Improvement In Brain Perfusion Research Articles

Improvement of brain perfusion in patients with chronic brain ischemia at epidural spinal cord electrical stimulation.

ObjectiveIncreasing life expectancy and aging of the population is accompanied by a steady increase in the number of elderly patients with chronic cerebral ischemia and age-related cognitive impairment associated with cerebral hypoperfusion and microangiopathy. The aim of this study was to identify long-term changes in cerebral blood flow (CBF) in patients with chronic cerebral ischemia at the epidural electrical stimulation of the spinal cord (SCS).Materials and methodsChanges in cerebral blood flow were studied according to CT perfusion in 59 patients (aged 55–78 years) with vertebrogenic pain syndromes and chronic cerebral ischemia during epidural electrical stimulation of the spinal cord at the cervical (C3–C5) and lower thoracic (Th9–Th10) levels.ResultsIn all patients, on the 5th day of trial SCS, an increase in cerebral blood flow by from 58.6 ± 1.13 ml/100 ml/min to 64.8 ± 1.21 ml/100 ml/min (p < 0.01) with stimulation at the Th9-Th10 level and from 58.8 ± 1.12 ml/100 ml/min to 68.2 ± 1.42 ml/100 ml/min (p < 0, 01) with stimulation at the C3-C5 level. These changes in brain perfusion were preserved during the follow-up examination 1 year after the implantation of chronic SCS system. The greatest increase in CBF was registered in the frontotemporal regions, subcortical structures and white matter of the brain. Changes in cerebral perfusion did not correlate with the degree of reduction in the severity of the accompanying pain syndrome. The change in CBF in the control group (32 patients) in all periods was not statistically significant.ConclusionOur results show that SCS is accompanied by a persistent improvement in brain perfusion, which may be potentially useful for developing methods for reducing age-related vascular disorders in the elderly.

A Case Series of 39 United States Veterans with Mild Traumatic Brain Injury Treated with Hyperbaric Oxygen Therapy

Importance: The Defense and Veterans Brain Injury Center reported 358,088 mild traumatic brain injury (mTBI) among U.S. service members worldwide between the years 2000 and 2020. Veterans with mTBI have higher rates of Post-Traumatic Stress Disorder (PTSD), depressive disorder, substance use disorder, anxiety disorder, and suicide than their healthy counterparts. Currently, there is no effective treatment for mTBI. Objective: To assess the efficacy of hyperbaric oxygen therapy (HBOT) as a treatment option for mTBI. Design, Setting, Participants: This is a case series of 39 U.S. Veterans diagnosed with mTBI and treated with HBOT. Of these participants, 36 were men and 3 women, and their ages ranged between 28 and 69. The treatment was administered by The 22 Project (a veteran-centered nonprofit organization) using monoplace hyperbaric chambers located in Delray Beach, Florida. Neuroimaging using Single Photon Emission Computer Tomography (SPECT) brain scans performed pre- and post-HBOT were made available for secondary analysis. Nilearn Python Library was utilized to visualize the corresponding neuroimaging data. A two-sided paired t-test in R was used to compare the pre- and post-treatment results. Intervention: A full treatment of HBOT involved 40 sessions. Each session consisted of the administration of 100% oxygen at 1.5 atmospheres for 90 min, twice a day, for 20 days, Mondays to Fridays only. Main Outcome and Measure: Perfusion in the brain’s Brodmann Areas (BA) comparing pre- and post-HBOT using NeuroGam software analysis from brain SPECT scan neuroimaging and multi-symptom self-reports. Results: A comparison between the pre- and post-HBOT brain scans showed significant improvement in the brain perfusion, and the difference was statistically significant (p &lt; 0.001). Separately, participants reported reduced pain, improved mood, and better sleep, an outcome that translated into an average of about 46.6% improvement in the measured symptoms. Conclusions and Relevance: This series demonstrated that HBOT could be a useful treatment for mTBI in U.S. veterans. The participants in the study showed marked improvement in both brain perfusion measured on SPECT scan imaging and measured mTBI symptoms. This is the first study to use brain SPECT scans with quantitative numerical measurements to demonstrate improvement in brain perfusion in veterans with mild TBI treated with HBOT and measured mTBI symptoms. Future research studies are currently being done to validate these important findings.

Regional cerebral hypoperfusion as a cause of symptoms and progression of multiple sclerosis

Background. Neurodegenerative processes play an important role in the development of clinical features of multiple sclerosis (MS) as well as in the progression of the disease. At the same time, neurodegenerative mechanisms of MS are not completely clear, which makes researchers pay special attention to pathogenetic aspects of the disease that have not been studied before. Previously it was shown that MS patients can have alterations in the local cerebral blood flow, however, the meaning of the detected abnormalities is still not clear.The aim of our workis to evaluate the perfusion character in the demyelinating lesions and normalappearing brain structures, and to determine their relation to clinical features of MS.Material and methods. 49 patients with relapsing-remitting and secondary progressive MS with clinical and MRI remission were included in the study. The patients underwent contrast-enhanced MR perfusion of the brain on the 3 Tesla MR-tomograph, as well as the Functional System Score, Expanded Disability Status Score and Fatigue Status Score evaluation. The data analysis included automatic construction of perfusion maps of the cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) values in the normal-appearing brain structures and in the demyelinating lesions and statistical analysis.Results. The received results allow to presume that variation of CBV values in MS lesions can indicate heterogeneity of processes in these lesions – from reactivation of inflammation to remyelination.Significant reduction of perfusion in nucleus lenticularis was revealed. This reduction did not depend on the severity of the disease and correlated negatively with the fatigue score. This allows to suppose that the therapy focused on brain perfusion improvement can be used as symptomatic therapy of MS. Considering the fact that regional hypoperfusion precedes the development of brain structure atrophy, it is hypothesized that the improvement of perfusion may prevent neurodegeneration in MS. The obtained findings need further investigation.

Effects of uncomplicated carotid endarterectomy on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery by comparison with unoperated patients

Objective: The purpose of the present exploratory study was to evaluate the effects of uncomplicated carotid endarterectomy (CEA) on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery (ICA) by comparison with unoperated patients.Methods: Patients with age ≤75 years and unilateral asymptomatic severe stenosis (≥70%) of the cervical ICA underwent CEA with antiplatelet therapy (surgically treated group: 116 patients) or antiplatelet therapy alone or neither (medically treated group: 45 patients). For the surgically treated group, neuropsychological testing and brain perfusion measurement using single-photon emission computed tomography were performed within one month before surgery and one month after surgery. For the medically treated group, the same testing and measurement were performed twice at an interval of 1 to 2 months.Results: None of the operated patients developed new major ischemic events after surgery or intraoperative cerebral hyperperfusion. None of the patients in the medically treated group experienced neurological deficits including transient ischemic attacks during the study period. The incidence of patients with interval cognitive improvement was significantly greater in the surgically treated group (11 patients: 9%) than in the medically treated group (0%) (p = 0.0352). The incidence of patients with interval brain perfusion improvement in the ipsilateral cerebral hemisphere was significantly greater in the surgically treated group (24 patients: 21%) than in the medically treated group (0%) (p = 0.0003).Conclusions: Uncomplicated CEA may improve cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the ICA when compared with unoperated patients.

Electroacupuncture Alleviates Headache and Reduces Cerebral Blood Flow Velocity in Aneurysmal Subarachnoid Hemorrhage

Background: Aneurysmal subarachnoid hemorrhage (SAH) is a medical emergency characterized by extravasation of blood into the subarachnoid space after the rupture of a cerebral aneurysm and presents a high risk of complications and death. Case: A young patient (a previously healthy 32-year-old man) presented with SAH accompanied by a severe headache and vasospasm (as shown on a transcranial Doppler scan). The objective was to use integrative medicine to treat his SAH in an intensive care unit (ICU). Conventional and traditional Chinese Medicine (TCM) practices were used. The TCM treatment consisted of electroacupuncture (EA) in BL 2/TE 23 and BL 10/GB 20 at 2/100 Hz during his stay in the ICU. Results: EA inhibited the increase of blood flow speed in the middle cerebral and basilar artery and alleviated the patient's severe headache and vasospasm. Thus, among the possible mechanisms of EA that account for our results, we propose that its effects on humoral adjustment mechanisms and neurogenic factors contribute to modulation of the imbalance between the sympathetic and parasympathetic nervous system activities and thereby results in improved endothelial dysfunction and modulation of the cytokine profile and inflammatory mediators. Conclusions: The results achieved with this patient suggest that EA was able to reduce headache in addition to reducing cerebral blood flow speed with improvement in brain perfusion. Controlled prospective studies are required to reaffirm and consolidate EA as an important technique for addressing SAH.

Early brain perfusion improvement after ventriculoperitoneal shunt surgery in patients with idiopathic normal pressure hydrocephalus evaluated by 99mTc-HMPAO SPECT - preliminary report.

Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome that consists of the triad: gait disturbance, mental deterioration and urinary incontinence associated with normal cerebrospinal fluid pressure (CSF), without pre-existing abnormalities. The most popular treatment option is surgical implantation of a shunt. Brain perfusion increase occurring months or years after successful shunt surgery is well described in the literature. Early improvement of perfusion is not well documented. Therefore, the objective of the present study was to determine patterns of brain perfusion changes 3-6 days after the ventriculoperitoneal shunting in patients with iNPH by using 99mTc-HMPAO SPECT. Sixteen patients with iNPH (9 women, 7 men, mean age 64.1 ± 12.7 years) who underwent ventriculoperitoneal shunt surgery were included into the study group. Indications for implanting a shunt were based on clinical history, neuroimaging and CSF dynamic studies with an infusion test. Brain perfusion SPECT was performed 1-2 days before and 3-6 days after the surgical treatment. For comparison of perfusion before and after the surgery SPECT scans were assessed visually and semiquantitatively with voxel based analysis. No side effects were observed after the surgery. Brain perfusion improvement after shunting was observed in 10 patients (62.5%). Patterns of perfusion changes varied between patients, with combinations of different bilateral and lateralized brain regions involved. Perfusion increased in the whole brain (3 patients), in the right cerebral hemisphere (1 patient) or in the separate cerebral regions (6 patients): frontal, parietal, temporal, cerebellum, cingulate gyrus. Perfusion improvement was predominantly observed in the frontal lobes: right frontal (3 cases, 18.8%), left frontal (3 cases, 18.8%). Cerebral perfusion is recovered promptly after ventriculoperitoneal shunt surgery in about 60% of patients with iNPH. This improvement may be global or regional in different cerebral areas with prevalence of the frontal lobes.

Importance of Early Cranioplasty in Reversing the "Syndrome of the Trephine/Motor Trephine Syndrome/Sinking Skin Flap Syndrome".

The "Motor Trephine Syndrome (MTS)" also known as the "Sunken brain and Scalp Flap Syndrome" or the "Sinking Skin Flap Syndrome (SSFS)" or the "Syndrome of the trephined" is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. This syndrome is associated with sensorimotor deficit and neurological deterioration following decompressive craniectomy which is performed for various neurosurgical conditions involving cerebral swelling causing mass effect. The neurological deterioration can be exacerbated or precipitated by CSF diversion procedures like a Ventriculo-Peritoneal shunt. It was the objective of this study to observe if any improvement in the patient's condition, or if any beneficial effects in his sensorimotor deficit could be gained by performing an early cranioplasty as against after the usual delay of one to two years normally allowed for post-craniectomy cases. A 52 year old male suffered severe head injury in a road traffic accident and underwent a craniectomy and contusectomy of the left Fronto-Temporo-Parietal (FTP) region for treatment of Acute Subdural hematoma (SDH) as well as hemorrhagic and non-hemorrhagic contusions of the brain with severe mass effect. On recovery from this acute event he was bed bound, on tracheostomy, his GCS was E4VTrM4 with residual right sided hemiparesis. Three months later, he developed Hydrocephalus for which a Right Ventriculo-Peritoneal (V-P) shunt was performed. Following this procedure, severe depression of the skin/scalp flap occurred and the neurological recovery was not as expected. He was diagnosed as a case of "Syndrome of the trephined". An immediate Cranioplasty was performed, on the third month following the craniectomy procedure, in an attempt to resolve the rapidly deteriorating neurological status of the patient. In the case presented, following the early Cranioplasty which was performed within three months of the initial craniectomy, the patient's neurological condition and cognitive functions showed a remarkable, immediate and dramatic improvement. The early Cranioplastic repair led to a remarkable clinical recovery of the patient, with improvement in the cognitive behavior and motor deficit with a rapid reversal of the sensorimotor paresis, reflecting an improvement in brain perfusion. Patients with the classical "Motor trephine syndrome/ Sinking skin flap syndrome" following large craniectomy defects, may hugely benefit from an early cranioplasty procedure, with a reversal of features of this syndrome and early recovery of their neurological and cognitive functions. Hence, an early cranioplasty can serve as a therapeutic procedure, rather than merely a cosmetic one.

Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion

Symptomatic internal carotid artery (ICA) occlusion with hemodynamic impairment remains a dismal disease when untreated. In this prospective, single-center, controlled study, we investigated the feasibility, safety, and long-term outcome of stenting by endovascular recanalization for patients with chronic ICA occlusion. Forty patients with symptomatic chronically occluded ICA were assigned to receive endovascular recanalization (group A, n = 18) or conservative management (group B, n = 22). The primary end point was 100% complete recanalization of the primary occlusion at 60 minutes, and secondary end points were improvement in neurologic function and cognitive function. Patients in the 2 groups were comparable in demographic and baseline characteristics. Successful recanalization was achieved in 88.9% (16 of 18) of patients with the restoration of Thrombolysis in Myocardial Ischemia/Thrombolysis in Cerebral Ischemia 2 or 3 flow. There was no procedural or new cerebral ischemic event. Improvement in brain perfusion was observed in 12 (12 of 18, 75%) patients on single-photon emission computed tomography. Improvement in neurologic function defined as a reduction of ≥4 points on the National Institutes of Health Stroke Scale (NIHSS) at 6 months was observed in group A (baseline, 6.83 ± 3.01 vs 6 months, 2.61 ± 1.20; P < .01) and group B (baseline, 6.05 ± 2.75 vs 6 months, 4.77 ± 1.69; P < .05). A significant difference in NIHSS scores was noted between group A and B at 1, 3, and 6 months (P < .05 or .001). Improvement in cognitive function defined as an increase of ≥8 on the Montreal Cognitive Assessment (MoCA) was observed in group A at 3 and 6 months (baseline, 14.67 ± 3.56 vs 3 months, 24.17 ± 3.55 and 6 months, 24.72 ± 2.85; P < .01). Significant improvement in MoCA was also observed in group B (P < .01). Furthermore, a significant difference in MoCA scores was noted between group A and B at 1, 3, and 6 months (P < .05 or .001). Endovascular recanalization is feasible and safe for patients with symptomatic chronic carotid artery occlusion. Successful carotid artery stenting can improve neurological function and global cognitive function than nonrevascularization.

Change in brain perfusion after extracranial–intracranial bypass surgery detected using the mean transit time of computed tomography perfusion

BackgroundCerebral perfusion can be evaluated using a computed tomography (CT) scan by intravenous bolus injection of contrast media. The purpose of this study was to investigate the value of CT perfusion (CTP) in follow-up of extracranial–intracranial (EC-IC) bypass surgery. MethodsWe retrospectively reviewed pre- and postoperative CTP studies in 14 patients who received EC-IC bypass surgery because of cerebral arterial occlusion or stenosis. Brain areas showing prolongation of the mean transit time (MTT) were automatically identified and quantitatively measured. ResultsAll 14 patients showed MTT prolongation in the preoperative CTP study. In 13 patients, a reduction in brain volume with MTT prolongation was noted during postoperative CTP. These 13 patients had a patent EC-IC anastomosis, and 42 ± 21% of the brain area with MTT prolongation returned to normal MTT during CTP 7 ± 4 days (range 2–13 days) after surgery. On clinical follow up of 41 ± 16 months (range 14–60 months), no stroke or transient ischemic attack was noted after bypass surgery in these 13 patients. The brain volume with MTT prolongation did not decrease in just one patient whose EC-IC anastomosis was not patent, and the patient suffered a minor stroke during surgery. ConclusionQuantitative results for the brain area with MTT prolongation were positively correlated with improvement in brain perfusion shown on MTT, EC-IC bypass patency, and patient outcome.

P-454 - A case of dysexecutive syndrome that responded to methylphenidate

Dysexecutive syndrome (DS) is characterized by impairments in executive function and emotional and behavioural disturbances. Available pharmacological interventions for cognitive enhancement, have limited efficacy in improving the symptoms while metylphenidate is known to be effective in Attention Deficit/Hiperactivity Disorder, a condition characterized, as in DS, by prefrontal cortico-subcortical dysfunction. To report a case of successfull management of severe DS with methylphenidate. Evaluate the effectiveness of methylphenidate on DS. A 49-years-old male patient with severe vascular DS, was started on methylphenidate 10 mg daily (increased to 36 mg id).Patient was evaluated with Mini-Mental State (MMS), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) at T0 (before intervention), T1 (after 48 h), T2 (after 6 months) and T3 (after 18 months). Single photon emission computed tomography (SPECT) was undertaken at T0 and T3. A rapid and sustained improvement was observed, with a 23% improvement in MMS), decrease of 83% in CGI and a 24.5% reduction in total BPRS, at T1 with beneficial effects persisting at T3. Brain SPECT at T3 revealed an improvement of perfusion deficits documented at T0. Methylphenidate rapidly improved the symptoms of DS, and the effect persisted over 18 months with an associated improvement in brain perfusion. Methylphenidate can thus be a promising therapeutic choice in cases of DS.

Functional electrical stimulation improves brain perfusion in cranial trauma patients

Demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation (FES). It was studied 14 patients with hemiplegia who were submitted to a program with FES during fourteen weeks. Brain perfusion SPECT was performed before and after FES therapy. These patients were further separated into 2 groups according to the hemiplegia cause: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT. Patients with cranial trauma had a reduction in the hypoperfused area and patients with major vascular insult had an increase in the hypoperfused area after FES therapy. FES therapy can result in brain perfusion improvement in patients with brain lesions due to cranial trauma but probably not in patients with major vascular insults with large infarct area.