Elevated cerebral blood volume contributes to increased FLAIR signal in the cerebral sulci of propofol-sedated children

BACKGROUND AND PURPOSE

Hyperintense FLAIR signal in the cerebral sulci of anesthetized children is attributed to supplemental oxygen (fraction of inspired oxygen) but resembles FLAIR hypersignal associated with perfusion abnormalities in Moyamoya disease and carotid stenosis. We investigated whether cerebral perfusion, known to be altered by anesthesia, contributes to diffuse signal intensity in sulci in children and explored the relative contributions of supplemental oxygen, cerebral perfusion, and anesthesia to signal intensity in sulci.

MATERIALS AND METHODS

Supraventricular signal intensity in sulci on pre- and postcontrast T2 FLAIR images of 24 propofol-sedated children (6.20 ± 3.28 years) breathing supplemental oxygen and 18 nonsedated children (14.28 ± 2.08 years) breathing room air was graded from 0 to 3. The Spearman correlation of signal intensity in sulci with the fraction of inspired oxygen and age in 42 subjects, and with dynamic susceptibility contrast measures of cortical CBF, CBV, and MTT available in 25 subjects, were evaluated overall and compared between subgroups. Factors most influential on signal intensity in sulci were identified by stepwise logistic regression.

RESULTS

CBV was more influential on noncontrast FLAIR signal intensity in sulci than the fraction of inspired oxygen or age in propofol-sedated children (CBV: r = 0.612, P = .026; fraction of inspired oxygen: r = -0.418, P = .042; age: r = 0.523, P = .009) and overall (CBV: r = 0.671, P = .0002; fraction of inspired oxygen: r = 0.442, P = .003; age: r = -0.374, P = .015). MTT (CBV/CBF) was influential in the overall cohort (r = 0.461, P = .020). Signal intensity in sulci increased with contrast in 45% of subjects, decreased in none, and was greater (P < .0001) in younger propofol-sedated subjects, in whom the signal intensity in sulci increased with age postcontrast (r = .600, P = .002).

CONCLUSIONS

Elevated cortical CBV appears to contribute to increased signal intensity in sulci on noncontrast FLAIR in propofol-sedated children. The effects of propofol on age-related cerebral perfusion and vascular permeability may play a role.

Ocular haemodynamics in some subgroups of normal pressure glaucoma

The authors studied, by means of Color Doppler Imaging, a group of Normal Pressure Glaucoma subjects They found some haemodynamic abnormalities in them which differed in the various subgroups. It would seem that, for each NPG subgroup, there are specific physiopathological and clinical features.

Treatment with enalapril modifies the pain perception pattern in hypertensive patients

The cardiovascular system shares numerous anatomic and functional pathways with the antinociceptive network. The aim of this study was to investigate whether angiotensin-converting enzyme (ACE) inhibitor treatment could affect hypertension-related hypalgesia. Twenty-five untreated hypertensive patients, together with a control group of 14 normotensive subjects, underwent dental pain perception evaluation by means of a pulpar test (graded increase of test current applied to healthy teeth). After the evaluation of the dental pain threshold (occurrence of pulp sensation) and tolerance (time when the subjects asked for the test to be stopped), all the subjects underwent a 24-hour ambulatory blood pressure monitoring. The hypertensive group then was treated with 20 mg/d enalapril, whereas the normotensive subjects remained without any treatment. After a time interval of 6+/-2 months, the dental pain sensitivity was retested in all the subjects, and ambulatory blood pressure was recorded during treatment in the hypertensive patients. At the first assessment, hypertensive patients showed a higher pain threshold than normotensive subjects (P<.001). On retesting of pain sensitivity in hypertensive patients, a significant decrease of both pain threshold and tolerance, leading to their normalization, was observed during treatment (P<.001 and P<.005, respectively), in the presence of reduced 24-hour and office blood pressure values. A slight, though significant, correlation was observed between variations in pain tolerance and baseline blood pressure changes occurring during treatment. During follow-up, the normotensive subjects did not show any significant pain perception or office blood pressure changes. Hypertension-related hypalgesia was confirmed. Mechanisms acting both through lowering of blood pressure and specific pharmacodynamic properties may account for the normalization of pain sensitivity observed in hypertensive patients during treatment with ACE inhibitors.

[Cerebral hypoperfusion symptoms in elderly subjects with hyperkinetic and/or hypokinetic arrhythmia. Study of institutionalized and non- institutionalized patients]

BACKGROUND

We evaluated the symptomatology caused by cerebral hypoperfusion in a group of over-65 year old hospitalized and non-patients, with hyperkinetic and hypokinetic arrhythmias.

METHODS

2441 clinical records of hospitalized and ambulatory patients at the unit of Cardiology, "Pugliese-Ciaccio" Hospital of Catanzaro between January 1st 1991 and March 31st 1995 were examined. The clinical records of those patients who had showed anamnestic episodes of syncope, lipothymia and dizziness were selected. The selected sample was made of 36 hospitalized patients and 36 ambulatory patients. The Holter-ECGs of these patients were examined.

RESULTS

Six episodes of syncope (16.7%) were found in the hospitalized patients and 4 in the ambulatory patients (11.1%). Ten (27.8%) and 8 (22.2%) episodes of lipothymia, were found in the hospitalized and ambulatory patients respectively. Dizziness was found in 20 (55.5%) hospitalized and in 24 (66.6%) ambulatory patients. In all the patients the symptoms appeared during the recording and were linked to hyperkinetic arrhythmias in 22 (61.1%) hospitalized patients and in 25 (69.4%) ambulatory patients and to hypokinetic arrhythmias in 14 (39.9%) and 11 (30.5%) hospitalized and ambulatory patients.

CONCLUSIONS

The present study pointed out that patients with hyperkinetic arrhythmias (both hospitalized and ambulatory) show symptoms of cerebral hypoperfusion more frequently than those with hyperkinetic arrhythmias.

Twenty-four-hour noninvasive blood pressure monitoring and pain perception

Although a hypertension-related hypalgesia has been described, the relation between pain perception and the 24-hour blood pressure trend is still unknown. The ambulatory blood pressure monitoring parameters and dental pain sensitivity were correlated in 67 male subjects. The pulpar test (graded increase of test current of 0 to 0.03 mA) was performed on three healthy teeth, and mean dental pain threshold (occurrence of pulp sensation) and pain tolerance (time when the subjects asked for the test to be stopped) were evaluated. Three groups of subjects with normal (n = 34), intermediate (n = 13), and high (n = 20) blood pressure values were identified according to ambulatory monitoring results. Pain threshold differed among the three groups (P < .02), being higher in the group with highest blood pressure. The groups of hypertensive subjects showed higher pain tolerance than the normotensive group (P < .02). Pain threshold was correlated with 24-hour, diurnal, and nocturnal blood pressure values. Pain tolerance was also related to 24-hour blood pressure and to diurnal and nocturnal diastolic and mean arterial pressure values. Systolic and diastolic blood pressure loads were significantly associated with pain threshold, and diastolic load was also associated with tolerance. The blood pressure variability (SD) did not relate to pain perception. The 24-hour arterial pressure was more closely associated with pain perception than the blood pressure values obtained before the pulpar test. A close correlation between pain perception and 24-hour ambulatory blood pressure was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Benign edematous polysynovitis in the elderly (RS3PE syndrome)

The Authors provide an update on benign edematous polysynovitis in the elderly and propose clinical and laboratory criteria for a correct diagnosis. They also propose the use of the term "polysynovitis" rather than polyarthritis, as they think it describes the histopathological findings of the disease better. Finally, they attempt to correctly distinguish RS3PE syndrome from polymyalgia rheumatica, rheumatoid arthritis and chondrocalcinosis.