Middle Cerebral Artery In Patients Research Articles

Comparative Study between the Effect of Nifedipine, Ritodrine and Magnesium Sulphate Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Background: Spontaneous preterm labor (SPTL) and preterm birth (PTB), is the single most important cause of perinatal mortality and morbidity in high-income countries despite the enormous efforts over the past several decades. Preterm labor is defined as regular, painful, frequent uterine contractions causing a progressive effacement and dilatation of the cervix occurring before 37 completed weeks of gestation. Many drug therapies were used as tocolytics in cases of preterm labor, however none of them proved to be the best. The present study was performed to compare three of the used drugs for tocolysis to assess their efficacy and side effects on the mother and fetus. Aim: The aim of this study is to compare the effect of oral nifedipine, intravenous ritodrine infusion and magnesium sulfate infusion used as tocolytics in cases of preterm labour on Doppler parameters of fetal umbilical and middle cerebral artery and to evaluate their effects on the mother and the fetus in order to choose the safest and the most effective drug. Methodology: This study was held in the period from December 2014 to october 2015 on 90 patients attended and admitted from the Casualty Unit of the Obstetric Department In Elsayed Glal University Hospital with preterm labor pains , intact membranes, singleton pregnancy between 28 and completed 34 weeks gestation. All patients had been dated accurately with a gestational age based on the last menstrual period and if available a corresponding second trimester ultrasound report performed before 20 weeks gestation. Treatment continued until contractions stopped for 24 hours, maximum doses were attained without response; unacceptable side effects occurred or labor proceeded. Successful treatment was defined as cessation of contractions observed for 24 hours and no further cervical changes. Patients with successful treatment were put under observation for another 24 hours without additional treatment then discharged on no maintenance therapy. Results: Maternal tachycardia, palpitation and dyspnea were more common in the ritodrine group with (p-value = 0.000). The present study showed increase in umbilical artery PI after treatment in the magnesium sulfate group only which was statistically significant (P value = 0.016). The study showed statistically significant increase in middle cerebral artery PI after treatment in magnesium sulfate group with a P value=0.000 and statistically significant decrease in middle cerebral artery with nifedipine group with P value=0.027. When comparing the cerebroplacental ratio before and after treatment in the three groups; the study showed significant increase in cerebroplacental ratio after treatment in the magnesium sulfate group with P value = 0.000, which is statistically significant. This suggests that nifedipine could be used as a safer alternative to ritodrine and magnesium sulfate. Conclusion: In our study, nifedipine therapy was not associated with a significant change in maternal systolic and diastolic blood pressure after 24h, with minor insignificant effect on maternal heart rate. Fetal heart rate was not affected after therapy. Fetal Doppler study found no clinically significant effect on the pulsatility index (PI) of umbilical and middle cerebral artery, while with magnesium sulfate therapy there was increase in cerebro- placental ratio 24hr after treatment, these findings ensure safety of the drugs on the maternal and fetal aspects.

Cerebral MR oximetry during acetazolamide augmentation: Beyond cerebrovascular reactivity in hemodynamic failure.

Oxygen extraction fraction (OEF) elevation predicts increased ischemic stroke incidence among patients with carotid steno-occlusive disease, and can be estimated from quantitative susceptibility mapping (QSM) MRI. To explore QSM oximetry during acetazolamide (ACZ) challenge, hypothesizing that detectable OEF alterations will reflect hemodynamic compromise in unilateral cerebrovascular disease (CVD) patients. Retrospective. Fourteen unilateral CVD patients, and 24 healthy controls (HC). Multiecho gradient echo (GRE) and T1 -weighted images at 3T. We constructed QSM images and R2* maps from multiecho GRE images. QSM-OEF maps were generated from the susceptibility difference between venous blood and background brain tissue. Intrasubject diseased/contralateral hemisphere OEF ratios in the middle cerebral artery (MCA) territories were calculated. Intravascular susceptibility in the straight sinus (SS) and MCA was also measured. The result significance was determined using t-tests and Pearson's correlation. Mean and standard deviation for the patient diseased/contralateral OEF ratios were 1.15 ± 0.14 at baseline and 1.23 ± 0.17 post-ACZ. Disease group R2* ratios were 0.95 ± 0.05 at baseline and 1.03 ± 0.08 post-ACZ. Left/right OEF and R2* ratios for the HC group were 0.98 ± 0.06 and 0.99 ± 0.038, respectively. Susceptibility (ppb) in the SS and MCA in patients was 162.63 ± 35.4 and -22.33 ± 13.70, respectively, at baseline, 124.56 ± 37.43 and -19.27 ± 23.14 post-ACZ. The HC group SS and MCA susceptibility was 146.10 ± 24.79 and -19.59 ± 12.37, respectively. Patient group OEF ratios were greater than 1.0 before and after ACZ challenge (P < 0.01 and < 0.001, respectively, one-sample t-test), and were greater than HC ratios (P < 0.001 unpaired t-test). OEF and R2* ratios increased from baseline to post-ACZ (P = 0.024, 0.004, respectively, paired t-test). Detectable blood oxygenation change was confirmed by finding SS susceptibility decreased from baseline to post-ACZ (P < 0.001, paired t-test), while MCA susceptibility did not change significantly (P = 0.67, paired t-test). These results suggest QSM is sensitive to dynamic OEF modulation during hemodynamic augmentation. 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:175-182.

Electroacupuncture Improves Cerebral Vasospasm and Functional Outcome of Patients With Aneurysmal Subarachnoid Hemorrhage.

Cerebral vasospasm is the major cause of a poor outcome after aneurysmal subarachnoid hemorrhage (aSAH), and effective treatments for vasospasm are limited. The purpose of this study was to research the impact of electroacupuncture (EA) on cerebral vasospasm and the outcomes of patients with aSAH. A total of 60 age- and sex-matched aSAH patients were collected from Ningbo First Hospital between December 2015 and June 2017. All patients were given a basic treatment of nimodipine and randomized into two groups. The study group was treated with EA therapy on the Baihui (GV20) acupoint, and the control group was given mock transcutaneous electrical nerve stimulation. Cerebral vasospasm was measured by computed tomographic perfusion (CTP) and transcranial doppler (TCD). The mean flow velocity (MFV) in the middle cerebral artery (MCA), cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) of the patients were analyzed. The CBV and MTT exhibited significant differences between the study and control groups on the 1st (p = 0.026 and p = 0.001), 7th (p = 0.020 and p < 0.001), and 14th (p = 0.001 and p < 0.001) day after surgery, whereas CBF exhibited statistical significance only on the 14th day after surgery (p = 0.002). The MFV in MCA were significantly reduced after EA treatment in all patients (all p < 0.001). Additionally, the MFV in the MCA in patients treated with EA were considerably reduced compared with those of the control group (3rd day p = 0.046; 5th day, p = 0.010; 7th day, p < 0.001). Moreover, better outcomes were noted in the EA-treated group for the 1st month (p < 0.001) and 3rd month (p = 0.001) after surgery than in the control group. In conclusion, EA represents a potential method to treat cerebral vasospasm after aSAH and can improve the outcomes of patients with aSAH.

Effect of Transdermal Nitroglycerine on Doppler Velocity Waveforms of the Uterine, Umbilical and Fetal Middle Cerebral Arteries in Patients with Chronic Placental Insufficiency: A Prospective RCT.

Increase in Nitric Oxide (NO) may be important in vascular adaptation needed to accommodate increased uteroplacental blood flow as pregnancy advances. Hence, in certain conditions like Pregnancy Induced Hypertension (PIH) and Fetal Growth Restriction (FGR), NO donors may play an effective role in increasing uteroplacental perfusion. Transdermal route appears to be a safe and effective route. To evaluate the effect of nitroglycerine patch on Doppler velocity waveforms of the uterine, umbilical and fetal middle cerebral arteries in patients with chronic placental insufficiency. A prospective randomized controlled clinical trial was conducted on eighty consecutive pregnant women with FGR with or without PIH and having evidence of altered waveform velocimetry in uterine, umbilical and fetal middle cerebral artery. They were divided into two groups- study and control group. Transdermal nitroglycerine patch (10 mg per 24 hours) was applied in study group for three consecutive days. Changes in various Doppler indices were noted after three days of patch application and compared between the two groups. Analysis was carried out using SPSS (Statistical Package for Social Studies) for Windows version 20.0 and online GraphPad software (Prism 5 for Windows) version 5.01. A significant fall in the systolic and diastolic ratio (S/D), Pulsatility Index (PI) and Resistivity Index (RI) of the uterine (3.07±0.52, 1.04±0.14 and 0.54±0.10 respectively, p<0.001) and umbilical artery (3.73±3.30, 1.18±0.21and 0.64±0.07 respectively, p<0.001) was noted after three days of patch application. No such significant change was observed in the middle cerebral artery indices. The therapeutic approach of NO donor administration via transdermal route in pregnant patients with chronic placental insufficiency, apparently improved both maternal and fetoplacental haemodynamics, thus may help in improving perinatal outcome.

Local blood pressure associates with the degree of luminal stenosis in patients with atherosclerotic disease in the middle cerebral artery.

The mechanism underlying atherosclerotic ischemic events within the middle cerebral artery (MCA) is unclear. High structural stress induced by blood pressure might be a potential aetiology as plaque rupture occurs when such mechanical loading exceeds its material strength. To perform reliable analyses quantifying the mechanical loading within a plaque, the local blood pressure is needed. However, data on MCA blood pressure is currently lacking. In this study, the arterial pressure proximal to the stenotic site in the MCA was measured in 15 patients scheduled for intervention. The relationships between these local measurements and pre-intervention and intra-intervention non-invasive arm measurements were assessed. The impact of luminal stenosis on the local blood pressure was quantified. Compared with the pre-intervention arm measurement, the intra-intervention arm pressure decreased significantly by 23.9 ± 11.8 and 9.3 ± 14.7 % at diastole and systole, respectively. The pressure proximal to the stenosis was much lower than the pre-intervention arm measurement (diastole: 65.3 ± 15.7 vs 82.0 ± 9.7, p < 0.01; systole: 81.1 ± 15.9 vs 133.9 ± 18.7, p < 0.01; unit: mmHg). The systolic pressure in the MCA in patients with stenosis <70 % (n = 6) was significantly higher than the value in patients with stenosis ≥70 % (n = 9) (92.0 ± 7.3 vs 73.9 ± 16.1, p = 0.02; unit: mmHg), as was pulse pressure (22.8 ± 6.4 vs 11.1 ± 8.3, p = 0.01; unit: mmHg). However, diastolic pressure remained unaffected (69.2 ± 9.3 vs 62.8 ± 19.0, p = 0.58; unit: mmHg). In conclusion, the obtained results are helpful in understanding the local hemodynamic environment modulated by the presence of atherosclerosis. The local pressure measurements can be used for computational analysis to quantify the critical mechanical condition within an MCA lesion.

Increase of Serum CXCL16 Level Correlates Well to Microembolic Signals in Acute Stroke Patients with Carotid Artery Stenosis

BackgroundThe majority of strokes are combined with the instability of atherosclerotic plaques. Microembolic signals (MES) have been considered as evidence of plaque destabilization. We found that increased CXCL16 correlated to atherosclerotic ischemic stroke. Thus, we explored whether CXCL16 correlates to MES. MethodsThe study recruited 104 controls and 118 patients with acute ischemic stroke that has an ipsilateral carotid artery stenosis of >50%. The ipsilateral middle cerebral artery of patients was insonated for 60min using Doppler device within 72h of their clinical presentation. ResultsWe found that CXCL16 was significantly increased in the stroke patients. Furthermore, there was a significant difference in CXCL16 between the MES-positive and MES-negative patients. Using CXCL16 to distinguish the controls and stroke patients, the area under the ROC curve (AUC) was 0.722; the cut-off value was 2.015ng/ml. The sensitivity and specificity were 70.5% and 67.9%, respectively. Furthermore, if we used CXCL16 to distinguish the MES-positive and MES-negative patients, the AUC was 0.736; the cut-off value was 2.115ng/ml. The sensitivity and specificity were 88.5% and 56.5%, respectively. ConclusionsHigher levels CXCL16 may be a biomarker for predicting stroke incidence and might contribute to plaque destabilization.

Predictive Factors for the Spontaneous Recanalization of Large and Middle Cerebral Arteries after Acute Occlusion

This study aims to investigate the predictive factors for the spontaneous recanalization of occluded arteries in patients with acute ischemic stroke. A total of 139 patients with consecutive acute ischemic stroke were enrolled from June 2010 to June 2013. The clinical and biochemical parameters were measured in each participant. Occlusion and recanalization of the carotid artery, the middle cerebral artery, and the vertebral and basilar arteries were identified by using computed tomographic angiography or digital subtraction angiography. Among the 139 patients, 23 showed spontaneous recanalization, whereas 116 did not. In the patients with spontaneous recanalization, the proportion of atrial fibrillation was significantly lower (0% versus 29.31%, P= .01), whereas the proportion of stage 3 hypertension was significantly higher (60.87% versus 32.76%, P= .01) than that of those without recanalization. Logistic regression analysis showed that the proportion of atrial fibrillation was negatively (odds ratio [OR]: .117, 95% confidence interval [CI]: .015-.918, P= .04) associated with spontaneous recanalization, whereas the proportion of stage 3 hypertension was positively (OR: 4.316, 95% CI: 1.533-12.154, P= .01) associated with it. Atrial fibrillation is associated with reduced spontaneous recanalization of the large and middle cerebral arteries in patients after acute ischemic stroke-induced occlusion, whereas stage 3 hypertension may contribute to the promotion of the recanalization.

Relationship between deep medullary veins in susceptibility-weighted imaging and ipsilateral cerebrovascular reactivity of middle cerebral artery in patients with ischemic stroke.

Deep cerebral veins have been recently associated with the severity of hemodynamic impairment in moyamoya disease. The aim of the current study was to determine the correlation of deep medullary veins (DMVs) in susceptibility-weighted imaging (SWI) with ipsilateral cerebrovascular reactivity (CVR) of and anterior cecebrocervical artery stenosis in patients with ischemic stroke. Patients with unilateral TIA or infarction who underwent 3.0 T magnetic resonance imaging SWI, digital subtraction angiography and transcranial Doppler with CO2 stimulation within the first 7 days of hospitalization were retrospectively selected. CVR and stenosis of anterior cerebrocervical arteries were compared between different DMVs stages in symptomatic hemispheres (SHs) and asymptomatic hemispheres (AHs). A total of 61 patients were subsequently included in the present study. A univariate analysis was conducted and results for age (PAHs=0.004, PSHs=0.006), hypertension (PAHs=0.008, PSHs=0.020), current smoking (PAHs=0.006, PSHs=0.021), CVR (PAHs=0.000, PSHs=0.000), and artery stenosis (PAHs=0.000, PSHs=0.000) were obtained. The results suggested statistically significant differences between DMVs grades in SHs and AHs. A subsequent multivariate analysis revealed that CVR (ORAHs=0.925, 95% CIAHs: 0.873–0.981; ORSHs=0.945, 95% CISHs: 0.896–0.996), and artery stenosis (ORAH=3.147, 95% CIAH: 1.010–9.806; ORSHs=2.882, 95% CISHs: 1.017–8.166) were independent risk factors of DMVs. In conclusion, 3.0 T SWI was useful in detecting the DMVs around the lateral ventricle in patients with atherosclerotic ischemic stroke. CVR and stenosis of anterior cerebrocervical arteries were independent risk factors for ipsilateral DMVs in SHs and AHs.

Abstract TP39: High Accuracy of Magnetic Resonance T2*- Weighted Sequences for Detection of Intracranial Arterial Thrombus

Introduction: Rapid detection and location of vessel occlusion are pivotal in the intra-arterial management of patients with acute stroke in the emergency room. MRI has demonstrated to detect intravascular thrombus but its accuracy compared to CT angiography has not been well established. Hypothesis: Our purpose is to determine the accuracy of 1.5 T MRI T2*-weighted (W) sequences compared to immediate CT angiography as the standard reference imaging modality, for detection of intra-arterial thrombus in patients with suspected acute MCA infarction. Methods: Consecutive patients with suspected middle cerebral artery (MCA) territory stroke were selected from 2008 to 2009. The inclusion criteria for the study subjects: CTA, T2*W sequences included on MRI protocol and restricted diffusion in MCA territory on DWI within 12 hrs of clinical onset. Two investigators reviewed DWI and T2*W sequences for the presence of infarction and thrombus. Intracranial internal carotid artery (ICA), M1 and M2 segments of the MCA were accessed. Consensus was reached with a third reviewer for data analyses. Accuracy, sensitivity, specificity, positive and negative predictive values (PPV/NPV) were calculated. Results: Fifty-one patients were included in the study, of which 40 patients had confirmed arterial thrombus and 11 patients had normal studies on CTA. Of the subjects with arterial occlusion on CTA, the mean time interval from stroke onset to CTA was 4.2 h +/- 2.3 h (range, 0.4-12h). The mean time interval from CTA to MRI was 29.5 min +/- 11.1 min. Twenty-six cases showed M1 thrombus on CTA, of these, 22 cases had corresponding thrombus and 4 cases had no abnormality in T2*W sequences on MRI. Nevertheless, 25 patients demonstrated no M1 thrombus, either on CTA or MRI. After statistical analyses, we observed an accuracy of 92%, sensitivity of 85%, specificity of 100%, PPV 100% and NPV of 86% for M1 occlusion. The Kappa obtained was 0.79. Conclusion: In conclusion, T2*W sequences demonstrated overall high accuracy and specificity for detection of arterial thrombus in the M1 segment of the MCA in patients with suspected acute MCA ischemic stroke.

Neurovascular Reactivity in Patients with Acute Ischemic Stroke

OBJECTIVE: We aimed to assess the motor evoked blood flow velocity (BFV) changes in both middle cerebral arteries (MCA) using transcranial Doppler (TCD) monitoring in patients with acute ischemic strokes and healthy subjects. METHODS: Eighty-two patients with acute territorial infarction in the MCA territory, 83 patients with acute lacunar infarction in MCA territory and 21 control subjects were investigated. A long term TCD monitoring device was used for the simultaneous recording of both MCA during 10 cycles of 20 seconds while the subjects performed hand gripping with a frequency of one per second, and subsequently 20 seconds when they were resting to assess BFV changes on activated cortical motor areas. Neurovascular reactivity was defined as a relative increase in blood flow velocities which were calculated as the percentage change in baseline value. RESULTS: Hand gripping showed a marked rise in the blood flow velocities in both MCAs in all subjects (p<0.001 for all vessels). Patients with territorial infarction had significantly lower neurovascular reactivity (15.0%±9.5) than those of patients with lacunar infarction (19.9%±11.5 p<0.007). CONCLUSION: Our results suggest that unilateral cerebrovascular ischemic events can affect blood flow in both MCAs in patients with acute ischemic events in the MCA territory, and neurovascular reactivity was preserved in patients with lacunar stroke in contrast to territorial stroke.

Color Doppler ultrasonography in full term neonates with hypoxic ischemic encephalopathy and prediction of outcome

Background: Impaired cerebral circulation plays the main role in the pathogenesis of hypoxic-ischemic brain injury in neonates. Objectives: We aimed to determine blood flow parameters via color Doppler ultrasonography in full-term neonates with hypoxic-ischemic (HI) brain injury at 12h postpartum and the correlation of these parameters with long-term outcomes at the age of 1-year. Design and subjects: Our study included 40 full term neonates with HIE (Patients group) and 25 healthy full term neonates (control group). All neonates were subjected to early color Doppler ultrasonography. At the age of 1-year the neurodevelopmental condition was evaluated. Results: The end-diastolic velocity (EDV) and peak systolic velocity (PSV) PSV values of cerebral arteries of patient group were significantly lower than those of the control group. Resistive index (RI) values were significantly higher in patient group than in the control group (P<0.05). The values obtained from right and left anterior and middle cerebral arteries of patients and controls were significantly correlated (P<0.05). During follow up of these cases, seven died in NICU, eleven were found to have neurodevelopmental sequelae and twenty-two were found to be normal. In comparison between neonates with good prognosis (No. 22) and those of poor prognosis (No. 18) in terms of EDV, PSV and RI retrospectively, we found EDV and PSV to be significantly lower and RI to be significantly higher (P<0.05). Conclusion: Detection of a decrease in cerebral blood flow in neonates in the first 12h postpartum has a prognostic value.

A retrospective pilot study of correlation of cerebral augmentation effects of external counterpulsation with functional outcome after acute ischaemic stroke

ObjectiveExternal counterpulsation (ECP) is a non-invasive method used to augment cerebral blood flow of patients with ischaemic stroke via induced hypertension. We aimed to explore the correlation between the cerebral blood flow augmentation effects induced by ECP and clinical outcome after acute ischaemic stroke.MethodsWe retrospectively analysed our ECP registry of patients with ischaemic stroke who were enrolled within 7 days after stroke onset. Bilateral middle cerebral arteries of patients were monitored using transcranial Doppler (TCD). Flow velocity changes before, during and after ECP were, respectively, recorded for 3 min. The cerebral augmentation index (CAI) was the increase in percentage of the middle cerebral artery mean flow velocity during ECP compared with baseline. TCD data were analysed based on the side ipsilateral or contralateral to the infarct. The modified Rankin Scale (mRS) (good outcome: mRS 0∼2; poor outcome: mRS 3∼6) was evaluated 6 months after the index stroke.Results72 patients were included (mean age, 63.8±10.7 years; 87.5% males). At month 6 after stroke onset, univariate analysis showed that the National Institutes of Health Stroke Scale at recruitment was significantly higher and ECP therapy duration was longer in the poor outcome group, while the ipsilateral CAI was significantly lower in the good outcome group than that in the poor outcome group (3.71±4.94 vs 7.73±7.66, p=0.044). Multivariate logistic regression showed that ipsilateral CAI was independently correlated with an unfavourable functional outcome after adjusting for confounding factors.ConclusionsThe higher degree of cerebral blood flow velocity augmentation on the side ipsilateral to the infarct induced by ECP is independently correlated with an unfavourable functional outcome after acute ischaemic stroke.

Arteriovenous shunts and capillary blush as an early sign of basal ganglia infarction after successful mechanical intra-arterial thrombectomy in ischaemic stroke.

Recent studies indicate an interest in early infarct assessment, mainly using post-interventional perfusion imaging. This work evaluated two specific angiographic signs for infarct prediction in the basal ganglia immediately after successful mechanical intra-arterial thrombectomy. In this retrospective study, 57 consecutive patients (mean ± SD age 67 ± 15 years) with acute occlusion of the proximal anterior circulation who underwent mechanical thrombectomy of the M1 segment of the middle cerebral artery were included. Two separate angiographic signs, early venous drainage and capillary blush, were identified and analysed regarding their statistical significance for infarct prediction within the basal ganglia. Four patients were excluded due to parenchymal haemorrhage. Forty-four of 53 patients developed infarction of the basal ganglia. Sensitivity/specificity were 93%/27%, respectively, for the capillary blush sign and 88%/63%, respectively, for the early venous drainage sign. Combining both signs increased the sensitivity and specificity to 88% and 81%, respectively, and increased the positive predictive value to 95%. Both angiographic signs seem to predict the irreversible damage of tissue in the basal ganglia reliably despite successful recanalization of the middle cerebral artery in patients with ischaemic stroke. • Evaluation of success in neurointerventional procedures is mainly based on recanalization rates. • Two separate angiographic signs can predict infarction immediately after proximal MCA recanalization. • Combining both signs increases their specificity.

Vascular tortuosity may be related to intracranial artery atherosclerosis.

Conventional risk factors cannot explain the individual or ethnic difference in the location of cerebral atherosclerosis. Vascular geometry may play a role on this. To investigate the association between the geometrical properties of the middle cerebral artery and intracranial atherosclerosis. Stroke patients with either symptomatic middle cerebral artery or proximal internal carotid artery diseases were enrolled. The diameter, length, and tortuosity (arc-chord ratio, by percent) of the middle cerebral artery was compared between stroke patients and the age- and gender-matched healthy subjects. The geometrical property was also compared between the symptomatic middle cerebral artery and the normal-looking contralateral middle cerebral artery, and between the contralateral middle cerebral arteries in patients with symptomatic middle cerebral artery and proximal internal carotid artery diseases. One hundred seventy-seven patients (101 with middle cerebral artery disease and 76 with proximal internal carotid artery disease) were studied. Symptomatic middle cerebral artery was more tortuous (119·31 ± 16·95 vs. 112·98 ± 14·16; P = 0·009) than the contralateral middle cerebral artery. The contralateral middle cerebral artery of patients with symptomatic middle cerebral artery disease demonstrated a smaller proximal diameter (P = 0·007) and a greater vascular tortuosity than the contralateral middle cerebral artery of patients with proximal internal carotid artery disease (112·01 ± 12·25 vs. 107·46 ± 9·35; P = 0·008) and corresponding middle cerebral artery of healthy control subjects (112·01 ± 12·25 vs. 108·73 ± 9·79; P = 0·04). Young age, female, small diameter, the absence of diabetes, and high tortuosity of the contralateral middle cerebral artery were independently associated with middle cerebral artery atherosclerotic disease. High tortuosity and small diameter are related to middle cerebral artery atherosclerosis, probably by altering hemodynamics. Different degree of tortuosity may be one of the reasons for individual differences in location of cerebral atherosclerosis.

Middle cerebral arterial flow changes on transcranial color and spectral Doppler sonography in patients with increased intracranial pressure.

Intracranial pressure usually increases after severe brain injury. However, a method for noninvasive evaluation of intracranial pressure is still lacking. The purpose of this study was to explore the potential role of transcranial color Doppler sonography in assessing intracranial pressure by observing the middle cerebral artery blood flow parameters in patients with increased intracranial pressure of varying etiology. The hemodynamic changes in the middle cerebral artery in patients with varying degrees of increased intracranial pressure were investigated by transcranial color Doppler sonography in 93 patients who had emergency surgery for brain injury. Middle cerebral artery Doppler flow spectra changed regularly as intracranial pressure increased. The pulsatility index (PI) and resistive index (RI) had a significantly positive correlation with intracranial pressure (r = 0.90 and 0.89, respectively; P< .001), whereas the middle cerebral artery diastolic velocity showed a significant negative correlation with intracranial pressure (r = -0.52; P< .01). A receiver operating characteristic curve showed that the RI and PI cutoff values were 0.705 and 1.335, respectively, for predicting increased intracranial pressure, with sensitivity of 0.885 and specificity of 0.970. In addition to the PI and RI, middle cerebral artery diastolic flow velocity measurement by transcranial color Doppler sonography may also be a useful variable for evaluating intracranial pressure in patients with acute brain injury.

Cerebrolysin effects on neurological outcomes and cerebral blood flow in acute ischemic stroke.

BackgroundCerebrolysin, a brain-derived neuropeptide, has been shown to improve the neurological outcomes of stroke, but no study has demonstrated its effect on cerebral blood flow. This study aimed to determine the cerebrolysin impact on the neurological outcomes and cerebral blood flow.MethodsIn a randomized, double-blinded, placebo-controlled trial, 46 patients who had acute focal ischemic stroke were randomly assigned into two groups to receive intravenously either 30 mL of cerebrolysin diluted in normal saline daily for 10 days (n=23) or normal saline alone (n=23) adjunct to 100 mg of aspirin daily. All patients were examined using the National Institutes of Health Stroke Scale and transcranial Doppler to measure the mean flow velocity and pulsatility index (PI) of their cerebral arteries at baseline as well as on days 30, 60, and 90.ResultsThe patients’ mean age was 60±9.7 years, and 51.2% of patients were male. The National Institutes of Health Stroke Scale was significantly lower in the cerebrolysin group compared with the placebo group on day 60 (median 10, interquartile range 9–11, P=0.008) and day 90 (median 11, interquartile range 10–13.5, P=0.001). The median of PI in the right middle cerebral artery was significantly lower in the cerebrolysin group compared with the placebo group on days 30, 60, and 90 (P<0.05). One patient in the cerebrolysin group and two patients in the placebo group died before day 30 (4.3% versus 8.7%).ConclusionCerebrolysin can be useful to improve the neurological outcomes and the PI of middle cerebral artery in patients with acute focal ischemic stroke.

Cerebral microembolism in patients with segmental left ventricular wall motion abnormalities

Background and purposeThe significance of segmental heart wall motion abnormalities for stroke is unknown. The aims of the study included (1) comparison of the frequency and type of embolic signals in the middle cerebral artery in patients with segmental left ventricular wall hypokinesis due to coronary heart disease with and without stroke, and (2) determination of the relationship between inflammatory parameters, fibrinogen level, dyslipidemia and microembolic signals in the middle cerebral artery in patients with segmental heart hypokinesis. Material and methodsThe study included 68 patients with segmental heart hypokinesis (33 without stroke [group I] and 35 with stroke [group II]), as well as 37 healthy volunteers and a reference group of 30 patients. Echocardiography and carotid/transcranial Doppler with detection of microembolic signals were performed. Patients from group I and II had erythrocyte sedimentation rate, leucocyte count, triglycerides, total cholesterol, HDL, and LDL examined. ResultsEmbolic signals were detected in patients with segmental heart hypokinesis significantly more frequently than in the control and reference groups. The high number of embolic signals, signals of high intensity, hypokinesis of the distal part of the intraventricular septum, increased cholesterol levels, LDL and triglycerides were all found more frequently in patients from group II than in group I. Embolic signals were detected more frequently in patients with high fibrinogen levels and leukocytosis. ConclusionsEmbolic signals in the middle cerebral artery in patients with segmental left ventricular hypokinesis have to be considered as a risk factor of stroke. The following changes are observed in patients with cardiogenic stroke: hypokinetic intraventricular septum, high intensity embolic signals, increased serum fibrinogen levels and leucocyte count. It may indicate the importance of these factors in the aetiology of stroke.

Doppler Ultrasound Velocimetry of Middle Cerebral Arteries of Patients With Sickle Cell Disease At Aminu Kano Teaching Hospital: A Preliminary Report

Transcranial Doppler ultrasound scan is a noninvasive method of evaluating the major intracranial vessels. It is becoming an important screening tool for predicting high-risk sickle cell patients for developing cerebrovascular disease. This study evaluates the patients' characteristics, common indications, and findings on Doppler ultrasound of the middle cerebral arteries of sickle cell patients performed at Aminu Kano Teaching Hospital, Kano, Nigeria.This is a preliminary report of an ongoing review of the transcranial Doppler scans done at Aminu Kano Teaching Hospital. The records of all patients, the indications for Doppler examination, and major findings on the middle cerebral arteries were documented.There are 60 patients, consisting of 22 males and 38 females. Their ages ranged from 1.0 to 41.0 years, with mean of 11.58 ± 7.30 years. About a third of the patients were asymptomatic (38.3%). Those with headache constituted 20.0%, whereas those with past cerebral syndrome constituted 8.3%. Other indications include stroke (11.67%) and transient ischemic attack (3.3%).The mean peak systolic velocity of the middle cerebral artery measured 204.8 cm/s (±80 cm/s) and 208.8 (±79 cm/s) on the respective right and left side. This right-to-left difference was statistically significant (P = 0.046). Symptomatic and female patients showed higher mean peak systolic velocity values when compared with males, although the difference was not statistically significant.

Doppler Ultrasound Velocimetry of Middle Cerebral Arteries of Patients With Sickle Cell Disease at Aminu Kano Teaching Hospital

Transcranial Doppler ultrasound scan is a noninvasive method of evaluating the major intracranial vessels. It is becoming an important screening tool for predicting high-risk sickle cell patients for developing cerebrovascular disease. This study evaluates the patients' characteristics, common indications, and findings on Doppler ultrasound of the middle cerebral arteries of sickle cell patients performed at Aminu Kano Teaching Hospital, Kano, Nigeria.This is a preliminary report of an ongoing review of the transcranial Doppler scans done at Aminu Kano Teaching Hospital. The records of all patients, the indications for Doppler examination, and major findings on the middle cerebral arteries were documented.There are 60 patients, consisting of 22 males and 38 females. Their ages ranged from 1.0 to 41.0 years, with mean of 11.58 ± 7.30 years. About a third of the patients were asymptomatic (38.3%). Those with headache constituted 20.0%, whereas those with past cerebral syndrome constituted 8.3%. Other indications include stroke (11.67%) and transient ischemic attack (3.3%).The mean peak systolic velocity of the middle cerebral artery measured 204.8 cm/s (±80 cm/s) and 208.8 (±79 cm/s) on the respective right and left side. This right-to-left difference was statistically significant (P = 0.046). Symptomatic and female patients showed higher mean peak systolic velocity values when compared with males, although the difference was not statistically significant.

Segmental left ventricular hypokinesis is associated with embolic signals in transcranial Doppler

Global left ventricular (LV) hypokinesis is considered to be the cause of stroke, while the significance of segmental wall motion abnormalities is still unknown. The aim of the study was to determine the frequency of embolic signals in the middle cerebral artery in patients with segmental LV wall hypokinesis in the course of coronary artery disease (CAD) with and without stroke. The study included 68 patients (aged 21-87 years) with segmental LV wall hypokinesis (33 patients without and 35 with stroke). The reference group comprised 30 patients (aged 43-76 years) with atherosclerotic risk factors; the control group comprised 37 healthy volunteers (aged 41-71 years). All subjects underwent echocardiography and carotid and transcranial Doppler ultrasound with the detection of microembolic signals. Embolic signals were observed significantly more often in patients with segmental LV wall hypokinesis than in the control and reference groups. In patients with CAD and stroke, an increased number of embolic signals (≥3) was observed significantly more often compared with patients without stroke. Compared with other locations, interventricular septum and apex hypokinesis was associated with a higher frequency of embolic signals in the middle cerebral arteries. Segmental LV motion abnormalities in the form of hypokinesis in patients with CAD are associated with the presence of embolic signals in the middle cerebral arteries, which may have clinical significance as a risk factor for stroke.