Chronic Cerebral Vascular Disease Research Articles

Moya-Moya Disease a Case Report and Literature Review

Moya-Moya disease is a rare chronic cerebral vascular disease (arteriopathy), which can affect both children and adults and gives rise to severe clinical manifestations of ischemic or hemorrhagic origin. This angiogenic disease is an intrinsic primary pathological process, characterized by a narrowing of the distal internal carotid artery that extends to the proximal segments of the middle and anterior cerebral arteries, inducing the formation of replacement vessels that give a characteristic appearance on angiography forming a smoke cloud: Moya Moya network. The involvement of the posterior circulation is very rare. Its etiology is still poorly understood and represents 10 to 15% of the causes of strokes, with 2 age peaks where it is more frequent: children around 5 years and adults around 40 years. Its evolution can be slow with intermittent symptoms or fulminant with a rapid neurological decline. Imaging is the reference examination in the diagnosis of Moya-Moya. MRI (Magnetic Resonance Imaging) has an important and growing role in the management of the disease. We report a case of a 48 year old patient with diabetes and hypertension, hospitalized for a deep left hematoma.

Moyamoya disease incidentally discovered in head trauma

Moyamoya disease is a chronic cerebral vascular disease of undetermined origin, characterized by stenosis and progressive occlusion of the distal portion of the internal carotid arteries and the proximal portion of the middle and anterior cerebral arteries with resulting, abnormal vascular network development at the base of the skull, realizing a smoke volute appearance or moyamoya. The disease is most common in East Asia. It has two peaks of incidence: around the age of 05 years and during the 4th decade with a female predominance. In children, it leads more frequently to repeated ischemic strokes, while in adults, cerebral hemorrhages are observed. Cerebral MRI and arteriography are the imaging modalities allowing the positive diagnosis of the disease as well as the planning of the management which is based on a revascularization surgery which must be indicated at the optimal period during the follow-up of the disease.

Chronic cerebrovascular diseases and neuroprotection: the clinical efficacy of meldonium (Mildronat)

To evaluate the efficacy of meldonium (mildronat) in patients with chronic cerebral vascular disease (CVD). An open comparative study of the clinical efficacy of meldonium (mildronat) in patients with chronic CVD caused by arterial hypertension and atherosclerosis was conducted. The main group included 30 (60%) patients who were prescribed meldonium (mildronat) at a dose of 1000 mg per day in addition to routine basic therapy. The control group was consisted of 20 (40%) patients who received routine basic therapy only. The duration of the study was 60 days. To evaluate the clinical efficacy of the meldonium (mildronat), the main subjective clinical symptoms, neurological, psychoemotional and cognitive status, quality of life were assessed when patients were included in the study (before treatment), on the 11th and 60th days from the start of treatment. To assess the meldonium (mildronat) effect on the endothelium vascular wall, asymmetric dimethylarginine (ADMA), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and endothelin-1 were determined in the blood when patients were included in the study, on the 11th and 60th days from the start of treatment. Meldonium (mildronat) has a positive therapeutic effect on the main clinical symptoms and cognitive functions which appears in increasing the quickness of mental activity, improving short-term and operative memory, increasing the resistance of mental processes and memory traces to interfering influences, and improving cognitive evoked potentials P300 results. Meldonium (mildronat) therapy leads to the decrease in the level of state and trait anxiety. The quality of life of patients treated with meldonium (mildronat) increases due to the physical and mental components. The effect of meldonium (mildronat) on the decrease in endothelin-1 and PAI-1 levels, which indicates the antitrombogenic effect of the drug, has been identified. Nootropic, anxiolytic and antitrombogenic effects of meldonium (mildronat) in patients with chronic CVD are demonstrated that makes it possible to recommend this drug for widespread use by specialists in clinical practice.

Comparison of adaptive statistical iterative and filtered back projection reconstruction techniques in brain CT

PurposeTo compare image quality and visualization of normal structures and lesions in brain computed tomography (CT) with adaptive statistical iterative reconstruction (ASIR) and filtered back projection (FBP) reconstruction techniques in different X-ray tube current–time products. Materials and methodsIn this IRB-approved prospective study, forty patients (nineteen men, twenty-one women; mean age 69.5±11.2 years) received brain scan at different tube current–time products (300 and 200mAs) in 64-section multi-detector CT (GE, Discovery CT750 HD). Images were reconstructed with FBP and four levels of ASIR-FBP blending. Two radiologists (please note that our hospital is renowned for its geriatric medicine department, and these two radiologists are more experienced in chronic cerebral vascular disease than in neoplastic disease, so this research did not contain cerebral tumors but as a discussion) assessed all the reconstructed images for visibility of normal structures, lesion conspicuity, image contrast and diagnostic confidence in a blinded and randomized manner. Volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded. All the data were analyzed by using SPSS 13.0 statistical analysis software. ResultsThere was no statistically significant difference between the image qualities at 200mAs with 50% ASIR blending technique and 300mAs with FBP technique (p>.05). While between the image qualities at 200mAs with FBP and 300mAs with FBP technique a statistically significant difference (p<.05) was found. ConclusionASIR provided same image quality and diagnostic ability in brain imaging with greater than 30% dose reduction compared with FBP reconstruction technique.

Quantitative mapping of basal and vasareactive cerebral blood flow using split-dose 123I-iodoamphetamine and single photon emission computed tomography

A new method has been developed for diffusible tracers, to quantify CBF at rest and after pharmacological stress from a single session of dynamic scans with dual bolus administration of a radiotracer.The calculation process consisted of three steps, including the procedures of incorporating background radioactivity contaminated from the previous scan. Feasibility of this approach was tested on clinical SPECT studies on 16 subjects. Two sequential SPECT scans, 30 min apart, were carried out on each subject, after each of two split-dose administrations of 111 MBq IMP. Of these, 11 subjects received acetazolamide at 10 min before the second IMP injection. Additional PET scans were also carried out on 6 subjects on a separate day, at rest and after acetazolamide administration. The other 5 subjects were scanned only at rest during the whole study period.Quantitative CBF obtained by this method was in a good agreement with those determined with PET (y(ml/100 g/min)=1.07×(ml/100 g/min)−1.14, r=0.94). Vasareactivity was approximately 40% over the whole cerebral area on healthy controls, which was consistent with a literature value. Reproducibility of CBF determined in the rest–rest study was 1.5±5.7%. Noise enhancement of CBF images, particularly the second CBF, was reduced, providing reasonable image quality.Repeat assessment of quantitative CBF from a single session of scans with split-dose IMP is accurate, and may be applied to clinical research for assessing vascular reactivity in patients with chronic cerebral vascular disease.

Second Phase Platelet Aggregation Induced by Adenosine Diphosphate in Patients with Cerebral Vascular Disease and in Control Subjects

SummaryAdenosine diphosphate-induced second phase platelet aggregation was studied in 70 patients with established cerebral vascular disease, 27 patients with chronic cerebral vascular disease taking dipyridamole, and 53 control subjects. The appearances of aggregation graphs relating changes in optical density in platelet-rich plasma to time after addition of adenosine diphosphate are described. An intermediate rate change in optical density was observed between first and second phase aggregation.Induction of second phase aggregation depends on the concentration of adenosine diphosphate and the platelet count of the plasma. Individual rseponses vary greatly, and there is appreciable variability in repeated estimations, but in the same plasma responses to adenosine diphosphate are accurately reproducible.In both patients and controls the mean logarithm of the adenosine diphosphate concentration that just induces second phase aggregation is inversely proportional to the mean platelet count of platelet-rich plasma. At all platelet concentrations studied, the smallest concentration of adenosine diphosphate that brought about second phase aggregation was significantly less in the patients than in controls. There was no significant correlation between the means of the two variables in patients taking dipyridamole. The findings in this group of patients accord with the assumption that dipyridamole favourably affects the abnormal reaction of platelets to adenosine diphosphate in some of the patients with cerebral vascular disease.

Cerebral functions in acute and chronic cerebral vascular disease: Effects of inhalation of high concentrations of oxygen

Cerebral functions in acute and chronic cerebral vascular disease: Effects of inhalation of high concentrations of oxygen