial feeding pressure to the brain and thus prevent cerebral hyperperfusion during HDT. The mechanism for maintaining constant cerebral flow was by increased ECA flow, thus supporting the role of these vascular beds as a shunting pathway.NEW & NOTEWORTHY We investigated whether gravity-induced changes in intracranial pressure influence cerebral blood flow regulation in young men. We recorded extra- and intracerebral blood flow during changes in posture, and data indicate that the external carotid artery may serve as an overflow pathway to prevent cerebral hyperperfusion during increases in cerebral arterial blood pressure.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Julian F R Paton
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lonnie G Petersen
- Department of Biomedical Science, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, University of California, San Diego, California.,Department of Mechanical and Aerospace Engineering, University of California, San Diego, California
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Vilela MD, Pedrosa HA, Mesquita BF, Horiguchi CLF. Low-Pressure Hydrocephalus and Shunt Malfunction Following a Lumbar Puncture in an Adult Reversed by an Epidural Blood Patch. World Neurosurg 2020; 143:56-61. [PMID: 32712403 PMCID: PMC7377781 DOI: 10.1016/j.wneu.2020.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/06/2022]
Abstract
Background Low-pressure hydrocephalus (LPH) is a relatively rare condition, and its presentation is similar to the classically seen high-pressure hydrocephalus, with headaches, cranial nerve dysfunction, ataxia, and disturbances of consciousness. Cerebral cerebrospinal fluid loss in the presence of altered brain viscoelastic properties has previously been suggested as the pathophysiologic process leading to ventriculomegaly, despite low or negative intracranial pressures and patent shunts. More recently, cerebral venous overdrainage has been proposed as a possible explanation in the pathogenesis of LPH, although its connection to lumbar punctures in patients with shunts has not been contemplated yet. The effectiveness of epidural blood patch in the management of post-lumbar puncture LPH has been shown in children but has not been reported in adults. Case Description Herein we detail 2 episodes of shunt malfunction in a 30-year-old female patient with a history of hydrocephalus related to a posterior fossa tumor diagnosed during childhood. In both instances, imaging studies demonstrated ventricular dilation along with perimedullary cistern enlargement and brainstem distortion, which occurred following a lumbar puncture despite a patent shunt. A lumbar blood patch was effective in both episodes, enabling resolution of the ventriculomegaly and a good outcome. Conclusions A blood patch can be efficient in adults with post-lumbar puncture LPH. Some symptoms may be explained by brainstem compression caused by enlarged cerebrospinal fluid spaces at the skull base. The role of cerebral venous overdrainage in the setting of post-lumbar puncture LPH is further supported.
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Affiliation(s)
- Marcelo D Vilela
- Department of Neurological Surgery, University of Washington, Seattle, USA; Neurosurgery, Mater Dei Hospital, Belo Horizonte, Brazil.
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Ghali MGZ, Marchenko V, Yaşargil MG, Ghali GZ. Structure and function of the perivascular fluid compartment and vertebral venous plexus: Illumining a novel theory on mechanisms underlying the pathogenesis of Alzheimer's, cerebral small vessel, and neurodegenerative diseases. Neurobiol Dis 2020; 144:105022. [PMID: 32687942 DOI: 10.1016/j.nbd.2020.105022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/13/2020] [Accepted: 07/15/2020] [Indexed: 01/14/2023] Open
Abstract
Blood dynamically and richly supplies the cerebral tissue via microvessels invested in pia matter perforating the cerebral substance. Arteries penetrating the cerebral substance derive an investment from one or two successive layers of pia mater, luminally apposed to the pial-glial basal lamina of the microvasculature and abluminally apposed to a series of aquaporin IV-studded astrocytic end feet constituting the soi-disant glia limitans. The full investment of successive layers forms the variably continuous walls of the periarteriolar, pericapillary, and perivenular divisions of the perivascular fluid compartment. The pia matter disappears at the distal periarteriolar division of the perivascular fluid compartment. Plasma from arteriolar blood sequentially transudates into the periarteriolar division of the perivascular fluid compartment and subarachnoid cisterns in precession to trickling into the neural interstitium. Fluid from the neural interstitium successively propagates into the venules through the subarachnoid cisterns and perivenular division of the perivascular fluid compartment. Fluid fluent within the perivascular fluid compartment flows gegen the net direction of arteriovenular flow. Microvessel oscillations at the central tendency of the cerebral vasomotion generate corresponding oscillations of within the surrounding perivascular fluid compartment, interposed betwixt the abluminal surface of the vessels and internal surface of the pia mater. The precise microanatomy of this most fascinating among designable spaces has eluded the efforts of various investigators to interrogate its structure, though most authors non-consensusly concur the investing layers effectively and functionally segregate the perivascular and subarachnoid fluid compartments. Enlargement of the perivascular fluid compartment in a variety of neurological disorders, including senile dementia of the Alzheimer's type and cerebral small vessel disease, may alternately or coordinately constitute a correlative marker of disease severity and a possible cause implicated in the mechanistic pathogenesis of these conditions. Venular pressures modulating oscillatory dynamic flow within the perivascular fluid compartment may similarly contribute to the development of a variety among neurological disorders. An intimate understanding of subtle features typifying microanatomy and microphysiology of the investing structures and spaces of the cerebral microvasculature may powerfully inform mechanistic pathophysiology mediating a variety of neurovascular ischemic, neuroinfectious, neuroautoimmune, and neurodegenerative diseases.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Street, San Francisco, CA 94143, United States; Department of Neurobiology and Anatomy, 2900 W. Queen Lane, Philadelphia, PA 19129, United States.
| | - Vitaliy Marchenko
- Department of Neurobiology and Anatomy, 2900 W. Queen Lane, Philadelphia, PA 19129, United States; Department of Neurophysiology, Bogomoletz Institute, Kyiv, Ukraine; Department of Neuroscience, Московский государственный университет имени М. В., Ломоносова GSP-1, Leninskie Gory, Moscow 119991, Russian Federation
| | - M Gazi Yaşargil
- Department of Neurosurgery, University Hospital Zurich Rämistrasse 100, 8091 Zurich, Switzerland
| | - George Zaki Ghali
- United States Environmental Protection Agency, Arlington, Virginia, USA; Emeritus Professor of Toxicology, Purdue University, West Lafayette, Indiana, USA
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Abstract
People undertaking prolonged vigorous exercise experience substantial bodily fluid losses due to thermoregulatory sweating. If these fluid losses are not replaced, endurance capacity may be impaired in association with a myriad of alterations in physiological function, including hyperthermia, hyperventilation, cardiovascular strain with reductions in brain, skeletal muscle and skin blood perfusion, greater reliance on muscle glycogen and cellular metabolism, alterations in neural activity and, in some conditions, compromised muscle metabolism and aerobic capacity. The physiological strain accompanying progressive exercise-induced dehydration to a level of ~ 4% of body mass loss can be attenuated or even prevented by: (1) ingesting fluids during exercise, (2) exercising in cold environments, and/or (3) working at intensities that require a small fraction of the overall body functional capacity. The impact of dehydration upon physiological function therefore depends on the functional demand evoked by exercise and environmental stress, as cardiac output, limb blood perfusion and muscle metabolism are stable or increase during small muscle mass exercise or resting conditions, but are impaired during whole-body moderate to intense exercise. Progressive dehydration is also associated with an accelerated drop in perfusion and oxygen supply to the human brain during submaximal and maximal endurance exercise. Yet their consequences on aerobic metabolism are greater in the exercising muscles because of the much smaller functional oxygen extraction reserve. This review describes how dehydration differentially impacts physiological function during exercise requiring low compared to high functional demand, with an emphasis on the responses of the human brain, heart and skeletal muscles.
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Mohammadyari P, Gadda G, Taibi A, Munuera Del Cerro J. Paediatric haemodynamic modelling: development and experimental validation using quantitative flow MRI. Eur Radiol Exp 2020; 4:16. [PMID: 32173785 PMCID: PMC7073351 DOI: 10.1186/s41747-020-0146-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Congenital vascular disease is one of the leading causes of death in paediatric age. Despite the importance of paediatric haemodynamics, large investigations have been devoted to the evaluation of circulation in adults. The novelty of this study consists in the development of a well calibrated mathematical model of cardiovascular circulation in paediatric subjects. To reach the purpose, a model for adult circulation was modified and recalibrated with experimental data and literature from children to be able to calculate the flow rates and pressures in the brain and neck. Methods The haemodynamic model simulates the 76 main arteries, together with the main veins in brain and neck. A proper magnetic resonance imaging (MRI) dataset of 29 volunteers aged 12 ± 5 years (mean ± standard deviation) was used to extract age-dependent physiological and clinical parameters such as heart rate, flow rate, vessel cross section area, and blood pressure. The computational model was calibrated using such experimental data. The paediatric and adult model results were compared. Results Increase of the vessels stiffness due to aging contributes to a flow rate decrease while blood pressure increases. In accordance, our simulation results show about 16% decrease in mean pressure of internal jugular vein in paediatric rather than adult subjects. The model outcomes indicated about 88% correlation with MRI data. Conclusions The mathematical model simulates the paediatric head and neck blood circulation. The model provides detailed information of human haemodynamics including arterial and venous network to study both paediatric and adult blood circulation.
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Affiliation(s)
- Parvin Mohammadyari
- Department of Physics and Earth Sciences, University of Ferrara, Via Giuseppe Saragat, 1, 44122, Ferrara, Italy
| | - Giacomo Gadda
- National Institute for Nuclear Physics (INFN) - Section of Ferrara, Via Giuseppe Saragat, 1, 44122, Ferrara, Italy.
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, Via Giuseppe Saragat, 1, 44122, Ferrara, Italy
| | - Josep Munuera Del Cerro
- Department of Diagnostic Imaging, Fundació Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
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Cerebrovascular haemodynamics during isometric resistance exercise with and without the Valsalva manoeuvre. Eur J Appl Physiol 2020; 120:467-479. [PMID: 31912226 DOI: 10.1007/s00421-019-04291-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/20/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To examine the interactive effects of VM and isometric resistance exercise on cerebral haemodynamics. METHODS Eleven healthy participants (mean ± SD 28 ± 9 years; 2 females) completed 20-s bilateral isometric leg extension at 50% of maximal voluntary contraction with continued ventilation (RE), a 20-s VM at mouth pressure of 40 mmHg (VM), and a combination (RE + VM), in randomised order. Mean beat-to-beat blood velocity in the posterior (PCAvmean) and middle cerebral arteries (MCAvmean), vertebral artery blood flow, end-tidal partial pressure of CO2 and mean arterial pressure (MAP) were measured. RE data were time aligned to RE + VM and analysed according to standard VM phases. RESULTS Interaction effects (VM phase × condition) were observed for MCAvmean, PCAvmean, vertebral artery blood flow and MAP (all ≤ 0.010). Phase I MCAvmean was greatest for RE [88 ± 19, vs. 71 ± 11 and 78 ± 12 cm s-1 for VM (P = 0.008) and RE + VM (P = 0.021), respectively]. Greater increases in MCAvmean than PCAvmean occurred in phase I of RE only (24 ± 15% vs. 16 ± 16%, post hoc P = 0.044). In phase IIb, MAP was lower in RE than RE + VM (115 ± 15 vs. 138 ± 21 mmHg, P = 0.004), but did not reduce MCAvmean (78 ± 8 vs. 79 ± 9 cm s-1, P = 0.579) or PCAvmean (45 ± 11 vs .46 ± 11 cm s-1, P = 0.617). Phase IIb MCAvmean and PCAvmean was lowest in VM (66 ± 6 and 39 ± 8 cm s-1, respectively, all P < 0.001), whereas in Phase IV, MCAvmean, PCAvmean and MAP were greater in VM than in RE and RE + VM (all P < 0.020). CONCLUSION RE and RE + VM produce similar cerebrovascular responses despite different MAP profiles. However, the VM produced the greatest cerebrovascular challenge afterward.
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Valley MT, Moore MG, Zhuang J, Mesa N, Castelli D, Sullivan D, Reimers M, Waters J. Separation of hemodynamic signals from GCaMP fluorescence measured with wide-field imaging. J Neurophysiol 2020; 123:356-366. [DOI: 10.1152/jn.00304.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Wide-field calcium imaging is often used to measure brain dynamics in behaving mice. With a large field of view and a high sampling rate, wide-field imaging can monitor activity from several distant cortical areas simultaneously, revealing cortical interactions. Interpretation of wide-field images is complicated, however, by the absorption of light by hemoglobin, which can substantially affect the measured fluorescence. One approach to separating hemodynamics and calcium signals is to use multiwavelength backscatter recordings to measure light absorption by hemoglobin. Following this approach, we develop a spatially detailed regression-based method to estimate hemodynamics. This Spatial Model is based on a linear form of the Beer–Lambert relationship but is fit at every pixel in the image and does not rely on the estimation of physical parameters. In awake mice of three transgenic lines, the Spatial Model offers improved separation of hemodynamics and changes in GCaMP fluorescence. The improvement is pronounced near blood vessels and, in contrast with the Beer–Lambert equations, can remove vascular artifacts along the sagittal midline and in general permits more accurate fluorescence-based determination of neuronal activity across the cortex. NEW & NOTEWORTHY This paper addresses a well-known and strong source of contamination in wide-field calcium-imaging data: hemodynamics. To guide researchers toward the best method to separate calcium signals from hemodynamics, we compare the performance of several methods in three commonly used mouse lines and present a novel regression model that outperforms the other techniques we consider.
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Affiliation(s)
- M. T. Valley
- Allen Institute for Brain Science, Seattle, Washington
| | - M. G. Moore
- Neuroscience Program and Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan
| | - J. Zhuang
- Allen Institute for Brain Science, Seattle, Washington
| | - N. Mesa
- Allen Institute for Brain Science, Seattle, Washington
| | - D. Castelli
- Allen Institute for Brain Science, Seattle, Washington
| | - D. Sullivan
- Allen Institute for Brain Science, Seattle, Washington
| | - M. Reimers
- Neuroscience Program and Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan
| | - J. Waters
- Allen Institute for Brain Science, Seattle, Washington
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Influence of a neck compression collar on cerebrovascular and autonomic function in men and women. PLoS One 2019; 14:e0225868. [PMID: 31790493 PMCID: PMC6886761 DOI: 10.1371/journal.pone.0225868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neck compression collars have been proposed to reduce injury to the brain caused by head impacts. Our objective was to test if compression of the carotid artery affected the baroreflex and influenced blood pressure control. METHODS Cerebrovascular and autonomic responses of healthy young men and women (n = 8 each) to paced deep breathing, Valsalva, and 70o head-up tilt with or without use of a Q-collar were determined. Continuous measurements of heart rate, beat-to-beat blood pressure, transcranial Doppler, and end-tidal gases were obtained. Heart rate variability was measured during supine rest and head-up tilt. Carotid artery and jugular vein cross-sectional area were measured at end-inhalation and end-exhalation using cross-sectional ultrasound images at diastole. RESULTS Wearing the collar reduced carotid cross-sectional area (CSA; P = 0.022; η2 = 0.03) and increased jugular CSA (P = 0.001; η 2 = 0.30). In both men and women, wearing the collar increased systolic blood pressure during Valsalva (P<0.05; η 2 = 0.38). In only men, wearing the collar resulted in prolonged pressure recovery time during Valsalva (P = 0.02; η 2 = 0.05). In only women, wearing the collar increased baseline diastolic (P = 0.026; η 2 = 0.09) and mean (P = 0.041; η 2 = 0.06) middle cerebral artery (MCA) blood flow velocity, which attenuated the normal increase of diastolic (P = 0.01; η 2 = 0.03) and mean (P = 0.038; η 2 = 0.02) MCA blood flow velocity during Valsalva. There were no effects of sex or collar on the responses to deep breathing (P>0.05), and there were no effects of the collar on cerebrovascular function, hemodynamics, cardiovagal baroreceptor sensitivity, or heart rate variability (P>0.05) during upright tilt. CONCLUSION Use of the Q-collar compresses both the jugular vein and carotid artery influencing sympathetic nerve activity in both men and women while influencing brain blood flow in women.
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Collapsibility of the internal jugular veins in the lateral decubitus body position: A potential protective role of the cerebral venous outflow against neurodegeneration. Med Hypotheses 2019; 133:109397. [DOI: 10.1016/j.mehy.2019.109397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/16/2019] [Accepted: 09/10/2019] [Indexed: 01/26/2023]
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