1
|
Sayin ES, Sobczyk O, Poublanc J, Mikulis DJ, Fisher JA, Kuo KHM, Duffin J. Assessment of cerebrovascular function in patients with sickle cell disease using transfer function analysis. Physiol Rep 2022; 10:e15472. [PMID: 36200271 PMCID: PMC9535348 DOI: 10.14814/phy2.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
In patients with sickle cell disease (SCD), the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Successful compensation depends on an increase in oxygen supply such as that provided by an increase in cerebral blood flow (CBF). We used magnetic resonance imaging to provide a high-resolution assessment of the ability of SCD patients to respond to a vasoactive stimulus in middle, anterior, and posterior cerebral artery territories for both white and gray matter. Cerebrovascular reactivity (CVR) was measured as the blood oxygen level dependent signal (a surrogate for CBF) response to an increase in the end tidal partial pressure of CO2 (PET CO2 ). The dynamic aspect of the response was measured as the time constant of the first order response kinetics (tau). To confirm and support these findings we used an alternative examination of the response, transfer function analysis (TFA), to measure the responsiveness (gain), the speed of response (phase), and the consistency of the response over time (coherence). We tested 34 patients with SCD and compared the results to those of 24 healthy controls participants. The results from a three-way ANOVA showed that patients with SCD have reduced CVR (p < 0.001) and lower coherence (p < 0.001) in gray matter and white matter and reduced gain in gray matter only (p < 0.001). In terms of the speed of the response to CO2 , tau (p < 0.001) and TFA phase (p < 0.001) were increased in SCD patients compared to healthy control subjects. These findings show that the cerebrovascular responsiveness to CO2 in patients with SCD is both decreased and slowed compared to healthy controls.
Collapse
Affiliation(s)
- Ece Su Sayin
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
| | - Olivia Sobczyk
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
| | - Julien Poublanc
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
| | - David J. Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging LaboratoryUniversity Health NetworkTorontoCanada
- Institute of Medical SciencesUniversity of TorontoTorontoCanada
| | - Joseph A. Fisher
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - James Duffin
- Department of PhysiologyUniversity of TorontoTorontoCanada
- Departments of Anaesthesia and Pain ManagementUniversity Health NetworkTorontoCanada
| |
Collapse
|
2
|
Sasaoka K, Ohta H, Ishizuka T, Osuga T, Morishita K, Sasaki N, Takiguchi M. Local cerebral blood flow assessment using transcranial Doppler ultrasonography in a dog with brain infarction in the right middle cerebral artery territory. J Vet Med Sci 2022; 84:1385-1390. [PMID: 36031362 DOI: 10.1292/jvms.22-0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 12-year-old neutered male Chihuahua was diagnosed with acute brain infarction in the right middle cerebral artery (MCA) territory. Transcranial Doppler ultrasonography (TCD) was performed to assess the local cerebral blood flow at the time of diagnosis and after 4 and 31 hr. Initially, the right MCA retained blood flow but with a lower cerebral blood flow velocity (CBFV; 14.9 cm/sec) than the left MCA (27.9 cm/sec). The TCD vascular resistance variables were higher in the right than in the left MCA. An increase in the CBFV and a decrease in TCD vascular resistance variables were observed, consistent with improvements in neurological symptoms. TCD can be a non-invasive, and easy-to-use modality for bedside monitoring of cerebral edema and infarction.
Collapse
Affiliation(s)
- Kazuyoshi Sasaoka
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University
| | - Hiroshi Ohta
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University.,Present address: Companion Animal Internal Medicine, Department of Companion Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University
| | - Tomohito Ishizuka
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University
| | - Tatsuyuki Osuga
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University.,Present address: Laboratory of Veterinary Internal Medicine, Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University
| |
Collapse
|
3
|
Sasaoka K, Ohta H, Ishizuka T, Kojima K, Sasaki N, Takiguchi M. Transcranial Doppler ultrasonography detects the elevation of cerebral blood flow during ictal-phase of pentetrazol-induced seizures in dogs. Am J Vet Res 2022; 83:331-338. [DOI: 10.2460/ajvr.21.06.0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
OBJECTIVE
To investigate the association between changes in cerebral blood flow and electrographic epileptic seizure in dogs using transcranial Doppler ultrasonography (TCD).
ANIMALS
6 healthy Beagle dogs.
PROCEDURES
Each dog was administered pentetrazol (1.5 mg/kg/min) or saline (0.9% NaCl) solution under general anesthesia with continuous infusion of propofol. Both pentetrazol and saline solution were administered to all 6 dogs, with at least 28 days interval between the experiments. Blood flow waveforms in the middle cerebral artery and the basilar artery were obtained using TCD at baseline, after pentetrazol administration, and after diazepam administration. TCD velocities, including peak systolic velocity, end-diastolic velocity, and mean velocity and resistance variables, were determined from the Doppler waveforms.
RESULTS
During ictal-phase of pentetrazol-induced seizures, the TCD velocities significantly increased in the basilar and middle cerebral arteries while TCD vascular resistance variables did not change in either artery. The TCD velocities significantly decreased after diazepam administration. Systemic parameters, such as the heart rate, mean arterial pressure, systemic vascular resistance, cardiac index, end-tidal carbon dioxide, oxygen saturation, and body temperature, did not change significantly during seizures.
CLINICAL RELEVANCE
This study showed that cerebral blood flow, as obtained from TCD velocities, increased by 130% during ictal-phase of pentetrazol-induced seizures in dogs. The elevated velocities returned to baseline after seizure suppression. Thus, TCD may be used to detect electrographic seizures during the treatment of status epilepticus in dogs, and further clinical studies clarifying the association between changes in cerebral blood flow and non-convulsive seizure cases are needed.
Collapse
Affiliation(s)
- Kazuyoshi Sasaoka
- 1Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Hiroshi Ohta
- 2Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Tomohito Ishizuka
- 1Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Kazuki Kojima
- 2Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Noboru Sasaki
- 2Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| | - Mitsuyoshi Takiguchi
- 2Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido, Japan
| |
Collapse
|
4
|
Liu Y, Abbasi M, Arturo Larco JL, Kadirvel R, Kallmes DF, Brinjikji W, Savastano L. Preclinical testing platforms for mechanical thrombectomy in stroke: a review on phantoms, in-vivo animal, and cadaveric models. J Neurointerv Surg 2021; 13:816-822. [PMID: 33722966 PMCID: PMC8364863 DOI: 10.1136/neurintsurg-2020-017133] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/03/2022]
Abstract
Preclinical testing platforms have been instrumental in the research and development of thrombectomy devices. However, there is no single model which fully captures the complexity of cerebrovascular anatomy, physiology, and the dynamic artery-clot-device interaction. This article provides a critical review of phantoms, in-vivo animal, and human cadaveric models used for thrombectomy testing and provides insights into the strengths and limitations of each platform. Articles published in the past 10 years that reported thrombectomy testing platforms were identified. Characteristics of each test platform, such as intracranial anatomy, artery tortuosity, vessel friction, flow conditions, device-vessel interaction, and visualization, were captured and benchmarked against human cerebral vessels involved in large-vessel occlusion stroke. Thrombectomy phantoms have been constructed from silicone, direct 3D-printed polymers, and glass. These phantoms represent oversimplified patient-specific cerebrovascular geometry but enable adequate visualization of devices and clots under appropriate flow conditions. They do not realistically mimic the artery-clot interaction. For the animal models, arteries from swine, canines, and rabbits have been reported. These models can reasonably replicate the artery-clot-device interaction and have the unique value of evaluating the safety of thrombectomy devices. However, the vasculature geometries are substantially less complex and flow conditions are different from human cerebral arteries. Cadaveric models are the most accurate vascular representations but with limited access and challenges in reproducibility of testing conditions. Multiple test platforms should be likely used for comprehensive evaluation of thrombectomy devices. Interpretation of the testing results should take into consideration platform-specific limitations.
Collapse
Affiliation(s)
- Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | |
Collapse
|
5
|
Bittermann S, Precht C, Henke D, Forterre F, Karli P. Slit ventricle syndrome and subdural haemorrhage due to suspected overshunting in a dog with hydrocephalus internus. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2015-000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sophie Bittermann
- Division of Neurological SciencesDivision of Clinical NeurologyDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of BernBernSwitzerland
| | - Christina Precht
- Division of Clinical RadiologyDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of Bern, SwitzerlandBernSwitzerland
| | - Diana Henke
- Division of Neurological SciencesDivision of Clinical NeurologyDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of BernBernSwitzerland
| | - Franck Forterre
- Division of Small Animal SurgeryDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of Bern, SwitzerlandBernSwitzerland
| | - Philemon Karli
- Division of Neurological SciencesDivision of Clinical NeurologyDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of BernBernSwitzerland
| |
Collapse
|
6
|
Bittermann S, Lang J, Henke D, Howard J, Gorgas D. Magnetic resonance imaging signs of presumed elevated intracranial pressure in dogs. Vet J 2014; 201:101-8. [DOI: 10.1016/j.tvjl.2014.04.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 03/17/2014] [Accepted: 04/30/2014] [Indexed: 11/30/2022]
|
7
|
YANG XY, ZHOU SJ, YU YF, SHEN YF, XU HZ. Cerebral hyperaemia after isoflurane anaesthesia for craniotomy of patients with supratentorial brain tumour. Acta Anaesthesiol Scand 2013; 57:1301-7. [PMID: 24032397 DOI: 10.1111/aas.12176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies look into cerebral blood flow (CBF) changes during emergence from general anaesthesia for craniotomy. The purpose of this study was to assess CBF changes during emergence from general anaesthesia for craniotomy, through monitoring blood oxygen saturation of jugular vein bulb (SjvO2 ) and transcranial Doppler (TCD). METHODS We enrolled 30 patients undergoing selective craniotomy (group C) for supratentorial brain tumour resection and 30 patients undergoing selective abdominal surgery (group A). Mean velocity of middle cerebral artery (Vmca), mean arterial pressure (MAP), SjvO2 (only measured in group C), and arterial CO2 partial pressure were measured before anaesthesia, at tracheal extubation, and 30, 60, 90, 120 min after extubation. RESULTS Vmca of the same side of tumour was significantly higher than contralateral Vmca before anaesthesia and at all times after extubation in group C. The ipsilateral Vmca increased significantly (95.7 ± 16.9 cm/s vs. 63.7 ± 6.7 cm/s, P < 0.01) at extubation in group C, then declined but still above baseline significantly in the first 2 h after extubation. While Vmca of the right side changed only slightly (63.6 ± 7.7 cm/s vs. 61.8 ± 8.1 cm/s, P < 0.01) but significantly at extubation in group A. SjvO2 increased significantly (81.4% ± 7.4% vs. 60.9% ± 3.7%, P < 0.01) at extubation in group C, and remained above baseline significantly for 2 h. There was no significant correlation between Vmca and MAP at any time. CONCLUSIONS Cerebral hyperaemia occurs after supratentorial brain tumour resection surgery. The hyperaemia is more pronounced on the same side as the tumour.
Collapse
Affiliation(s)
- X-Y. YANG
- Department of Anaesthesiology; Huashan Hospital; Fudan University; Shanghai China
| | - S-J. ZHOU
- Department of Anaesthesiology; Huashan Hospital; Fudan University; Shanghai China
| | - Y-F. YU
- Department of Anaesthesiology; Huashan Hospital; Fudan University; Shanghai China
| | - Y-F. SHEN
- Department of Anaesthesiology; Huashan Hospital; Fudan University; Shanghai China
| | - H-Z. XU
- Department of Neurosurgery; Huashan Hospital; Fudan University; Shanghai China
| |
Collapse
|
8
|
Duque F, Dominguez-Roldan J, Martinez-Taboada F, Macías-García B, Rodríguez-Medina P, Barrera-Chacon R. Effects of medetomidine and medetomidine-butorphanol on transcranial color-coded duplex ultrasonography in healthy dogs. Res Vet Sci 2013; 95:648-53. [DOI: 10.1016/j.rvsc.2013.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 02/18/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
|
9
|
Carvalho C, Andrade Neto J, Diniz S. Small breed dogs with confirmed stroke: concurrent diseases and sonographic findings. ARQ BRAS MED VET ZOO 2012. [DOI: 10.1590/s0102-09352012000500014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebrovascular accidents (CVA) are important causes of neurological clinical signs in dogs. The objective of this work was to describe concurrent diseases and ultrasonographic features in dogs with CVA confirmed through postmortem evaluation. All medical records of transcranial Doppler ultrasonography (TCDUS) examinations performed in 512 dogs between 2007 and 2009 were reviewed, searching for history and clinical diagnosis, as well as sonographic and histological results. Forty-two dogs were selected, showing acute onset of clinical signs with no progressive focal cerebral dysfunction and diagnosis of cerebrovascular disease confirmed at necropsy. Concurrent diseases and conditions were: cerebral amyloid microangiopathy (33%), endocrinopathies (31%), coagulopathy (24%), Schnauzer hyperlipemia (7%) and unknown (5%). The relation between sonography and histology results indicated 100% sensitivity and 90% specificity for focal lesion detection. A diffuse decrease in echogenicity was related to inflammatory diseases and/or edema with 62% sensitivity. A diffuse increase in echogenicity has 100% sensitivity and was usually related to aging changes. This study showed the occurrence of coexisting diseases with CVA and sonographic features of these conditions in small breed dogs.
Collapse
Affiliation(s)
- C.F. Carvalho
- UNICSUL; Provet - Diagnóstico e Especialidades Veterinárias
| | | | | |
Collapse
|
10
|
LEN TREVORK, NEARY JPATRICK, ASMUNDSON GORDONJG, GOODMAN DAVIDG, BJORNSON BRUCE, BHAMBHANI YAGESHN. Cerebrovascular Reactivity Impairment after Sport-Induced Concussion. Med Sci Sports Exerc 2011; 43:2241-8. [DOI: 10.1249/mss.0b013e3182249539] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
DUQUE JAVIER, DOMINGUEZ-ROLDAN JOSEM, CASAMIAN-SORROSAL DOMINGO, BARRERA-CHACON RAFAEL. IMAGING DIAGNOSIS-TRANSCRANIAL COLOR-CODED DUPLEX SONOGRAPHY IN A DOG WITH HEPATIC ENCEPHALOPATHY. Vet Radiol Ultrasound 2010. [DOI: 10.1111/j.1740-8261.2010.01750.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
12
|
Duque FJ, Barrera-Chacon R, Ruiz P, Casamian-Sorrosal D, Zaragoza C, Dominguez-Roldan JM. Effect of transient carotid artery compression during transcranial Doppler ultrasonography in dogs. Vet Rec 2010; 167:481-4. [DOI: 10.1136/vr.c4141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F. J. Duque
- Department of Animal Medicine; Faculty of Veterinary Sciences; University of Extremadura; Avenida Universidad s/n 10071 Caceres Spain
| | - R. Barrera-Chacon
- Department of Animal Medicine; Faculty of Veterinary Sciences; University of Extremadura; Avenida Universidad s/n 10071 Caceres Spain
| | - P. Ruiz
- Department of Animal Medicine; Faculty of Veterinary Sciences; University of Extremadura; Avenida Universidad s/n 10071 Caceres Spain
| | - D. Casamian-Sorrosal
- Small Animal Hospital and Langford Veterinary Diagnostics; Department of Clinical Veterinary Science; University of Bristol, Langford House; Langford Somerset BS40 5DU
| | - C. Zaragoza
- Department of Animal Medicine; Faculty of Veterinary Sciences; University of Extremadura; Avenida Universidad s/n 10071 Caceres Spain
| | - J. M. Dominguez-Roldan
- Department of Critical Care; Clinical Hospital Virgen del Rocio; University of Sevilla, Avenida Manuel Siurot; 41013 Sevilla Spain
| |
Collapse
|
13
|
Álvarez-Fernández JA, Martín-Velasco MM, Igeño-Cano JC, Pérez-Quintero R. [Transcranial Doppler ultrasonography usefulness in cardiac arrest resuscitation]. Med Intensiva 2010; 34:550-8. [PMID: 20211509 DOI: 10.1016/j.medin.2009.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 10/19/2009] [Accepted: 12/17/2009] [Indexed: 11/25/2022]
Abstract
An effective tissue perfusion has decisive influence on the final prognosis both during cardiopulmonary resuscitation (CPR) and after recovery of spontaneous circulation (ROSC). The transcranial Doppler ultranosography (TCD) examines the velocity and pulsatility of cerebral blood flow, making it possible to perform "beat to beat" hemodynamic analysis. During CPR, TCD peak systolic velocity reflects cerebral perfusion of the chest compressions. Beyond 2 hours after ROSC, persistence in the cerebral arteries of a hemodynamic TCD pattern (low velocities with high pulsatilities) predicts poor neurological prognosis. Early or delayed presence of a hyperemic TCD pattern (high velocities with low pulsatilities) is associated conclusively with evolution to intracranial hypertension and its appearance during the rewarming process should lead to immediate return to therapeutic hypothermia. The coincidence of hypodynamic cerebral arteries and others with normal or hyperemic TCD patterns may indicate the presence of focal hypoperfusion that could predict stroke after ROSC.
Collapse
Affiliation(s)
- J A Álvarez-Fernández
- Unidad de Neurosonología y Hemodinámica Cerebral, Hospital Hospiten-Rambla, Santa Cruz de Tenerife, Islas Canarias, España.
| | | | | | | |
Collapse
|
14
|
Carvalho C, Chammas M, Andrade Neto J, Jimenez C, Diniz S, Cerri G. Transcranial duplex doppler ultrasonography in dogs with hydrocephalus. ARQ BRAS MED VET ZOO 2010. [DOI: 10.1590/s0102-09352010000100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transcranial duplex Doppler ultrasound was performed in 32 conscious dogs presenting ventriculomegaly detected in B-mode, obtaining measures of lateral ventricles and resistance parameters of main cerebral arteries before and after 30 days of clinical treatment. The animals were distributed divided in two groups: group 1, dogs that presented remission or decrease of the neurological signs of the disease after clinical therapy; and group 2, dogs that displayed worsening of the neurological signs or clinical stability. The data were all presented in tables and were submitted to paired t test and to logistic regression models to evaluate the influence of the RI reduction on both groups. There was no significant influence of the variables in the B-mode. After the treatment, the mean resistive index (RI) was significantly lower for the group that presented clinical improvement. There was no significant difference of the mean RI reduction for the same artery when the right and left sides were compared. It could be concluded that transcranial duplex Doppler ultrasound is a method of cerebral hemodynamic assessment able to monitor more precisely the treatment of hydrocephalus in dogs and verify the responses.
Collapse
|
15
|
Duque FJ, Dominguez-Roldan JM, Ruiz P, Zaragoza C, Barrera-Chacon R. Assessing Circle of Willis blood circulation in dogs with transcranial color-coded duplex sonography. Vet Radiol Ultrasound 2009; 50:530-5. [PMID: 19788040 DOI: 10.1111/j.1740-8261.2009.01577.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Insonation of Circle of Willis by transcranial Doppler duplex color sonography is described in 30 healthy dogs with 15 weighing < 33 lb and 15 weighing >33 lb. Imaging was via a temporal window to explore the rostral, middle, and caudal cerebral arteries on both the left and right-hand sides; and through an suboccipital window to study the basilar artery. Normal mean values of the peak systolic velocity (PSV), end diastolic velocity, mean velocity, resistance index (RI), and pulsatility index (PI) were characterized and compared with those obtained in previous studies. There was significant differences in the PSV, RI, and PI in the rostral cerebral artery between dogs weighing < 33 vs. > 33 lb. Mean PSV was higher in weighing over 33 lb, whereas the mean resistive index and mean PI were lower in these dogs.
Collapse
Affiliation(s)
- Francisco J Duque
- Department of Animal Medicine, Faculty of Veterinary Sciences, University of Extremadura, Avda. Universidad s/n, 10071 Caceres, Spain
| | | | | | | | | |
Collapse
|
16
|
King AM. Development, advances and applications of diagnostic ultrasound in animals. Vet J 2006; 171:408-20. [PMID: 15961332 DOI: 10.1016/j.tvjl.2004.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2004] [Indexed: 10/25/2022]
Abstract
Ultrasound has many industrial applications but it was first introduced as a medical diagnostic aid in the 1940s with its first veterinary application, the detection of ovine pregnancy, being reported in 1966. Since then, improvements in equipment quality combined with an increased awareness of the benefits of ultrasound as an imaging technique have led to its widespread use in the veterinary field. Recent advances in computer technology have significantly influenced equipment design and the miniaturization of transducers allows intra-operative and intra-vascular applications. Software advances have improved the ability to manipulate and process data, leading to an increased amount of information being obtained from each examination and the advent of 'remote diagnosis'. Ultrasound guided interventional techniques can now be used for diagnostic or therapeutic purposes. Many of these developments have been introduced by equipment manufacturers but have found specific applications in the veterinary field. Ultrasound is currently employed in a very diverse range of situations, not just as a diagnostic tool in the routine clinical workup of a range of species, but also for disease screening, conservation projects, commercial services, herd management and clinical research.
Collapse
Affiliation(s)
- A M King
- Institute of Comparative Medicine, University of Glasgow Veterinary School, Bearsden Road, Glasgow, G61 1QH, UK.
| |
Collapse
|
17
|
Steiner LA, Johnston AJ, Czosnyka M, Chatfield DA, Salvador R, Coles JP, Gupta AK, Pickard JD, Menon DK. Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients. Crit Care Med 2004; 32:1049-54. [PMID: 15071400 DOI: 10.1097/01.ccm.0000120054.32845.a6] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To directly compare the cerebrovascular effects of norepinephrine and dopamine in patients with acute traumatic brain injury. DESIGN Prospective randomized crossover trial. SETTING Neurosciences critical care unit of a university hospital. PATIENTS Ten acutely head-injured patients requiring vasoactive drugs to maintain a cerebral perfusion pressure of 65 mm Hg. INTERVENTIONS Patients were randomized to start the protocol with either norepinephrine or dopamine. Using an infusion of the allocated drug, cerebral perfusion pressure was adjusted to 65 mm Hg. After 20 mins of data collection, cerebral perfusion pressure was increased to 75 mm Hg by increasing the infusion rate of the vasoactive agent. After 20 mins of data collection, cerebral perfusion pressure was increased to 85 mm Hg and again data were collected for 20 mins. Subsequently, the infusion rate of the vasoactive drug was reduced until a cerebral perfusion pressure of 65 mm Hg was reached and the drug was exchanged against the other agent. The protocol was then repeated. MEASUREMENTS AND MAIN RESULTS Mean arterial pressure and intracranial pressure were monitored and cerebral blood flow was estimated with transcranial Doppler. Norepinephrine led to predictable and significant increases in flow velocity for each step increase in cerebral perfusion pressure (57.5+/-19.9 cm x sec, 61.3+/-22.3 cm x sec, and 68.4+/-24.8 cm x sec at 65, 75, and 85 mm Hg, respectively; p <.05 for all three comparisons), but changes with dopamine were variable and inconsistent. There were no differences between absolute values of flow velocity or intracranial pressure between the two drugs at any cerebral perfusion pressure level. CONCLUSIONS Norepinephrine may be more predictable and efficient to augment cerebral perfusion in patients with traumatic brain injury.
Collapse
|
18
|
Lee K, Choi M, Yoon J, Jung J. Spectral waveform analysis of major arteries in conscious dogs by Doppler ultrasonography. Vet Radiol Ultrasound 2004; 45:166-71. [PMID: 15072150 DOI: 10.1111/j.1740-8261.2004.04027.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Normal values of arterial blood flow velocity and waveforms in major arteries of 10 healthy conscious Beagle dogs were determined using Doppler ultrasonography. Peak systolic, early diastolic, and end-diastolic velocities of the basilar artery, common carotid artery, abdominal aorta, external iliac artery, femoral artery, and peak ejection velocity of the valvular aorta were evaluated. Pulsatility index (PI) of the basilar artery and blood pressure were recorded. All arteries had a high-resistance flow pattern with triphasic flow velocity except the basilar artery, which had a low-resistance pattern. Mean peak systolic velocities of the basilar artery, common carotid artery, abdominal aorta, external iliac artery, and femoral artery were 72 +/- 19, 115 +/- 17, 121 +/- 24, 105 +/- 25, and 110 +/- 17 cm/s, respectively. The PI of the basilar artery and peak ejection velocity of the valvular aorta were 1.37 +/- 0.13 and 96 +/- 16 cm/s, respectively. Mean systolic and diastolic blood pressures were 137 +/- 13 and 78 +/- 15 mmHg, respectively. Present findings may be used as references in future studies on vascular diseases and hemodynamics in dogs.
Collapse
Affiliation(s)
- Kichang Lee
- Veterinary Radiology Department, College of Veterinary Medicine, Seoul National University, Korea
| | | | | | | |
Collapse
|
19
|
Belfort MA, Tooke-Miller C, Allen JC, Dizon-Townson D, Varner MA. Labetalol decreases cerebral perfusion pressure without negatively affecting cerebral blood flow in hypertensive gravidas. Hypertens Pregnancy 2003; 21:185-97. [PMID: 12517326 DOI: 10.1081/prg-120015845] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To research the cerebral hemodynamic effects of labetalol in pregnant women with hypertension. DESIGN Prospective observational study. SETTING Tertiary Care Medical Center. POPULATION Pregnant patients with hypertension. METHODS Transcranial Doppler (TCD) ultrasound was used to measure the blood velocity in the middle cerebral arteries (MCA) of eight pregnant patients with hypertension, before and after the administration of a 200 mg oral dose of labetalol. Five patients had severe preeclampsia, and three had chronic hypertension with superimposed preeclampsia. MCA blood velocity and systemic blood pressure were measured simultaneously at the baseline, and at 60 and 180 min after labetalol. Selected cerebral hemodynamic parameters were compared with normative curves. Values outside of the 5th and 95th percentiles were regarded as abnormal. MAIN OUTCOME MEASURES Cerebral perfusion pressure (CPP), resistance area product (RAP), and cerebral flow index (CFI). RESULTS Patient age, gestational age, and parity were similar to those of the normal women from whom the normative data were obtained. Women with hypertension had higher baseline CPP, MAP, and RAP than normal pregnant women, but their CFI was within the normal range. Labetalol reduced the CPP, as well as the systolic, diastolic, and mean BP significantly at 60 and 180 min without significantly affecting the heart rate, MCA velocities, RAP, or CFI. CONCLUSIONS Labetalol effectively reduces CPP, without affecting cerebral perfusion, primarily by a decrease in systemic blood pressure. This makes it an ideal agent for blood pressure control in severely hypertensive pregnant women.
Collapse
Affiliation(s)
- Michael A Belfort
- Division of Maternal-Fetal Medicine, Department of Obstetrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | | | | | | | | |
Collapse
|
20
|
Terborg C, Bramer S, Weiller C, Röther J. Short-term effect of cigarette smoking on CO(2)-induced vasomotor reactivity in man: a study with near-infrared spectroscopy and tanscranial Doppler sonography. J Neurol Sci 2002; 205:15-20. [PMID: 12409178 DOI: 10.1016/s0022-510x(02)00308-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cigarette smoking is a major risk factor for stroke, and quitting reduces the stroke risk within a few years. The aim of our study was to clarify whether CO(2)-induced vasomotor reactivity (VMR) is impaired in smokers after smoking a cigarette as a possible factor of an increased stroke risk. We compared VMR of 23 healthy smokers assessed at baseline, immediately, and 30 min after smoking a cigarette (1.2 mg nicotine) with values from nonsmoking, age-matched controls (n=24), obtained at identical time intervals. Cerebral blood flow velocities (CBFV) of both middle cerebral arteries (transcranial Doppler sonography), changes in concentration of cerebral oxygenated, deoxygenated, and total hemoglobin (HbO(2), Hb, and HbT, near-infrared spectroscopy), mean arterial blood pressure (MAP), and skin blood flow were recorded during normo- and hypercapnia. VMR was calculated as percentage change in CBFV and as micromolar change in concentration of HbO(2), Hb, and HbT per 1% increase in endtidal CO(2). CBFV in smokers was increased at baseline (left, p<0.05; right, p=0.05), immediately (p<0.01), and 30 min after smoking (p<0.05) as compared with nonsmokers. MAP rose immediately after smoking (p<0.01) and declined after 30 min. VMR in smokers at baseline did not differ from controls, decreased immediately after smoking (p<0.05), and normalized after 30 min (p>0.05). Increased baseline CBFV in smokers after smoking might be due to arteriolar dilation, increased MAP, and possibly constriction of basal cerebral arteries. Impaired VMR for about 30 min after smoking reflects endothelial dysfunction. This might contribute to the enhanced stroke risk in smokers.
Collapse
Affiliation(s)
- Christoph Terborg
- Department of Neurology, Friedrich-Schiller University of Jena, Philosophenweg 3, 07740 Jena, Germany.
| | | | | | | |
Collapse
|
21
|
Murillo-Cabezas F, Arteta-Arteta D, Flores-Cordero JM, Muñoz-Sánchez MA, Rincón-Ferrari MD, Rivera-Fernández MV, Alarcón-Cruz JC. [The usefulness of transcranial Doppler ultrasonography in the early phase of head injury]. Neurocirugia (Astur) 2002; 13:196-208. [PMID: 12148164 DOI: 10.1016/s1130-1473(02)70617-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES 1) To know the transcranial Doppler (TCD) patterns in the early phase of the severe and moderate head injury and its prognostic implications. 2) To ascertain the TCD measurements concordance among different operators. MATERIAL AND METHODS A prospective observational study in 275 consecutive intensive care unit patients with severe or moderate head injury was designed. Within 12 hrs. of the traumatic event a TCD study was done and a second one within the first 24 hrs. All patients were managed following a protocol made with the aim of promoting the early evacuation of the intracranial space occupying mass, preventing delayed brain damage and keeping the intracranial pressure (ICP) < 20 mm Hg and the cerebral perfusion pressure (CPP) > 60 mm Hg. The patient outcome was categorized with the Glasgow Outcome Score (GOS) at the discharge of the ICU. The mean velocity (MV) and the pulsatily index (PI) were measured in both middle cerebral arteries (MCA) and in the intracranial part of the internal carotid arteries in order to calculate the Lindegaard index. The presence of hypoperfusion, hyperaemia, vasospasm and cerebral circulatory arrest was registered. The presence of high intracranial pressure (HICP), the ICP peak and mode, the lowest CPP, the CPP mode, the minor medium arterial pressure (MAP) and the MAP mode were also recorded. A concordance analysis was made to ascertain the validity of the TCD data obtained by different operators. RESULTS The concordance analysis among observers showed a kappa index of 0.7863 (p < 0.0001). The median stay in ICU was 7 days (Q1-Q3 of 3-15 days). The intra-ICU mortality was 20.72% (57/275) and the 53.44% of patients (147/275) showed favourable outcome (GOS 4-5) at the discharge of the ICU. The initial TCD showed a MV decreased and a PI increased in the MCA. Eighty of the e 275 patients showed a normal haemodynamic pattern whereas the pattern was abnormal in the remaining 195, degrees the hypoperfusion pattern predominated overall (181/275, 61.87%). HIPO was registered in 123 patients (58.01) an not in 89 (41.99%). A statistic significant correlation was found between the HICP and the DTC data. The early hypoperfusion pattern was related with a higher incidence of HICP (p > 0.05). The decrease in the MV and the increase in the PI were significantly associated with a higher mortality and a worse functional outcome (except for the MV within the first day). The PI was high within the first 24 h in the group of patients who died but was normalised among the survivals group. CONCLUSIONS Early TCD detects a cerebral hypoperfusion status in the severe and moderate head injury that may imply therapeutic considerations. This hypoperfusion strongly correlates with the severity of the injury, the incidence of HICP and the functional outcome at the ICU discharge. In experienced hands, TCD measurements are reliable when done by different operators.
Collapse
Affiliation(s)
- F Murillo-Cabezas
- Unidad de Neurotraumatología, Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | | | | | | | | |
Collapse
|