1
|
Alshehri A, Ince J, Panerai RB, Divall P, Robinson TG, Minhas JS. Physiological Variability during Prehospital Stroke Care: Which Monitoring and Interventions Are Used? Healthcare (Basel) 2024; 12:835. [PMID: 38667597 PMCID: PMC11050416 DOI: 10.3390/healthcare12080835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/24/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Prehospital care is a fundamental component of stroke care that predominantly focuses on shortening the time between diagnosis and reaching definitive stroke management. With growing evidence of the physiological parameters affecting long-term patient outcomes, prehospital clinicians need to consider the balance between rapid transfer and increased physiological-parameter monitoring and intervention. This systematic review explores the existing literature on prehospital physiological monitoring and intervention to modify these parameters in stroke patients. The systematic review was registered on PROSPERO (CRD42022308991) and conducted across four databases with citation cascading. Based on the identified inclusion and exclusion criteria, 19 studies were retained for this review. The studies were classified into two themes: physiological-monitoring intervention and pharmacological-therapy intervention. A total of 14 included studies explored prehospital physiological monitoring. Elevated blood pressure was associated with increased hematoma volume in intracerebral hemorrhage and, in some reports, with increased rates of early neurological deterioration and prehospital neurological deterioration. A reduction in prehospital heart rate variability was associated with unfavorable clinical outcomes. Further, five of the included records investigated the delivery of pharmacological therapy in the prehospital environment for patients presenting with acute stroke. BP-lowering interventions were successfully demonstrated through three trials; however, evidence of their benefit to clinical outcomes is limited. Two studies investigating the use of oxygen and magnesium sulfate as neuroprotective agents did not demonstrate an improvement in patient's outcomes. This systematic review highlights the absence of continuous physiological parameter monitoring, investigates fundamental physiological parameters, and provides recommendations for future work, with the aim of improving stroke patient outcomes.
Collapse
Affiliation(s)
- Abdulaziz Alshehri
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- College of Applied Medical Sciences, University of Najran, Najran P.O. Box 1988, Saudi Arabia
| | - Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
| | - Ronney B. Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Pip Divall
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Thompson G. Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Jatinder S. Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.A.); (R.B.P.); (T.G.R.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
| |
Collapse
|
2
|
Ince J, Minhas JS, Panerai RB. Point/counterpoint: Cerebrovascular resistance is a flawed concept. J Cereb Blood Flow Metab 2023; 43:1216-1218. [PMID: 37113067 PMCID: PMC10291456 DOI: 10.1177/0271678x231172854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
The relationship between cerebral blood flow and blood pressure is a critical part of investigation of cerebral autoregulation. Conventionally, cerebrovascular resistance (CVR) has been used to describe this relationship, but the underlying principles used for this method is flawed in real-world application for several reasons. Despite this, the use of CVR remains entrenched within current literature. This 'Point/Counterpoint' review provides a summary of the flaws in using CVR and explains the benefits of calculating the more accurate critical closing pressure (CrCP) and resistance-area product (RAP) parameters, with support of real-world data.
Collapse
Affiliation(s)
- Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
3
|
Nicholls JK, Turner P, Lecchini-Visintini A, Ince J, de Vries G, Cappellugola L, Oura M, Ebirim KU, Pallett E, Ramnarine KV, Chung EML. Effects of Blood Pressure on Brain Tissue Pulsation Amplitude in a Phantom Model. Ultrasound Med Biol 2023:S0301-5629(23)00200-4. [PMID: 37400302 DOI: 10.1016/j.ultrasmedbio.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The precise mechanism and determinants of brain tissue pulsations (BTPs) are poorly understood, and the impact of blood pressure (BP) on BTPs is relatively unexplored. This study aimed to explore the relationship between BP parameters (mean arterial pressure [MAP] and pulse pressure [PP]) and BTP amplitude, using a transcranial tissue Doppler prototype. METHODS A phantom brain model generating arterial-induced BTPs was developed to observe BP changes in the absence of confounding variables and cerebral autoregulation feedback processes. A regression model was developed to investigate the relationship between bulk BTP amplitude and BP. The separate effects of PP and MAP were evaluated and quantified. RESULTS The regression model (R2 = 0.978) revealed that bulk BTP amplitude measured from 27 gates significantly increased with PP but not with MAP. Every 1 mm Hg increase in PP resulted in a bulk BTP amplitude increase of 0.29 µm. CONCLUSION Increments in BP were significantly associated with increments in bulk BTP amplitude. Further work should aim to confirm the relationship between BP and BTPs in the presence of cerebral autoregulation and explore further physiological factors having an impact on BTP measurements, such as cerebral blood flow volume, tissue distensibility and intracranial pressure.
Collapse
Affiliation(s)
- Jennifer K Nicholls
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Poppy Turner
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; School of Engineering, University of Leicester, Leicester, UK
| | - Andrea Lecchini-Visintini
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Georgina de Vries
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laurie Cappellugola
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Mitsuhiro Oura
- Nihon Kohden Corporation, Tokorozawa-shi, Saitama, Japan
| | | | - Edward Pallett
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kumar V Ramnarine
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK; Medical Physics Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emma M L Chung
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK.
| |
Collapse
|
4
|
Almudayni A, Alharbi M, Chowdhury A, Ince J, Alablani F, Minhas JS, Lecchini-Visintini A, Chung EML. Magnetic resonance imaging of the pulsing brain: a systematic review. MAGMA 2023; 36:3-14. [PMID: 36242710 PMCID: PMC9992013 DOI: 10.1007/s10334-022-01043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To perform a systematic review of the literature exploring magnetic resonance imaging (MRI) methods for measuring natural brain tissue pulsations (BTPs) in humans. METHODS A prospective systematic search of MEDLINE, SCOPUS and OpenGrey databases was conducted by two independent reviewers using a pre-determined strategy. The search focused on identifying reported measurements of naturally occurring BTP motion in humans. Studies involving non-human participants, MRI in combination with other modalities, MRI during invasive procedures and MRI studies involving externally applied tests were excluded. Data from the retrieved records were combined to create Forest plots comparing brain tissue displacement between Chiari-malformation type 1 (CM-I) patients and healthy controls using an independent samples t-test. RESULTS The search retrieved 22 eligible articles. Articles described 5 main MRI techniques for visualisation or quantification of intrinsic brain motion. MRI techniques generally agreed that the amplitude of BTPs varies regionally from 0.04 mm to ~ 0.80 mm, with larger tissue displacements occurring closer to the centre and base of the brain compared to peripheral regions. Studies of brain pathology using MRI BTP measurements are currently limited to tumour characterisation, idiopathic intracranial hypertension (IIH), and CM-I. A pooled analysis confirmed that displacement of tissue in the cerebellar tonsillar region of CM-I patients was + 0.31 mm [95% CI 0.23, 0.38, p < 0.0001] higher than in healthy controls. DISCUSSION MRI techniques used for measurements of brain motion are at an early stage of development with high heterogeneity across the methods used. Further work is required to provide normative data to support systematic BTPs characterisation in health and disease.
Collapse
Affiliation(s)
- Alanoud Almudayni
- College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia. .,Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Room 419, Robert Kilpatrick Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.
| | - Meshal Alharbi
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Room 419, Robert Kilpatrick Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.,College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alimul Chowdhury
- University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Room 419, Robert Kilpatrick Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Fatmah Alablani
- College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Room 419, Robert Kilpatrick Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Jatinder Singh Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Room 419, Robert Kilpatrick Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.,National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, LE5 4PW, UK
| | - Andrea Lecchini-Visintini
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Room 419, Robert Kilpatrick Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.,School of Electronics and Computer Science, University of Southampton, Southampton, SO17 1BJ, UK
| | - Emma Ming Lin Chung
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Room 419, Robert Kilpatrick Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK. .,University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK. .,National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, LE5 4PW, UK. .,School of Life Course and Population Sciences, King's College London, Room 3.25a, Shepherd's House, Guy's Campus, King's College London, London, SE1 7EH, UK.
| |
Collapse
|
5
|
Nicholls JK, Ince J, Minhas JS, Chung EML. Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review. Front Neurol 2022; 12:780324. [PMID: 35095726 PMCID: PMC8796731 DOI: 10.3389/fneur.2021.780324] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Large vessel occlusion (LVO) is the obstruction of large, proximal cerebral arteries and can account for up to 46% of acute ischaemic stroke (AIS) when both the A2 and P2 segments are included (from the anterior and posterior cerebral arteries). It is of paramount importance that LVO is promptly recognised to provide timely and effective acute stroke management. This review aims to scope recent literature to identify new emerging detection techniques for LVO. As a good comparator throughout this review, the commonly used National Institutes of Health Stroke Scale (NIHSS), at a cut-off of ≥11, has been reported to have a sensitivity of 86% and a specificity of 60% for LVO. Methods: Four electronic databases (Medline via OVID, CINAHL, Scopus, and Web of Science), and grey literature using OpenGrey, were systematically searched for published literature investigating developments in detection methods for LVO, reported from 2015 to 2021. The protocol for the search was published with the Open Science Framework (10.17605/OSF.IO/A98KN). Two independent researchers screened the titles, abstracts, and full texts of the articles, assessing their eligibility for inclusion. Results: The search identified 5,082 articles, in which 2,265 articles were screened to assess their eligibility. Sixty-two studies remained following full-text screening. LVO detection techniques were categorised into 5 groups: stroke scales (n = 30), imaging and physiological methods (n = 15), algorithmic and machine learning approaches (n = 9), physical symptoms (n = 5), and biomarkers (n = 3). Conclusions: This scoping review has explored literature on novel and advancements in pre-existing detection methods for LVO. The results of this review highlight LVO detection techniques, such as stroke scales and biomarkers, with good sensitivity and specificity performance, whilst also showing advancements to support existing LVO confirmatory methods, such as neuroimaging.
Collapse
Affiliation(s)
- Jennifer K. Nicholls
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Medical Physics, University Hospitals of Leicester, NHS Trust, Leicester, United Kingdom
| | - Jonathan Ince
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jatinder S. Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Emma M. L. Chung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Medical Physics, University Hospitals of Leicester, NHS Trust, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
- School of Life Course Sciences, King's College London, London, United Kingdom
| |
Collapse
|
6
|
Ince J, Lecchini-Visintini A, Almudayni A, Horsfield MA, Wormleighton J, Banahan C, Chung EML, Minhas JS. Brain tissue motion in acute hemorrhagic stroke using amplified MRI (aMRI). Magn Reson Imaging 2021; 86:17-19. [PMID: 34774985 DOI: 10.1016/j.mri.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
Brain tissue pulsates with each cardiac cycle, however the effect of disease on this natural motion is still unclear. Current literature mainly focuses on healthy brain tissue, with only limited studies looking at disease states such as Chiari malformation and acute ischemic stroke. This case report advances on recent literature by describing the case of a patient with an acute intracerebral hemorrhage and demonstrating an amplified MRI cine of the brain's motion. A clearer understanding of the effects of disease on brain motion may guide clinical application of pulsation measurement.
Collapse
Affiliation(s)
- Jonathan Ince
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Andrea Lecchini-Visintini
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; School of Engineering, University of Leicester, Leicester, UK
| | - Alanoud Almudayni
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | - Caroline Banahan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Emma M L Chung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; School of Life Course Sciences, King's College London, London, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
7
|
Clough RH, Ince J, Minhas JS. Evolving the Proposed HEMS Stroke Triaging Tool. J Emerg Med 2021; 60:812-813. [PMID: 34147229 DOI: 10.1016/j.jemermed.2020.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Rebecca H Clough
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
8
|
Ince J, Mankoo AS, Kadicheeni M, Swienton D, Panerai RB, Robinson TG, Minhas JS. Cerebrovascular tone and resistance measures differ between healthy control and patients with acute intracerebral haemorrhage: exploratory analyses from the BREATHE-ICH study. Physiol Meas 2021; 42. [PMID: 33853052 DOI: 10.1088/1361-6579/abf7da] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/14/2021] [Indexed: 11/12/2022]
Abstract
Objective.Cerebral autoregulation impairment in acute neurovascular disease is well described. The recent BREATHE-ICH study demonstrated improvements in dynamic cerebral autoregulation, by hypocapnia generated by hyperventilation, in the acute period following intracranial haemorrhage (ICH). This exploratory analysis of the BREATHE-ICH dataset aims to examine the differences in hypocapnic responses between healthy controls and patients with ICH, and determine whether haemodynamic indices differ between baseline and hypocapnic states.Approach.Acute ICH patients were recruited within 48 h of onset and healthy volunteers were recruited from a university setting. Transcranial Doppler measurements of the middle cerebral artery were obtained at baseline and then a hyperventilation intervention was used to induce hypocapnia. Patients with ICH were then followed up at 10-14 D post-event for repeated measurements.Main results.Data from 43 healthy controls and 12 patients with acute ICH met the criteria for statistical analysis. In both normocapnic and hypocapnic conditions, significantly higher critical closing pressure and resistance area product were observed in patients with ICH. Furthermore, critical closing pressure changes were observed to be sustained at 10-14 D follow up. During both the normocapnic and hypocapnic states, reduced autoregulation index was observed bilaterally in patients with ICH, compared to healthy controls.Significance.Whilst this exploratory analysis was limited by a small, non-age matched sample, significant differences between ICH patients and healthy controls were observed in factors associated with cerebrovascular tone and resistance. These differences suggest underlying cerebral autoregulation changes in ICH, which may play a pivotal role in the morbidity and mortality associated with ICH.
Collapse
Affiliation(s)
- Jonathan Ince
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Alex S Mankoo
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Meeriam Kadicheeni
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - David Swienton
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| |
Collapse
|
9
|
Turner P, Banahan C, Alharbi M, Ince J, Venturini S, Berger S, Bnini I, Campbell J, Beach KW, Horsfield M, Oura M, Lecchini-Visintini A, Chung EML. Brain Tissue Pulsation in Healthy Volunteers. Ultrasound Med Biol 2020; 46:3268-3278. [PMID: 32980160 DOI: 10.1016/j.ultrasmedbio.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/16/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
It is well known that the brain pulses with each cardiac cycle, but interest in measuring cardiac-induced brain tissue pulsations (BTPs) is relatively recent. This study was aimed at generating BTP reference data from healthy patients for future clinical comparisons and modelling. BTPs were measured through the forehead and temporal positions as a function of age, sex, heart rate, mean arterial pressure and pulse pressure. A multivariate regression model was developed based on transcranial tissue Doppler BTP measurements from 107 healthy adults (56 male) aged from 20-81 y. A subset of 5 participants (aged 20-49 y) underwent a brain magnetic resonance imaging scan to relate the position of the ultrasound beam to anatomy. BTP amplitudes were found to vary widely between patients (from ∼4 to ∼150 µm) and were strongly associated with pulse pressure. Comparison with magnetic resonance images confirmed regional variations in BTP with depth and probe position.
Collapse
Affiliation(s)
- Poppy Turner
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Department of Engineering, University of Leicester, Leicester, UK
| | - Caroline Banahan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Meshal Alharbi
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jonathan Ince
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sara Venturini
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Stefanie Berger
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Imane Bnini
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - James Campbell
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Kirk W Beach
- University of Washington, Seattle, Washington, USA
| | | | | | | | - Emma M L Chung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK; Leicester Cardiovascular Biomedical Research Centre, Leicester, UK.
| |
Collapse
|
10
|
Ince J, Minhas JS. A Lesson From the COVID-19 Pandemic: Preparing Future Health Care Professionals. J Emerg Med 2020; 59:718-719. [PMID: 33248505 DOI: 10.1016/j.jemermed.2020.06.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan Ince
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; University Hospitals of Leicester National Health Service Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
11
|
Ince J, Frisk LK. Limitations of Prehospital Stroke Scales for Large-Vessel Occlusion Detection. J Emerg Med 2020; 59:e153-e154. [PMID: 33183683 DOI: 10.1016/j.jemermed.2020.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jonathan Ince
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Lisa Kobayashi Frisk
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| |
Collapse
|
12
|
Alharbi M, Turner P, Ince J, Oura M, Ebirim KU, Almudayni A, Lecchini-Visintini A, Minhas JS, Chung EM. The Effects of Hypocapnia on Brain Tissue Pulsations. Brain Sci 2020; 10:E614. [PMID: 32899967 PMCID: PMC7565182 DOI: 10.3390/brainsci10090614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/16/2022] Open
Abstract
Hypocapnia is known to affect patients with acute stroke and plays a key role in governing cerebral autoregulation. However, the impact of hypocapnia on brain tissue pulsations (BTPs) is relatively unexplored. As BTPs are hypothesised to result from cerebrovascular resistance to the inflow of pulsatile arterial blood, it has also been hypothesised that cerebral autoregulation changes mediated by hypocapnia will alter BTP amplitude. This healthy volunteer study reports measurements of BTPs obtained using transcranial tissue Doppler (TCTD). Thirty participants underwent hyperventilation to induce mild hypocapnia. BTP amplitude, EtCO2, blood pressure, and heart rate were then analysed to explore the impact of hypocapnia on BTP amplitude. Significant changes in BTP amplitude were noted during recovery from hypocapnia, but not during the hyperventilation manoeuvre itself. However, a significant increase in heart rate and pulse pressure and decrease in mean arterial pressure were also observed to accompany hypocapnia, which may have confounded our findings. Whilst further investigation is required, the results of this study provide a starting point for better understanding of the effects of carbon dioxide levels on BTPs. Further research in this area is needed to identify the major physiological drivers of BTPs and quantify their interactions with other aspects of cerebral haemodynamics.
Collapse
Affiliation(s)
- Meshal Alharbi
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (M.A.); (P.T.); (J.I.); (A.A.); (J.S.M.)
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Poppy Turner
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (M.A.); (P.T.); (J.I.); (A.A.); (J.S.M.)
- School of Engineering, University of Leicester, Leicester LE1 7RH, UK; (K.U.E.); (A.L.-V.)
| | - Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (M.A.); (P.T.); (J.I.); (A.A.); (J.S.M.)
| | - Mitsuhiro Oura
- Nihon Kohden Corporation, Tokorozawa-shi, Saitama 359-0037, Japan;
| | - Kelechi U. Ebirim
- School of Engineering, University of Leicester, Leicester LE1 7RH, UK; (K.U.E.); (A.L.-V.)
| | - Alanoud Almudayni
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (M.A.); (P.T.); (J.I.); (A.A.); (J.S.M.)
- College of Applied Medical Sciences, King Sattam bin Abdulaziz University for Health Sciences, Kharj 11564, Saudi Arabia
| | | | - Jatinder S. Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (M.A.); (P.T.); (J.I.); (A.A.); (J.S.M.)
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Emma M.L. Chung
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (M.A.); (P.T.); (J.I.); (A.A.); (J.S.M.)
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| |
Collapse
|
13
|
Ince J, Alharbi M, Minhas JS, Chung EM. Ultrasound measurement of brain tissue movement in humans: A systematic review. Ultrasound 2019; 28:70-81. [PMID: 32528543 DOI: 10.1177/1742271x19894601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022]
Abstract
Introduction It has long been suggested that ultrasound could be used to measure brain tissue pulsations in humans, but potential clinical applications are relatively unexplored. The aim of this systematic review was to explore and synthesise available literature on ultrasound measurement of brain tissue motion in humans. Methods Our systematic review was designed to include predefined study selection criteria, quality evaluation, and a data extraction pro-forma, registered prospectively on PROSPERO (CRD42018114117). The systematic review was conducted by two independent reviewers. Results Ten studies were eligible for the evidence synthesis and qualitative evaluation. All eligible studies confirmed that brain tissue motion over the cardiac cycle could be measured using ultrasound; however, data acquisition, analysis, and outcomes varied. The majority of studies used tissue pulsatility imaging, with the right temporal window as the acquisition point. Currently available literature is largely exploratory, with measurements of brain tissue displacement over a narrow range of health conditions and ages. Explored health conditions include orthostatic hypotension and depression. Conclusion Further studies are needed to assess variability in brain tissue motion estimates across larger cohorts of healthy subjects and in patients with various medical conditions. This would be important for informing sample size estimates to ensure future studies are appropriately powered. Future research would also benefit from a consistent framework for data analysis and reporting, to facilitate comparative research and meta-analysis. Following standardisation and further healthy participant studies, future work should focus on assessing the clinical utility of brain tissue pulsation measurements in cerebrovascular disease states.
Collapse
Affiliation(s)
- Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Cardiovascular Sciences Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Meshal Alharbi
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Cardiovascular Sciences Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Cardiovascular Sciences Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - Emma Ml Chung
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Cardiovascular Sciences Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
14
|
Ince J, Minhas JS. Blood Pressure Control and Endovascular Therapy. J Emerg Med 2019; 57:249-250. [PMID: 31426940 DOI: 10.1016/j.jemermed.2019.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/30/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Jonathan Ince
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
15
|
Ince J, Longland A, Newbold J, Harris P. Changes in proportions of dry matter intakes by ponies with access to pasture and haylage for 3 and 20 hours per day respectively, for six weeks. J Equine Vet Sci 2011. [DOI: 10.1016/j.jevs.2011.03.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Abstract
Infection control teams are not alone in their need to manipulate data. How best can such manipulation be achieved and what tools are available to turn information into knowledge. The workshop included discussion and demonstration of some methods currently being used by infection control teams. While the workshop did not aim to produce all the answers, participants were able to question, discuss and learn new ways that they might take their own practice in the future.
Collapse
Affiliation(s)
- M D Simmons
- Camarthen PHL, West Wales General Hospital, Wales
| | | | | | | | | | | |
Collapse
|
17
|
Makin HL, Ince J, Tahourdin C, Dunn A. Government-funded phytoestrogen research in the United kingdom. J Med Food 1999; 2:275-7. [PMID: 19281400 DOI: 10.1089/jmf.1999.2.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
18
|
Ince J. The Reorganization of the Association. West J Med 1902. [DOI: 10.1136/bmj.2.2166.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
19
|
Ince J. REPORT OF THE REORGANIZATION COMMITTEE. West J Med 1902. [DOI: 10.1136/bmj.1.2163.1512-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
20
|
|
21
|
Ince J. The Annual Meeting and the Report of the Constitution Committee. West J Med 1901. [DOI: 10.1136/bmj.2.2120.433-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
22
|
Ince J. Report of the Constitution Committee. West J Med 1901. [DOI: 10.1136/bmj.2.2117.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
23
|
Ince J. The Proposed New Articles. West J Med 1900. [DOI: 10.1136/bmj.2.2063.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
24
|
Ince J. The Association and Medical Defence. West J Med 1897. [DOI: 10.1136/bmj.1.1887.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
25
|
Ince J. Proposed Presentation to Mr. Wheelhouse and Sir W. Foster. West J Med 1896. [DOI: 10.1136/bmj.2.1861.534-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
26
|
Ince J. Direct Repesentatives on the General Medical Council. West J Med 1896. [DOI: 10.1136/bmj.2.1860.474-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
27
|
|
28
|
Ince J. The Royal College of Surgeons and its Members. West J Med 1889. [DOI: 10.1136/bmj.1.1475.804-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
29
|
Ince J. THE LONDON AND PROVINCIAL MEDICAL PROTECTION AND BENEVOLENT SOCIETY. West J Med 1855. [DOI: 10.1136/bmj.s3-3.107.61-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|