Cerebral Circulation In Patients Research Articles

HEMODYNAMIC PARAMETERS OF EXTRACRANIAL CEREBRAL ARTERIES AND HEART IN PATIENTS WITH OCCLUSION OF THE INTERNAL CAROTID ARTERY DURING VASCULAR SURGERY

HighlightsWe have analyzed the parameters of cerebral hemodynamics and left ventricular functional capacity in patients with occlusion and stenosis of the contralateral internal carotid artery during vascular surgery. Considering the importance of the left ventricular functional capacity and treatment options to ensure the stability of cerebral circulation in patients with occlusion and hemodynamically significant stenosis of the contralateral carotid artery, its detailed study at all stages of vascular surgery remains necessary. AbstractAim. To study cerebral hemodynamics and left ventricular functional capacity in patients with occlusion and stenosis of the contralateral internal carotid artery (ICA) to optimize treatment at the preoperative phase.Methods. The study compared the hemodynamic parameters of the blood flow of the ICA, vertebral arteries and left ventricular functional capacity in patients with ICA occlusion and contralateral ICA stenosis, which formed the 1 group (12 patients), and patients with unilateral hemodynamically significant stenosis, which formed the 2 group (52 patients). The blood flow in the extracranial portions of the major arteries of the head and heart was assessed using ultrasound, and the arterial vascular system and brain structure was assessed using MRI and MRA.Results. Before surgery, statistically significant differences in velocity parameters in the vertebral arteries on the occlusion side were found; on the contralateral occlusion side, velocity parameters in ICA were significantly different from the corresponding indicators in the group with unilateral stenosis; after surgery, statistically significant differences were found in the common carotid and vertebral arteries on the occlusion side; on the contralateral occlusion side, differences in velocity parameters in the common carotid, internal, and vertebral arteries were revealed in comparison with the group with unilateral stenosis. Of the indicators of the left ventricular functional capacity, only left ventricular ejection fraction differed significantly when comparing the group of patients with occlusion and stenosis of ICA and the group of patients with unilateral stenosis. Moreover, when evaluating pre- and postoperative outcomes in the group of patients with occlusion, significant differences were obtained only regarding the vertebral artery on the side of occlusion – the peak systolic blood flow velocity and the volumetric blood flow velocity significantly decreased. There were no significant differences between the common carotid, internal carotid arteries on the contralateral occlusion side, and middle cerebral arteries.Conclusion. Carrying out a comprehensive ultrasound examination of the main arteries of the head in combination with magnetic resonance imaging of the brain is a reliable and adequate way to assess cerebral hemodynamics, changes in the vascular bed and structure of the brain. Given the extreme importance of the left ventricular functional capacity to ensure the stability of cerebral circulation in patients with occlusion of the internal carotid artery and contralateral hemodynamically significant stenosis, its detailed study before carotid endarterectomy is necessary to adjust therapeutic measures.

Microembolizations in the Arterial Cerebral Circulation in Patients with Atrial Fibrillation Ablation Using the Cryoballoon Technique-Protocol and Methodology of a Prospective Observational Study.

There is considerable uncertainty regarding the impact of microembolic signals (MESs) on neuropsychological abilities in patients receiving pulmonary vein isolation and beyond using the cryoballoon technique. We conducted the largest prospective observational study on this topic, providing insights into the gradual unmasking of procedure-related MESs and their impacts on neuropsychological outcomes. MESs were continuously detected periprocedurally using transcranial Doppler ultrasonography. Neuropsychological status was evaluated comprehensively using the CERAD Plus test battery, which consists of 11 neuropsychological subtests. Patients with atrial fibrillation were included in the study with an equal distribution (50:50) of paroxysmal or persistent presentations. Of 167 consecutive eligible patients, 100 were included within the study enrollment period from February 2021 to August 2022. The study, including the documentation of all follow-up visits, ended in November 2022. This paper focuses on describing the study protocol and methodology and presenting the baseline data.

Features of cerebral circulation in patients with chronic migraine

The relevance of differential diagnosis and treatment of primary and secondary headaches remains an important problem for physicians of various specialties. Migraine is a maladaptive disease, which necessitates further study of new pathogenetic mechanisms, symptomatic treatment improvement of migraine, as well as the development of more effective non-drug and drug methods for preventing migraine attacks. It is also important to determine the predictors of the chronic migraine development, which will prevent the episodic migraine transformation into a chronic form. The team of authors conducted a study to assess the degree of cerebral circulatory disorders in patients suffering from chronic migraine. The obtained results of the study made it possible to improve the diagnosis of both chronic and episodic migraine, to clarify the pathogenetic mechanisms of the formation of migraine attacks and the transformation possibility into chronic migraine. Practical recommendations have been developed to improve the effectiveness of ongoing symptomatic and preventive treatment, which improves patient’s quality of life. This article will be useful for doctors – neurologists, algologists, cephalgologists, GPs, doctors of functional and radiation diagnostics and doctors of other specialties, both for beginners and with experience

Features of gas exchange and metabolism of the brain during revascularization of the carotid arteries.

The relevance of the stated topic of scientific research is determined by the fact that stroke is still the most important medical and social problem both in the world as a whole and in the Republic of Kazakhstan in particular due to high rates of morbidity, mortality, and disability. In addition, cerebrovascular diseases occupy one of the leading places in the structure of morbidity, disability and mortality, second only to coronary heart disease in Kazakhstan as well as around the world. The purpose of this research work is to study the features of gas exchange and brain metabolism during the revascularization of the carotid arteries. The basis of the methodological approach in this research work is a combination of methods of systematic analysis of the main features of gas exchange and brain metabolism in combination with a systematic study of the results obtained during the treatment of patients diagnosed with carotid artery stenosis at the Syzganov National Research Surgery Center in the period 2015-2020, divided into two main groups according to the applied principles of treatment. The results obtained in this research work indicate high efficiency of carotid endarterectomy and carotid stenting in finding ways to solve problems with cerebral circulation in patients suffering from carotid artery stenosis, as well as with the need for further use of these methods in clinical practice. The results obtained in the course of this scientific study, as well as the conclusions formulated on their basis, are of significant practical importance in terms of creating effective methods for treatment of patients recovering after a stroke, as well as for prevention of occurrence and development of stroke (Tab. 4, Ref. 20). Text in PDF www.elis.sk Keywords: carotid artery stenting, carotid endarterectomy, ischemic stroke, atherosclerosis, heart attack.

Imaging of brain activity using fMRI in a patient with subjective cognitive decline

In clinical practice, subjective cognitive decline (SCD) is often difficult to diagnose because it is not detected by standard neuropsychological and cognitive tests.The described clinical case is presented to demonstrate the difficulties of diagnosis and treatment choice in a patient with SCD. fMRI might be considered as an instrumental method to analyze the functional relationship between the activity of brain structures and cerebral circulation in patients with SCD. Patient clinical and neuropsychological data with a detailed description of fMRI with a cognitive paradigm are presented. The article is focused on the early diagnosis of SCD and the prognostic assessment of the transition of SCD to dementia.

Management of Complex Jugular Paragangliomas: Surgical Resection and Outcomes.

This study aimed to review tumor control and cranial nerve function outcomes in patients with complex jugular paragangliomas and to refine the surgical strategies for complex jugular paragangliomas. We describe our experience with 12 patients with complex jugular paragangliomas diagnosed in our institution from January 2013 to June 2020. The main outcomes included tumor control, complications, and function of facial nerve and lower cranial nerves, postoperatively. Gross-total resection was achieved for 9 (75%) patients, and subtotal resection was achieved for 3 (25%) patients. The surgical tumor control rate was 100% after a mean follow-up of 45.5 months (range, 13-111 months). Postoperatively, 10 patients (83.3%) obtained unchanged or improved facial nerve function. However, new lower cranial nerve deficits occurred in 2 patients (16.7%) due to surgical removal of the concurrent vagal paraganglioma and scar tissue enclosing the IX and XII nerves. Our refined surgical techniques, including tension-free anterior facial nerve rerouting, sigmoid sinus tunnel-packing, and pushpacking techniques, could be a choice for the treatment of complex jugular paragangliomas to achieve tumor control and cranial nerves preservation. A 2-stage surgery should be applied to minimize the risk of bilateral cranial neuropathies and the influence on cerebral circulation in patients with bilateral paragangliomas. The preoperative endovascular intervention such as coil embolization or internal carotid artery stenting can be employed for the management of paragangliomas with internal carotid artery-associated lesions.

The state of the lumen of the major cerebral vessels and systems of regulation of cerebral circulation in patients with cerebral ischemia with the development of epileptic seizures

Introduction. Cerebrovascular diseases are often associated with the development of epileptic seizures. It was suggested that in the implementation of epileptogenesis in patients with ischemic brain damage, a hemodynamic factor, namely the state of the perfusion reserve, may be important.Objective. The examination of the state of cerebrovascular reactivity of different cerebral vascular basins in patients with the development of epileptic seizures affected by cerebral ischemia.Materials and methods. 772 patients with acute and chronic cerebral ischemia (265 stroke patients with epileptic seizures and 174 patients with seizures on the background of chronic cerebral ischemia and 203 patients with stroke and 130 patients with chronic cerebral ischemia without seizures) was comprehensively examined.Results. In patients with cerebral ischemia, focal seizures prevail. Cortical localization of ischemic foci prevailed in patients with both acute and chronic cerebral ischemia. Stenosis of the main arteries were more often detected as in patients with ischemic stroke with the development of epileptic seizures – 218 (82.3%) compared with patients with stroke in the comparison group – 151 (74.4%) patients, р < 0.05), and in patients with CBI (chronic brain ischemia) with the development of epileptic seizures – 121 (69.5%) people, p < 0.05) compared with patients in the comparison group – 74 (56.9%) patients. The prevalence of stenosisof the main cerebral arteries was revealed in more than 70% in patients with pre-stroke epileptic seizures – 77 (33.5%) compared with patients without precursor seizures, who have been diagnosed with stenosis of more than 70% were found in only 4 (11.5%) patients (χ2 = 10.1; p = 0.03). In the comparison group of patients, there was no significant difference in CVR (cerebrovascular reactivity) changes in the carotid system and in the VBS (vertebrobasilar system) – 30 (36.6%) and 42 (47.7%) examined, respectively.Conclusion. The revealed decrease in cerebrovascular reactivity in the vertebrobasilar basin can be considered as one of the risk factors for the development of epilepsy in conditions of brain ischemia.

Association of rs10507391 polymorphism with the development of acute cerebrovascular event

Abstract Purpose To study SNP rs10507391 association (A> T) with development of Acute Cerebrovascular Event in the patients with cardiovascular pathology and risk factors of its development who are representatives of the east Siberian population. Material and methods 260 patients with Acute Cerebrovascular Event participated in a research (age [57.0; 51.0–62.0]) and 272 patients of control group (age [55.0; 51.0–62.0].). Among the patients who transferred Acute Cerebrovascular Event, 157 men and 103 women. The control group included 170 men and 102 women. Inspection of the main group included: collecting complaints, anamnesis, clinical examination, computer tomography of a brain, electrocardiography, echo, ultrasonic of arteries, daily monitoring of arterial blood pressure and cardiac rhythm, analysis of a coagulant system of blood. Patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, supraventricular tachycardia, dislipidemiya, atherosclerosis brachiocephalic of arteries, disturbances of a system of a hemostasis. The control group is examined within the international HAPIEE project. The molecular and genetic research was conducted by PCR method in real time. Statistical processing of material was carried out with use of set of the Statistica for Windows 7.0, Excel and SPSS 22 application programs. Results When studying SNP rs10507391 association (A> T) connection between a rare genotype of a TT and an allele of T and the increased risk of Acute Cerebrovascular Event is established with development of Acute Cerebrovascular Event in all analyzed groups and subgroups of patients. Conclusion A genotype of a TT and an allele of T of SNP rs10507391 (A> T) increases risk of development of an acute disorder of cerebral circulation in patients regardless of the previous cardiovascular pathology and risk factors, including at patients with arterial hypertension, supraventricular tachyarrhythmias, atherosclerosis the brachiocephalic of arteries, disturbance of lipidic exchange and the system of a hemostasis. Funding Acknowledgement Type of funding sources: None.

Influence of cerebral hyperthermia on intracranial pressure and autoregulation of cerebral circulation in patients with acute brain injury

To study the effect of hyperthermia on intracranial pressure (ICP) and cerebral autoregulation (Prx). There were 8 patients with acute brain injury, signs of brain edema and intracranial hypertension. Cerebral autoregulation was assessed by using of PRx. ICP, CPP, BP, PRx were measured before and during hyperthermia. We have analyzed 33 episodes of cerebral hyperthermia over 38.30 C. Statistica 10.0 (StatSoft) was used for statistical analysis. Only ICP was significantly increased by 6 [3; 11] mm Hg (p<0.01). In patients with initially normal ICP, hyperthermia resulted increase of ICP in 48% of cases (median 24 [22; 28] mm Hg). In patients with baseline intracranial hypertension, progression of hypertension was noted in 100% cases (median 31 [27; 32] mm Hg) (p<0.01). Hyperthermia resulted intracranial hypertension regardless brain autoregulation status. Cerebral hyperthermia in patients with initially normal ICP results intracranial hypertension in 48% of cases. In case of elevated ICP, further progression of intracranial hypertension occurs in 100% of cases. Cerebral hyperthermia is followed by ICP elevation in both intact and impaired cerebral autoregulation.

Improving Effect of Promoting Cerebral Circulation on Patients with Senile Dementia

Purpose — To explore the improving effect of promoting cerebral circulation on patients with senile dementia. Methods — 96 patients with senile dementia admitted from January 2018 to December 2019 were selected and divided into A (conventional treatment) and B (conventional + promoting cerebral circulation treatment) groups, 48 cases in each group, according to the computerized flow grouping method. The clinical therapeutic effects of the two groups were compared and analyzed. Results — ① Compared with Group A, the total effective rate of Group B was higher (95.83%&gt;83.33%) (c2=4.019, P=0.045); ② Before treatment, there was no significant difference between groups (P&gt;0.05). After treatment, compared with Group A, Group B had higher MMSE score, lower ADAS-cog score, HAMD score and ADL score (P&lt;0.05); ③ During the clinical treatment of the two groups, no obvious adverse reactions were seen. Conclusion — The treatment of promoting cerebral circulation in patients with senile dementia can not only effectively improve the symptoms of dementia, but also improve the ability of daily living. This therapy is safe and reliable, and is worthy of clinical promotion and use.

Complaints of patients with functional dysorders of voice production accompained by hypotonic condition of the vocal apparatus

Complaints of patients with functional dysorders of voice production accompained by hypotonic condition of the vocal apparatus

Age and Sex Differences in Cerebral Circulation in Patients with Cerebral Atherosclerosis and Diabetes mellitus

Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients.The objective: was to determine sex and age differences in the structural and functional state of the vessels of the carotid and vertebro-basilar basins in patients with stage I–III cerebral atherosclerosis (CA) and type 2 diabetes mellitus.Materials and methods. A comprehensive clinical and instrumental study involved 229 patients with stageI–IIICA and type 2 diabetes mellitus. The patients were divided into 2 groups: I – the general group of patients who had an ischemic atherothrombotic stroke in the middle cerebral artery basin – CA III; II – with CA I–II stages. All patients underwent conventional clinical, laboratory and instrumental studies (Doppler ultrasound of the vessels of the head and neck – study of cerebral blood flow in the extra- and intracranial sections of the main arteries of the head and neck using the Aplio XG device (Toshiba).Results. In patients of group I, there were no age or sex differences in the linear systolic blood flow velocity (LSBFV) of the vessels of the carotid and vertebro-basilar basins. In group II patients over 60 years of age, the LSBFV in both internal carotid arteries was statistically significantly higher than in middle-aged patients, while the LSBFV in the left vertebral, posterior cerebral arteries and the basilar artery was statistically significantly higher in middle-aged patients than in the elderly. In our opinion, these differences can be explained by statistically significant differences in fasting blood glucose levels. It is important to note that statistically significant sex differences were found only for LSBFV in both common carotid arteries: in women with CA stages I-II, the rate of cerebral blood flow was higher than in men.Conclusions. For patients with stage III CA and T2DM, age and sex differences in the parameters of cerebral circulation both in the vessels of the carotid and in the vessels of the vertebro-basilar basins have not been established. Elderly patients with stage I–II CA and T2DM, in comparison with middle-aged patients, are characterized by a statistically significantly higher LSBFV in the vessels of the carotid basin and lower in the vessels of the vertebro-basilar basin. The rate of cerebral blood flow in female patients with stage I–II CA and diabetes mellitus is statistically significantly higher in both common carotid arteries, in contrast to the corresponding LSBFV indicators in male patients.

The disorder of cerebral circulation in patients of able-bodied age

The study was organized to evaluate influence of risk factors on hospital mortality in patients with acute stroke because incidence of stroke in patients of able-bodied age is increasing. All cases of in-patient care of patients of able-bodied age with acute stroke (n=4118) in the Tyumen Oblast clinical hospital № 2 during 2010-2018 were analyzed. The study was based on sampling data from hospital medical records. During the analyzed period, decreasing of in-patient lethality up to 34.9% in patients of able-bodied age was observed. During the period of "therapeutic window" 60% of patients of able-bodied age admitted died. The multivariate analysis was applied to assess influence of different factors on in-patient mortality. The presence of coronary heart disease increases risk of mortality up to 47.5%, Exp(Beta)=1.475, employment - up to 66.8%, Exp(Beta)=1.668 as compared to baseline risk. The presence of arterial hypertension and remoteness of symptom onset in ln (hours) (hospital admission) decreases mortality risk up to approximately 39.7%, Exp (Beta)=0.603 and up to 24.0%, Exp (Beta)=0.760, respectively (specificity - 75.86%, sensitivity - 72.18%; overall diagnostic accuracy - 75.23%). In patients of working age the presence of coronary heart disease and elder age are risk factors of stroke. The presence of coronary heart disease and employment are risk factors of in-patient mortality. Whereas presence of hypertension and employment decreases risk of lethal outcome.

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura.

Patent Foramen Ovale and impaired cerebral hemodynamics were proposed among the pathophysiological mechanisms explaining the increased risk for stroke in patients with Migraine with Aura (MA). Our study aimed at comparing the vasomotor reactivity (VMR) of the anterior and the posterior cerebral circulation in patients with Migraine with Aura, in patients with acute vascular ischemic accidents, and in controls. We hypothesized that VMR in MA patients is preserved in the anterior circulation and reduced in the posterior circulation. We prospectively assessed with Transcranial Doppler the vasomotor reactivity to breath holding of the Middle and Posterior Cerebral Arteries (MCA, PCA) in MA patients, in acute vascular patients and healthy controls. We also evaluated the possible effect of clinical characteristics of MA (attack frequency, aura length or type, disease history), vascular factors and the presence of right-to-left shunt on VMR. Diverging from our hypothesis, MA patients displayed a higher breath-holding index (BHI) than controls in the MCA (1.84±0.47%/s vs 1.53±0.47%/s, p = .001) as well as in the PCA (1.87±0.65%/s vs 1.47±0.44%/s, p < .001). In MA patients, MCA BHI was higher in those with large right-to-left shunts (2.09±0.42 vs 1.79±0.47, p = .046) and lower in those taking estrogens (1.30±0.30%/s vs 1.9±0.45%/s, p = .009). We did not observe an effect of MA characteristics on BHI. The increased BHI in MA patients with large right-to-left shunts could be explained by the vasoactive effect in the cerebral circulation of substances bypassing the deactivating pulmonary filters or by a constitutional trait of the vascular system associating persistent right-to-left shunts and hyper-reactive hemodynamics. Our results discourage the hypothesis that altered hemodynamics contribute to increasing the stroke risk in all MA patients. However, estrogens can lower VMR, curtailing the hemodynamic resources of MA patients.

1H Nuclear Magnetic Resonance (NMR)-Based Cerebrospinal Fluid and Plasma Metabolomic Analysis in Type 2 Diabetic Patients and Risk Prediction for Diabetic Microangiopathy.

Insulin resistance and metabolic derangement are present in patients with type 2 diabetes mellitus (T2DM). However, the metabolomic signature of T2DM in cerebrospinal fluid (CSF) has not been investigated thus far. In this prospective metabolomic study, fasting CSF and plasma samples from 40 T2DM patients to 36 control subjects undergoing elective surgery with spinal anesthesia were analyzed by 1H nuclear magnetic resonance (NMR) spectroscopy. NMR spectra of CSF and plasma metabolites were analyzed and correlated with the presence of T2DM and diabetic microangiopathy (retinopathy, nephropathy, and neuropathy) using an area under the curve (AUC) estimation. CSF metabolomic profiles in T2DM patients vs. controls revealed significantly increased levels of alanine, leucine, valine, tyrosine, lactate, pyruvate, and decreased levels of histidine. In addition, a combination of alanine, histidine, leucine, pyruvate, tyrosine, and valine in CSF showed a superior correlation with the presence of T2DM (AUC:0.951), diabetic retinopathy (AUC:0.858), nephropathy (AUC:0.811), and neuropathy (AUC:0.691). Similar correlations also appeared in plasma profiling. These metabolic alterations in CSF suggest decreasing aerobic metabolism and increasing anaerobic glycolysis in cerebral circulation of patients with T2DM. In conclusion, our results provide clues for the metabolic derangements in diabetic central neuropathy among T2DM patients; however, their clinical significance requires further exploration.

MORPHOLOGICAL AND PERFUSION PREDICTORS OF DISTANT CEREBRAL DISORDERS IN CARDIAC SURGERY PATIENTS

Aim. To assess the preoperative morphological state of the brain and the state of cerebral circulation in patients referred for coronary bypass surgery to identify predictors of long-term cerebral disorders.Material and Methods. The study included 33 male patients, divided into 2 groups according to the presence or the absence of distant neurological complications 5 years after surgery. All patients underwent non-contrast computed tomography of the brain and perfusion computed tomography. Computed tomography was repeated 5 years after surgery.Results. The perfusion indices in all measurement zones in patients of the two groups did not significantly differ. Significant differences in width of the third ventricle and ventricular-cranial index between patients of groups 1 and 2 were not identified. The incidence rates of leukoaraiosis significantly differed: leukoaraiosis was detected significantly more frequently in group 2 (78% of cases) than in patients of group 1 (31%), p=0.0455.Discussion. The dimensions of the brain cavity system and the preoperative state of the microcirculatory blood flow were not predictors of long-term postoperative neurological disorders. Five years after surgery, patients of group 2 showed clinical and morphological signs of past ischemic changes, which were not detected in patients of group 1 suggesting that leukoaraiosis was an unfavorable prognostic indicator of postoperative cerebrovascular disorders in the long-term period.Conclusion. When referring a patient with the presence of morphological manifestations of cerebral microangiopathy in the form of the leukoaraiosis phenomenon for cardiac surgery, these patients should be considered at risk requiring administration of the necessary set of measures for the prevention of long-term cerebral disorders.

MORPHOLOGICAL AND PERFUSION PREDICTORS OF DISTANT CEREBRAL DISORDERS IN CARDIAC SURGERY PATIENTS

Aim. To assess the preoperative morphological state of the brain and the state of cerebral circulation in patients referred for coronary bypass surgery to identify predictors of long-term cerebral disorders.Material and Methods. The study included 33 male patients, divided into 2 groups according to the presence or the absence of distant neurological complications 5 years after surgery. All patients underwent non-contrast computed tomography of the brain and perfusion computed tomography. Computed tomography was repeated 5 years after surgery.Results. The perfusion indices in all measurement zones in patients of the two groups did not significantly differ. Significant differences in width of the third ventricle and ventricular-cranial index between patients of groups 1 and 2 were not identified. The incidence rates of leukoaraiosis significantly differed: leukoaraiosis was detected significantly more frequently in group 2 (78% of cases) than in patients of group 1 (31%), p=0.0455.Discussion. The dimensions of the brain cavity system and the preoperative state of the microcirculatory blood flow were not predictors of long-term postoperative neurological disorders. Five years after surgery, patients of group 2 showed clinical and morphological signs of past ischemic changes, which were not detected in patients of group 1 suggesting that leukoaraiosis was an unfavorable prognostic indicator of postoperative cerebrovascular disorders in the long-term period.Conclusion. When referring a patient with the presence of morphological manifestations of cerebral microangiopathy in the form of the leukoaraiosis phenomenon for cardiac surgery, these patients should be considered at risk requiring administration of the necessary set of measures for the prevention of long-term cerebral disorders.

ДИАГНОСТИКА РАННИХ ПРИЗНАКОВ НЕДОСТАТОЧНОСТИ МОЗГОВОГО КРОВООБРАЩЕНИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЁГКИХ

A new method of diagnosis of cerebral circulation insufficiency in patients with chronic obstructive pulmonary disease (COPD) is presented. The essence of the method consists in determining the patient's age, smoking index, oxygen partial pressure in arterialized blood (pO2), forced expiratory volume per 1st second (FEV1), the level of hemoglobin in the clinical analysis of blood, and solution of the regression equation. The numerical value of the equation of 70 or more points allows to diagnose the presence of signs of cerebral circulation insufficiency, less than 70 points - their absence. Preliminary correlation analysis was carried out in 67 patients with COPD using statistical package STATISTICA 6.1 between the following variables: age, smoking index, pO2, FEV1, hemoglobin level. The coefficient of multiple determination (R2) was 0.79 (79.0%), which confirms the reliability of the model prediction. The invention relates to medicine, namely, internal diseases, in particular to pulmonology and can be used for the diagnosis of early signs of cerebral circulation insufficiency in patients with COPD for the purpose of a differentiated approach to the choice of therapeutic and preventive measures. The problem solved by the invention is to create a method that allows to detect disorders in the state of cerebral circulation in patients with COPD to improve the effectiveness of therapeutic and preventive measures and improve the prognosis of the disease.

Role of Noninvasive Imaging of Cerebral Arterial System in Ischemic Stroke: Comparison of Transcranial Color-coded Doppler Sonography with Magnetic Resonance Angiography.

Aim:To determine the accuracy of transcranial color-coded Doppler sonography (TCCS) in the evaluation of cerebral arterial system in patients with ischemic stroke attending a tertiary care hospital in South India.Objectives:(1) To describe the topographical distribution of atherosclerotic lesions in the cerebral circulation in patients presenting with ischemic stroke from the Indian subcontinent and (2) to determine the accuracy of TCCS for detection and quantification of intracranial stenoses in various segments of the intracerebral arterial system in comparison with magnetic resonance angiography (MRA).Materials and Methods:The demographic profile and risk factors of consecutive patients who presented to neurology outpatient department with cerebral ischemia and scheduled for MRA were determined. These patients had undergone neck Doppler, TCCS, and MRA. The agreement between the MRA and TCCS was assessed using kappa statistics. The sensitivity, specificity, and positive and negative predictive values of TCCS as compared to MRA were calculated.Results:Ninety patients were included in the final analysis. Intracranial atherosclerosis was found in 35.6% of cases. The agreement between TCCS and MRA in detecting lesions for the different arterial segments in the intracranial circulation was 0.83 for anterior cerebral artery (ACA), 0.66 for M1 segment of middle cerebral artery (MCA), 0.45 for M2 segment of MCA, 0.86 for terminal internal carotid artery (TICA), 0.46 for posterior cerebral artery (PCA), and 0.81 for vertebral artery (VA). The sensitivity for the detection of hemodynamically significant arterial lesions in different vascular segments was 100%, 70%, 33.3%, 90.9%, 33.3%, and 72.7% for ACA, M1, M2, TICA, PCA, and VA, respectively.Conclusion:Intracranial atherosclerosis was found to be the predominant distribution of cerebral atherosclerosis. TCCS is a safe method for evaluation of proximal basal cerebral arteries in the intracranial circulation with relatively better sensitivity in the anterior circulation.

Alteration of Venous Drainage Route in Idiopathic Normal Pressure Hydrocephalus and Normal Aging.

Idiopathic normal pressure hydrocephalus (iNPH) is a highly prevalent condition in the elderly population; however, the underlying pathophysiology in relation to the aging process remains unclear. To investigate the effect of removal of cerebrospinal fluid by lumbar “tap test” on the cerebral circulation in patients with iNPH, 14 patients with “probable” iNPH were studied using a novel blood tracking technique based on blood oxygenation level-dependent (BOLD) magnetic resonance signal intensity. By tracking the propagation of the low-frequency component of the BOLD signal, extended venous drainage times were observed in the periventricular region of the patients, which was reversed by tap test. Interestingly, the venous drainage time in the periventricular region exhibited an age-related prolongation in the healthy control group. Additional regression analyses involving 81 control subjects revealed a dissociation of deep and superficial venous systems with increasing age, presumably reflecting focal inefficiency in the deep system. Our results not only provide insights into the etiology of iNPH, but also point to a potential non-invasive biomarker for screening iNPH.