Cerebral Function In Patients Research Articles

Quantitative Electroencephalography Monitoring in Type A Aortic Dissection Surgery: A Clinical Case Review and Prospective Applications.

This review explores advanced methods for assessing perioperative cerebral function in Type A aortic dissection (TAAD) patients, with a focus on quantitative electroencephalography (QEEG). It highlights the critical issue of cerebral malperfusion, which is associated with higher mortality and poor prognosis during the perioperative phase in TAAD patients. The review centers on the utilization of QEEG as a pivotal tool for the extensive monitoring of brain function at various stages: preoperatively, intraoperatively, and postoperatively. It elaborates on the foundational principles of QEEG, including the mathematical and computational analysis of electroencephalographic signals, enriched with intuitive graphical representations of cerebral functional states. QEEG is presented as an innovative approach for the real-time, noninvasive, and reliable assessment of cerebral function. The review details the application of QEEG in monitoring conditions such as preoperative cerebral malperfusion, intraoperative deep hypothermic circulatory arrest, and postoperative recovery of cerebral function in patients undergoing TAAD treatment. Although QEEG is still in an exploratory phase for TAAD patients, it has shown efficacy in other domains, suggesting its potential in multimodal brain function monitoring. However, its broader application requires further research and technological advancements.

Chronic Hyponatremia and Brain Structure and Function Before and After Treatment

Rationale & ObjectiveHyponatremia is the most common electrolyte disorder and is associated with significant morbidity and mortality. This study investigated neurocognitive impairment, brain volume, and alterations in MRI-based measures of cerebral function in patients before and after treatment for hyponatremia. Study DesignProspective cohort study. Setting & ParticipantsPatients with presumed chronic hyponatremia without signs of hypo- or hypervolemia treated in the Emergency Department of a German tertiary care hospital. ExposureHyponatremia ([Na+] <125 mmol/L) before and after treatment leading to [Na+] >130 mmol/L. OutcomesStandardized neuropsychological testing (Mini-Mental-State examination [MMSE], DemTect, Trail-Making Test [TMT] A/B, Beck’s Depression Inventory, Timed Up and Go) and resting-state MRI were performed prior to and following treatment of hyponatremia to assess volumes of total brain, white and gray matter, as well as neuronal activity and its synchronization. Analytical ApproachChanges in outcomes after treatment for hyponatremia assessed using bootstrapped confidence intervals and Cohen’s d. Associations between parameters were assessed using correlation analyses. ResultsDuring a 3.7-year period, 26 patients were enrolled. Complete data were available for 21 patients. Mean [Na+] was 118.4 mmol/L before treatment and 135.5 mmol/L following treatment. Most measures of cognition improved significantly. Comparison of MRI studies showed a decrease in brain tissue volumes, neuronal activity, and synchronization across all gray matter after normalization of [Na+]. Volume effects were particularly prominent in the hippocampus. During hyponatremia, synchronization of neuronal activity was negatively correlated with [Na+] (r=-.836, [-.979, -.446]) and cognitive function (MMSE: r=-.523, [-.805, -.069]; DemTect: r=-.744, [-.951, -.385] and TMT-A: r=.692, [.255, .922]). LimitationsSmall sample size, insufficient quality of several MRI scans due to motion artifact. ConclusionsResolution of hyponatremia was associated with improved cognition and reductions in brain volumes and neuronal activity. Impaired cognition during hyponatremia is closely linked to increased neuronal activity rather than to tissue volumes. Furthermore, the hippocampus appears to be particularly susceptible to hyponatremia, exhibiting pronounced changes in tissue volume.

Dynamics of Cerebral Function in Patients with Acute Cerebellar Infarction.

Few studies were devoted to investigating cerebral functional changes after acute cerebellar infarction (CI). The purpose of this study was to examine the brain functional dynamics of CI using electroencephalographic (EEG) microstate analysis. And the possible heterogenicity in neural dynamics between CI with vertigo and CI with dizziness was explored. Thirty-four CI patients and 37 age- and gender-matched healthy controls(HC) were included in the study. Each included subject underwent a 19-channel video EEG examination. Five 10-s resting-state EEG epochs were extracted after data preprocessing. Then, microstate analysis and source localization were performed using the LORETA-KEY tool. Microstate parameters such as duration, coverage, occurrence, and transition probability are all extracted. The current study showed that the duration, coverage, and occurrence of microstate(Ms) B significantly increased in CI patients, but the duration and coverage of MsA and MsD decreased. Compared CI with vertigo to dizziness, finding a decreasedtrend in the coverage of MsD and the transition from MsA and MsB to MsD. Taken together, our study sheds new light on the dynamics of cerebral function after CI, mainly reflecting increased activity in functional networks involved in MsB and decreased activity in functional networks involved in MsA and MsD. Vertigo and dizziness post-CI may be suggested by cerebral functional dynamics. Further longitudinal studies are needed to validate and explore the alterations in brain dynamics to what extent depict the clinical traits and their potential applications in the recovery of CI.

Visual suppression of vestibulo-ocular reflex in patients treated with carotid artery revascularization: A potential biomarker for cerebral perfusion

BackgroundCarotid endarterectomy (CEA) and carotid artery stenting (CAS) are common treatments for ischemic stroke prevention in patients with carotid artery stenosis. However, the beneficial effects of CEA/CAS for cerebral hypoperfusion due to carotid artery stenosis have yet to be fully established. As dizziness is a common symptom in patients with carotid artery stenosis, we aimed to evaluate the effects of CEA/CAS on cerebral function in patients with carotid artery stenosis, using equilibrium function tests. MethodsThis prospective observational cohort study included 50 patients who had carotid artery stenosis and were scheduled to undergo CEA or CAS. Before CEA/CAS, we quantitatively evaluated the vestibulo-ocular reflex (VOR) and vestibular evoked myogenic potential (VEMP), as indicators of brainstem/inner ear functions related to balance, and visual suppression of VOR, as an indicator of cerebral control over the brainstem reflex related to balance. These were then compared with supratentorial cerebral blood flow (CBF). Changes in VOR, VEMP, visual suppression of VOR, CBF, and dizziness after CEA/CAS were also evaluated. ResultsThe visual suppression rates of VOR correlated with supratentorial CBFs before CEA/CAS (correlation coefficient = 0.47, p = 0.003). The visual suppression rates of VOR (p < 0.001) and supratentorial CBFs (p = 0.003) were improved by CEA/CAS, while VOR and VEMP did not change. Symptoms of dizziness improved after CEA/CAS. ConclusionsOur results suggest that visual suppression of the VOR may be a novel and practical marker for the beneficial effects of CEA/CAS on supratentorial cerebral function.

Voxel-based morphometry study of the brain structures in patients with congenital hereditary hearing loss

Objective: To analyze the physiological basics for changes of cerebral functions in patients with congenital hereditary hearing loss (CHHL), by using voxel-based morphometry (VBM). Methods: From June 2016 to June 2017, we recruited volunteers from Yangzhou Special Education School and CHHL patients from the Department of Otorhinolaryngology, Subei People's Hospital as a case group with a total of 14 cases (8 males and 6 females), with an average age from 10 to 18 (13.13 ± 0.39). At the same time,patients with no ear diseases were recruited as a control group, a total of 23 cases (10 males and 13 females), with an average age from 10 to18 (13.50 ± 0.49). Brain scanning with resting state functional magnetic resonance imaging was performed on all subjects, and 3D T1WI was collected and processed by the analyzing software. Two sample t-tests were conducted with alphasim correction at the threshold level of P<0.001. Different morphologies of cerebral cortex were identified between patients with CHHL and their normal controls retrospectively. Results: Compared to their normal controls, patients with CHHL had no significant difference in terms of brain volume, gray matter volume, white matter volume, and cerebrospinal fluid volume ((1 397.53±103.98)cm(3) vs. (1 439.45±128.84)cm(3), (765.19±60.27)cm(3) vs. (800.139±77.64)cm(3), (392.89±40.38)cm(3) vs. (414.54±49.22)cm(3), (314.17±25.81)cm(3) vs. (296.47±51.42)cm(3), all P>0.05). However, compared to their normal controls, patients with CHHL had significantly increased (P<0.001) gray matter in the following cerebral gyri: right temporal pole: middle temporal gyrus, right inferior temporal gyrus, left middle occipital gyrus, right inferior parietal gyrus, and left middle frontal gyrus, left superior occipital gyrus, right superior frontal gyrus, and left superior frontal gyrus. Furthermore, compared to their normal controls, patients with CHHL had significantly decreased (P<0.001) gray matter in the following cerebral gyri: left parahippocampal gyrus, right fusiform gyrus, right middle frontal gyrus, left inferior temporal gyrus, right middle occipital gyrus, left insula, right inferior frontal gyrus, left precentral gyrus, and right superior parietal gyrus. Conclusions: Patients with CHHL show global changes in cerebral cortex not limited to auditory associated cerebral areas. This suggests that adaptable reshaping of global brain structures and functions has occurred in patients with CHHL.

Hepatic encephalopathy - current considerations

Hepatic encephalopathy (EH) is a syndrome involving a series of neuropsychiatric abnormalities in patients with hepatocellular damage and/or portosystemic venous shunts in the absence of other cerebral diseases. It is the late consequence of portal hypertension with a high degree of spontaneous or surgically created portosystemic shunts. The pathogenic substrate is the diffuse disturbance of cerebral metabolism due to insufficient processing or shunting of the liver by intestinal toxic nitric products. The clinical evaluation by psychometric tests may reveal minimal EH for an adequate early management and preservation of the integrity of cerebral functions in patients with cirrhosis.

A combined study of 18F-FDG PET-CT and fMRI for assessing resting cerebral function in patients with major depressive disorder.

The present study investigated changes in the regional cerebral metabolic rates of glucose uptake (rCMRglc) using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and regional homogeneity (ReHo), together with resting-state blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI), in patients with major depressive disorder (MDD). In total, 18 patients with untreated MDD and 17 healthy control subjects underwent 18F-FDG PET and BOLD-fMRI scanning. The MDD patients' cerebral changes, measured as rCMRglc and ReHo values, were mapped and statistically analyzed. Compared with the control group, the patients with MDD had a decreased rCMRglc in the bilateral superior, middle and inferior frontal gyrus, in the bilateral superior and middle temporal gyrus, in the bilateral anterior cingulate cortex, in the bilateral putamen and caudate, and in the left pallidum, but an increased rCMRglc in the bilateral hippocampus and left thalamus. The ReHo values in the patient group were decreased in the bilateral superior and middle frontal gyrus, left pallidum, bilateral putamen and left anterior cingulate cortex, but increased in the right hippocampus and thalamus. No statistically significant differences were identified between decreased metabolism and ReHo brain regions of MDD patients (χ2=9.16; P=0.90) and between increased metabolism and ReHo brain regions (χ2=3.96; P=0.27), when comparing activated brain regions of PET and MRI. The standardized uptake values (SUV) of the bilateral superior, middle and inferior frontal gyrus, bilateral superior and middle temporal gyrus, bilateral putamen, the left caudate and pallidum, the left anterior cingulate cortex, and the bilateral hippocampus and thalamus were correlated with the ReHo (r=0.51–0.83; P<0.05). However, no correlation was detected between the SUV and ReHo in the right caudate and anterior cingulate cortex (r=0.41 and 0.37, respectively; P>0.05). Taken together, these results demonstrated that patients with MDD displayed characteristic patterns regarding changes of brain glucose uptake and ReHo in the resting state. Furthermore, 18F-FDG PET may be a more sensitive technique compared with BOLD-fMRI for the identification of brain lesions in patients with MDD.

Precuneus-related regional and network functional deficits in social anxiety disorder: A resting-state functional MRI study

BackgroundNeuroimaging findings suggest that social anxiety disorder (SAD) may be correlated with changes in regional- or network-level brain function. However, few studies have explored alterations in intrinsic resting cerebral function in patients with SAD at both the regional and network levels, particularly focusing on the theory of mind (ToM)-related regions. This study was performed to investigate changes in neural activity and functional connectivity (FC) in ToM-related regions during the resting state in SAD patients and to determine how these alterations are correlated with the clinical symptoms of SAD. MethodsForty-three SAD patients and 43 matched healthy controls underwent resting-state functional magnetic resonance imaging (rsfMRI) scans. First, the amplitude of low-frequency fluctuation (ALFF) approach was used to explore regional activity. Then, the ToM-related region, i.e., the left precuneus, which showed altered ALFF values, was adopted as a seed for further FC analyses to assess network-level alterations in SAD. Between-group differences were compared using voxel-based two-sample t-tests (P<0.05, with Gaussian random field correction). Pearson's correlation analyses were performed to examine relationships between alterations in ALFF and FC and clinical symptoms. ResultsCompared with the healthy controls, SAD patients showed decreased ALFF in the bilateral putamen (PUT) and left supplementary motor area (SMA) and increased ALFF in the right inferior parietal lobule (IPL), left precuneus and right cerebellar posterior lobe. Moreover, SAD patients exhibited lower connectivity between the left precuneus and the cerebellar posterior lobe, right inferior temporal gyrus (ITG), right parahippocampal gyrus (PHG) and left medial prefrontal cortex (mPFC). The altered ALFF values in the left precuneus and the hypoconnectivity between the left precuneus and left cerebellar posterior lobe were correlated with the patients' clinical symptoms (P<0.05). ConclusionThe precuneus, a ToM-related region, was altered at both the regional and network level in patients with SAD. Pathological fear and avoidance in SAD were correlated with abnormal regional function in the precuneus, whereas depression and anxiety were primarily correlated with functional deficits in the precuneus-related network. The altered FC within the precuneus-cerebellar region may reflect an imbalance in the neuromodulation of anxiety and depressive symptoms in SAD. These findings may facilitate a greater understanding of potential SAD neural substrates and could be used to identify potential targets for further treatment.

Frail phenotype is associated with distinct quantitative electroencephalographic findings among end-stage renal disease patients: an observational study

BackgroundFrailty is prevalent among patients with end-stage renal disease (ESRD) and is associated with an increased risk of cognitive impairment. However, apart from its influence on cognition, it is currently unknown whether frailty affects subtler cerebral function in patients with ESRD.MethodsPatients with ESRD were prospectively enrolled, with clinical features and laboratory data recorded. The severity of frailty among these patients with ESRD was ascertained using the previously validated simple FRAIL scale, and was categorized as none-to-mild and moderate-to-severe frailty. All participants underwent quantitative electroencephalography (EEG), with band powers documented following the generation of the delta to alpha ratio (DAR) and delta/theta to alpha/beta ratio (DTABR). EEG results were then compared between groups of different levels of frailty.ResultsIn this cohort, (mean age: 68.9 ± 10.4 years, 37% male, 3.4 ± 3 years of dialysis), 20, 60, 40, 17, and 6% patients exhibited positivity in the fatigue, resistance, ambulation, illness, and loss-of-body-weight domains, respectively, with 45.7% being none to mildly frail and 54.3% being moderately to severely frail. Those with mild frailty had a significantly higher delta power compared to those with more severe frailty, involving all topographic sites. Patients with ESRD and severe frailty had significantly lower global, left frontal, left temporo-occipital, and right temporo-occipital DAR and DTABR, except in the right frontal area, and tended to have central accentuation of alpha, beta, and theta power, and more homogeneous DTABR and DAR distribution compared to the findings in those with mild frailty.ConclusionsFrailty in patients with ESRD can have subtler neurophysiological influences, presenting as altered EEG findings, which warrant our attention.

Stress-induced brain activity, brain atrophy, and clinical disability in multiple sclerosis

Prospective clinical studies support a link between psychological stress and multiple sclerosis (MS) disease severity, and peripheral stress systems are frequently dysregulated in MS patients. However, the exact link between neurobiological stress systems and MS symptoms is unknown. To evaluate the link between neural stress responses and disease parameters, we used an arterial-spin-labeling functional MRI stress paradigm in 36 MS patients and 21 healthy controls. Specifically, we measured brain activity during a mental arithmetic paradigm with performance-adaptive task frequency and performance feedback and related this activity to disease parameters. Across all participants, stress increased heart rate, perceived stress, and neural activity in the visual, cerebellar and insular cortex areas compared with a resting condition. None of these responses was related to cognitive load (task frequency). Consistently, although performance and cognitive load were lower in patients than in controls, stress responses did not differ between groups. Insula activity elevated during stress compared with rest was negatively linked to impairment of pyramidal and cerebral functions in patients. Cerebellar activation was related negatively to gray matter (GM) atrophy (i.e., positively to GM volume) in patients. Interestingly, this link was also observed in overlapping areas in controls. Cognitive load did not contribute to these associations. The results show that our task induced psychological stress independent of cognitive load. Moreover, stress-induced brain activity reflects clinical disability in MS. Finally, the link between stress-induced activity and GM volume in patients and controls in overlapping areas suggests that this link cannot be caused by the disease alone.

Altered Intrinsic Regional Activity and Interregional Functional Connectivity in Post-stroke Aphasia.

Several neuroimaging studies have examined cerebral function in patients who suffer from aphasia, but the mechanism underlying this disorder remains poorly understood. In this study, we examined alterations in the local regional and remote interregional network cerebral functions in aphasia combined with amplitude of low-frequency fluctuations and interregional functional connectivity (FC) using resting-state functional magnetic resonance imaging. A total of 17 post-stroke aphasic patients, all having suffered a stroke in the left hemisphere, as well as 20 age- and sex-matched healthy controls, were enrolled in this study. The aphasic patients showed significantly increased intrinsic regional activity mainly in the contralesional mesial temporal (hippocampus/parahippocampus, [HIP/ParaHIP]) and lateral temporal cortices. In addition, intrinsic regional activity in the contralesional HIP/ParaHIP was negatively correlated with construction score. Aphasic patients showed increased remote interregional FC between the contralesional HIP/ParaHIP and fusiform gyrus, but reduced FC in the ipsilesional occipital and parietal cortices. These findings suggested that the intrinsic regional brain dysfunctions in aphasia were related to interregional functional connectivity. Changes in the intrinsic regional brain activity and associated remote functional connectivity pattern would provide valuable information to enhance the understanding of the pathophysiological mechanisms of aphasia.

Changes of neurocognitive cerebral functions in patients after aortic arch and brachiocephalic arteries surgery (review)

Changes of neurocognitive cerebral functions in patients after aortic arch and brachiocephalic arteries surgery (review)

Impact of early stages of (mild) hepatitis C viral infection on neurocognitive functions in otherwise healthy patients: an Egyptian magnetic resonance spectroscopy study

Background The alterations in cerebral function in patients with chronic hepatitis C virus (HCV) infection may be due to a direct effect of HCV on the brain, or due to neurotoxic-related systemic inflammation. Objective This study aimed to assess central nervous system involvement through brain magnetic resonance spectroscopy (MRS) as well as cognitive functions in HCV-infected patients with mild liver disease. Patients and methods Twenty-eight HCV-infected patients with slightly elevated liver enzymes were recruited from the outpatient Hepatology Clinic, Beni Sweif University Hospitals and Ain Shams University Hospitals. They underwent cognitive examination by means of the Wechsler attention, concentration, and memory subscales, as well as cerebral MRS. The results of all investigations were compared with corresponding results of 15 matched normal controls. Results The results showed mild but significant elevation of liver enzymes in the patient group compared with the control group with impaired levels of attention, concentration, and memory determined by the subscales. MRS findings showed elevated choline and myoinositol in the basal ganglia, decreased N -acetyl aspartate, and abnormal N -acetyl aspartate/creatine ratio. Conclusion Treatment plans for HCV should consider neuropsychological complications.

Bedside saccadometry as an objective and quantitative measure of hemisphere-specific neurological function in patients undergoing cranial surgery

Cranial surgery continues to carry a significant risk of neurological complications. New bedside tools that can objectively and quantitatively evaluate cerebral function may allow for earlier detection of such complications, more rapid initiation of therapy, and improved patient outcomes. We assessed the potential of saccadic eye movements as a measure of cerebral function in patients undergoing cranial surgery peri-operatively. Visually evoked saccades were measured in 20 patients before (−12hours) and after (+2 and +5days) undergoing cranial surgery. Hemisphere specific saccadic latencies were measured using a simple step-task and saccadic latency distributions were compared using the Kolmogorov–Smirnov test. Saccadic latency values were incorporated into an empirically validated mathematical model (Linear Approach to Threshold with Ergodic Rate [LATER] model) for further analysis (using Wilcoxon signed rank test). Thirteen males and seven females took part in our study (mean age 55±4.9years). Following cranial surgery, saccades initiated by the cerebral hemisphere on the operated side demonstrated significant deteriorations in function after 2days (p<0.01) that normalised after 5days. Analysis using the LATER model confirmed these findings, highlighting decreased cerebral information processing as a potential mechanism for noted changes (p<0.05). No patients suffered clinical complications after surgery. To conclude, bedside saccadometry can demonstrate hemisphere-specific changes after surgery in the absence of clinical symptoms. The LATER model confirms these findings and offers a mechanistic explanation for this change. Further work will be necessary to assess the practical validity of these changes in relation to clinical complications after surgery.

Assessment of Executive Functions in Chronic Hepatitis C Virus Infected Patients

Background: Chronic infection with HCV is one of the most important causes of chronic liver disease, which can progress to cirrhosis and hepatocellular carcinoma (HCC). It is well established that advanced forms of the disease are accompanied by overt and global cognitive deficits (hepatic encephalopathy) but now there is a growing evidence that the alterations in cerebral function in patients with chronic HCV infection may appear long before the development of severe liver cirrhosis, it has been hypothesized that it is related to a direct effect of HCV on the brain; or the neurotoxic effect of HCV-related systemic inflammation. Aim: The purpose of the study was to assess the possible existence of executive dysfunction in chronic HCV infected patients without cirrhosis. Study design: case control study. Participants: 100 elderly patients aged 60 years and above, 50 patients are HCV positive (cases) and 50 patients are HCV negative (controls) both groups have no liver cirrhosis. Methods: All participants were subjected to the following: Diagnosis of HCV by detection of HCV ab using ELISA technique, non invasive assessment of liver cirrhosis using abdominal ultrasound, and evaluation of executive functions using 5 neuropsychological tests (block design, digit span backwards, animal verbal fluency, clock drawing, and EXIT 25). Results: The study showed that there is a significant difference between cases and controls regarding Exit 25 and Digit span backwards tests scores indicating affection of the phonological loop component of working memory among HCV positive patients. Conclusion: Executive functions are affected in patients with chronic HCV infection without liver cirrhosis.

Cognitive impairments in patients with brain injury

The paper gives the data of Russian and foreign authors and the results of this paper authors’ investigation of higher cerebral functions in patients who have sustained brain injury (BI). It shows their high prevalence, the predominance of cognitive impairments (CI) over neurological disorders in patients with mild and moderate injury, presents their quantitative and qualitative features (a preponderance of focal symptoms in severe injury and neurodynamic disorders in mild injury), describes the predictors of their course and prognosis (the degree of injury is one of the most important predictors), and discusses current trends in the medical correction of detected abnormalities.

Electroencephalogram Analysis

Cerebral hemorrhage may cause cognitive dysfunction. Electroencephalogram (EEG) is a noninvasive diagnostic tool for assessment of cerebral function. A total of 174 patients (including cognitively impaired and cognitively normal) with cerebral hemorrhage, and 120 healthy persons (CN), were recruited between August 2008 and July 2012 at the Department of Neurology. EEG was used to analyze cerebral function of patients and normal persons. Correlation, clustering and concordance analyses were performed to analyze the relationship between EEG power and Montreal Cognitive Assessment (MoCA) scores. Cognitively impaired patients had a significantly decreased EEG beta power (0.793 ± 0.176 µV(2)) compared with cognitively normal patients (1.589 ± 0.205 µV(2), P < .01) or healthy persons (1.651 ± 0.185 µV(2), P < .01). Significantly negative correlations between beta power and hemorrhage region, size, amount, and patients' age were apparent (r = -0.91888, -0.78569, -0.84961, and -0.80365, respectively, all Ps < .001). There was good concordance between the K-means clustering algorithm calculating beta power and MoCA scoring (κ = .904, P < .001). In conclusion, the analysis method of EEG (beta power) abnormalities holds considerable promise to assess cognitive impairment after cerebral hemorrhage. Cognitive impairment was negatively correlated to hemorrhage region, size, amount, and age.

Effect of Acupuncture Therapy for Postponing Wallerian Degeneration of Cerebral Infarction as Shown by Diffusion Tensor Imaging

One aim of this study was to investigate the effects of acupuncture on cerebral function of patients with acute cerebral infarction. Another goal was to evaluate the relationship between acupuncture treatment and motor recovery patients with stroke and to provide a foundation for using acupuncture therapy for such patients. Twenty (20) patients with recent cerebral infarction were divided randomly to an acupuncture group and a control group. The infarction area in each patient was in the basal ganglia or included the basal ganglia with an area size of > 1 cm(2). Serial diffusion tensor imaging (DTI), fluid-attenuated inversion recovery (FLAIR), and T2-weighted imaging (T(2)WI) scans were performed on all patients and the results were evaluated using the National Institute of Health Stroke Scale and the Barthel Index each week. DTI images were postprocessed and analyzed. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of abnormal signals on DTI in the infarction areas and cerebral peduncles were calculated for both groups and compared with one another. (1) The ADC value of infarction lesions decreased at stroke onset; then, a significant elevation was observed after the acute stage, and a significant reduction in FA values was observed from stroke onset to the chronic stage. (2) The ADC of the bilateral cerebral peduncle was reduced on the infarction side. (3) There was a significant difference in ADC and FA values between the acupuncture and control groups. The FA value was higher in the acupuncture group than the control group. ADC and FA values might correlate to patient recovery and reveal the progress of secondary degeneration. Acupuncture treatment is effective for protecting neurons and facilitating recovery.

Cardiocerebral resuscitation: advances in cardiac arrest resuscitation

Cardiac arrest remains a leading cause of death in the world. Although advances in emergency cardiac care has been achieved, the survival rate of those non hospitalized hospital cardiac arrest remains low. Update in guidelines for CPR and emergency cardiovascular, their approach to out of hospital cardiac arrest is far from optimal. This provides an opportunity to advocate cardiocerebral resuscitation as an alternative to traditional cardiopulmonary resuscitation for non hospitalized cardiac arrest. Because cardiocerebral resuscitation results in improved survival and cerebral function in patients with witnessed cardiac arrest and a shockable rhythm whom have greatest chance of survival, it should replace CPR especially for non hospitalized cardiac arrest.(Med J Indones 2011; 20:306-9)

The use of evoked potentials in the management of patients with severe cerebral trauma.

Evoked potentials (SEP and BAEP) were measured daily in 18 patients who had suffered severe craniocerebral trauma, but could not be examined neurologically due to a barbiturate coma or neuromuscular blockade. The BAEP had only limited value as an indicator of the prognosis for these patients. The N20 component of the SEP appeared to be more valuable in this respect. Serial registration of the EPs was also of prognostic significance and proved to play an important role in the decision to stop or continue the barbiturate coma. In some patients serial measurement of the EPs also gave an indication of the presence of late posttraumatic intracranial mass lesions. EPs are useful for the monitoring of cerebral functions in patients who have suffered a contusion of the brain and can no longer be assessed clinically.