Cerebral Blood Flow Studies Research Articles

A preliminary study of cerebral blood flow, aging and dementia in people with Down syndrome.

People with Down syndrome (DS) develop Alzheimer's disease (AD) at an earlier age of onset than those with sporadic AD. AD neuropathology is typically present in DS by 40years of age with an onset of dementia approximately 10years later. This early onset is due to the overexpression of amyloid precursor protein from the third copy of chromosome 21. Cerebrovascular neuropathology is thought to contribute in 40-60% of cases sporadic AD. However, the vascular contribution to dementia in people with DS has been relatively unexplored. We hypothesised that vascular perfusion is compromised in older adults with DS relative to younger individuals and is further exacerbated in those with dementia. Cerebral blood flow (CBF) was measured using pulsed arterial spin labelling in 35 cognitively characterised adults with DS (26-65years). DS participants were also compared with 15 control subjects without DS or dementia (26-65years). Linear regression evaluated the difference in CBF across groups and diagnosis along with assessing the association between CBF and cognitive measures within the DS cohort. Cerebral blood flow was significantly lower among DS participants with probable AD compared with controls (P=0.02) and DS participants with no dementia (P=0.01). Within the DS cohort, CBF was significantly associated with the Severe Impairment Battery (SIB) measure and the Dementia Questionnaire for People with Learning Disabilities (DLD) rating (F3,25 =5.13; P=0.007). Both the SIB (β=0.74; t=2.71; P=0.01) and DLD (β=-0.96; t=-3.87; P<0.001) indicated greater impairment as global CBF decreased. Age was significantly associated with CBF among participants with DS. There was a non-linear effect of age, whereby CBF declined more rapidly after 45years of age. This preliminary study of CBF in DS indicates that cerebrovascular pathology may be a significant contributor to dementia in DS. CBF was associated with diagnosis, cognition and age. Notably, CBF decreases at a greater rate after age 45 and may represent a significant prodromal event in AD progression.

PROTECTIVE MECHANISMS AGAINST HYPOXIA IN DIVING SIMULATION IN SWIMMERS

Aim. The article deals with studying the systemic protective mechanisms of the brain against hypoxia during water immersion in highly skilled swimmers. Material and methods. 25 males aged 18–20 years were examined: 9 masters of sports, one master of sports of international class and 15 people not involved in sports. The study of cerebral blood flow was carried out by rheoencephalography (REG). REG was recorded at rest, when the face was immersed in water and during recovery. Examination was carried out 2 hours after the morning training session. In addition to cerebral blood flow, ECG and blood pressure were recorded at rest, during water immersion and recovery. Statistical data processing was performed using nonparametric Mann–Whitney and Wilcoxon criteria. Results. It was revealed that athletes at rest demonstrated more pronounced asymmetry of blood circulation and higher blood flow in the right hemisphere than people not involved in sports. However, during water immersion, the asymmetry disappears, blood flow improves, especially in the left hemisphere in the carotid artery territory as a result of a decrease in the tone of small vessels. In people not involved in sports, protective mechanisms are less pronounced. Conclusion. Vast experience in sports activities related to exercises performed in water and to training hypoxic exercises contributed to effective protective mechanisms against hypoxia based on the diving reflex.

Биофлавоноиды в лечении пациентов с сахарным диабетом 2-го типа и церебральным атеросклерозом

Цель работы — комплексная оценка влияния кверцетина на функциональное состояние центральной нервной и сердечно-сосудистой систем у больных ишемическим инсультом (ИИ) и сахарным диабетом 2-го типа (СД2) в восстановительный период. Материал и методы. В клинике ГУ «Институт геронтологии им. Д.Ф. Чеботарева НАМН Украины» проведено открытое пилотное когортное проспективное клиническое исследование, которое включало 30 больных, перенесших атеротромботический ишемический инсульт в каротидном бассейне (19 женщин и 11 мужчин), в возрасте от 55 до 75 лет (средний возраст 64,3±7,5 года), треть из них имели в анамнезе СД2. До и после курсового приема препарата кверцетин больным проводили комплексное клинико-неврологическое и нейропсихологическое обследование, исследование мозгового кровотока методом ультразвукового дуплексного сканирования экстра- и интракраниальных отделов магистральных артерий головы и шеи, электрокардиографию с оценкой вариабельности ритма сердца. Все больные получали кверцетин (лиофилизат для приготовления раствора для инъекций (комплекс кверцетина с повидоном) в дозе 0,5 г в сутки в течение 10 дней. Для приготовления раствора для внутривенного введения препарат растворяли в 100 мл изотонического раствора NaCl и вводили внутривенно капельно в течение 15-20 минут 1 раз в день. Результаты. У больных с левополушарным инсультом кверцетин оказывал более выраженное влияние на структуру биоэлектрической активности головного мозга и церебральную гемодинамику, чем у больных с правополушарной локализацией ИИ. У больных, перенесших ИИ, кверцетин улучшалпсихоэмоциональные и мнестические функции за счет положительной реорганизации биоэлектрической активности головного мозга, улучшения церебральной гемодинамики и гармонизации симпатического и парасимпатического звеньев вегетативной нервной системы. Выводы. Корригирующее влияние кверцетина на функциональное состояние мозга и сердца дает основание рекомендовать применение препарата в системе реабилитации больных, перенесших ишемический инсульт.

Cerebral glucose metabolism and Cerebral blood flow in thyroid dysfunction: An Activation Likelihood Estimation Meta-analysis

Thyroid dysfunction is frequently associated with functional disturbances of the brain. We performed a meta-analysis of previous positron emission tomography and single-photon emission computed tomography studies using a coordinate-based technique of activation-likelihood estimation (ALE) to investigate the potential background of neuropsychiatric complications in patients with hypo- and hyperthyroidism. We performed a systematic search of MEDLINE and EMBASE for English-language publications using the keywords of “positron emission tomography”, “single-photon emission computed tomography”, and “thyroid”. The software GingerALE ver 2.3.6 was used to transform all reported coordinates into stereotactic Montreal Neurological Institute space. A threshold of uncorrected p < 0.001 (minimum volume of 200 mm3) was applied to the resulting ALE map using cerebral metabolic rate of glucose (CMRglu), and cerebral blood flow (CBF). Six studies were eligible for inclusion in the study; 4 studies of cerebral metabolic rate of CMRglu, and 2 studies of CBF. In hypothyroidism, significant decreases in CMRglu were identified in 3 clusters including left anterior cingulate, right inferior occipital gyrus, and right cuneus. In hyperthyroidism, a significant decrease in CMRglu was identified in right superior frontal gyrus. In hypothyroidism, a significant decrease in CBF was observed in left postcentral gyrus. In conclusion, several brain regions showed altered CMRglu and CBF in patients with thyroid dysfunction compared with euthyroid controls. These findings might account for underlying mechanisms of thyroid hormones on psychological and physiological effects on brain.

Look-Locker FAIR TrueFISP for arterial spin labelling on mouse at 9.4 T.

Pulsed arterial spin labelling remains a non-invasive and highly used method for the study of rodent cerebral blood flow (CBF). Flow-sensitive alternating inversion recovery (FAIR) is one of the most commonly used MR-sequences for this purpose and exists with many different strategies to record the images. This study investigates Look-Locker (LL) TrueFISP readout for FAIR as an alternative to the standard EPI readout, which is provided by the manufacturer. The aim was to show the improved image quality using TrueFISP and to verify the reproducibility of the determination of the cerebral blood flow values. The measurement of many inversion points also allowed to investigate the influence of the correct blood relaxation rate on the fit of the CBF data. For the LL-FAIR TrueFISP an in-house written method was created. The method was tested on a group of C57BL/6 mice at the field strength of 9.4 T. The results show CBF maps with less distortion than for EPI and the values found are in good agreement with the literature. A comparison of the CBF values found with EPI and LL-TrueFISP shows very small differences, most being not significant. In conclusion, the method presented gives equivalent CBF maps in comparison to standard FAIR-EPI. Both methods have the same measurement time. TrueFISP has the advantage to EPI of producing undistorted images over larger areas of the mouse brain. It is advisable to check the value of the blood relaxation rate by measurement or to estimate it as a fitting parameter.

Neuroprotective Effects of Rasagiline in Parkinson's Disease: A Regional Cerebral Blood Flow Study.

Despite accumulating evidence for the clinical efficacy and neuroprotective properties of rasagiline in Parkinson's disease (PD), effects of rasagiline on brain perfusion in PD patients have not been elucidated. The present study aimed to investigate the effects of rasagiline on regional cerebral blood flow (rCBF) in patients with PD using single-photon emission computed tomography (SPECT). A total of 44 PD patients were recruited and treated with dopamine agonist, either alone or in combination with levodopa. Twenty-two of these patients (referred to as the rasagiline group) additionally received rasagiline (1mg/day). All patients underwent brain SPECT scans and clinical assessments at baseline and follow-up visits. The mean follow-up period was 2.2 years. Changes in rCBF were compared between the rasagiline group and the comparison group in a voxel-wise manner. Annual change in Unified Parkinson's Disease Rating Scale motor score was lower in the rasagiline group compared to the comparison group (P = .01). A significant group-by-time interaction effect on rCBF was found in the right precuneus (P = .001), where rCBF was decreased in the comparison group and remained stable in the rasagiline group. Our results show that adjunctive rasagiline treatment had beneficial effects on perfusion in the precuneus of PD patients, suggesting potential neuroprotective effects.

S1-15 SESSION 1: NEUROSURGERY CRANIAL VAULT EXPANSION WITH THE SPLIT BONE FLAP TECHNIQUE IN SHUNT RELATED CRANIOSYNOSTOSIS

Introduction: Shunt-related craniosynostosis causing craniocerebral disproportion represents a particular complication of the treatment of hydrocephalus. When the modification of the shunt opening pressure, does not improve the symptomatology, surgery for correction of craniocerebral disproportion is indicated. We present the results and advantages of the split bi-frontal bone technique that is a modification of the previous used frontal bone advancement technique. Methods: We report our series of 8 patients treated with this technique that consists in a splitting bi-frontal bone flap that is repositioned and left floating posteriorly. Splitting the bon flat permit to increase the cranial volume and to reduce the intracranial pressure. All the patients benefitted from a pre and post-operative cerebral blood flow CT. Results: All patients were relieved from there chronic headaches. This technique increases the volume of the skull favoring the expansion of the brain and allows good esthetical results. No peri-operative complications were reported. The study of cerebral blood flow confirmed the increase of the cerebral blood perfusion and the improvement of the regional cerebral blood flow in borderline regions. All patients in scholar age presented an improvement of their performance Conclusion: The bi-frontal split technique can be used for the treatment of slit ventricle syndrome for its efficacy, the low rate of complications and the good aesthetical results both in children and adults.

Persistent Metabolic Disturbance in the Perihemorrhagic Zone Despite a Normalized Cerebral Blood Flow Following Surgery for Intracerebral Hemorrhage.

BACKGROUNDWe hypothesized that reduced cerebral blood flow (CBF) and/or energy metabolic disturbances exist in the tissue surrounding a surgically evacuated intracerebral hemorrhage (ICH). If present, such CBF and/or metabolic impairments may contribute to ongoing tissue injury and the modest clinical efficacy of ICH surgery.OBJECTIVETo conduct an observational study of CBF and the energy metabolic state in the perihemorrhagic zone (PHZ) tissue and in seemingly normal cortex (SNX) by microdialysis (MD) following surgical ICH evacuation.METHODSWe evaluated 12 patients (median age 64; range 26-71 yr) for changes in CBF and energy metabolism following surgical ICH evacuation using Xenon-enhanced computed tomography (n = 10) or computed tomography perfusion (n = 2) for CBF and dual MD catheters, placed in the PHZ and the SNX at ICH surgery.RESULTSCBF was evaluated at a mean of 21 and 58 h postsurgery. In the hemisphere ipsilateral to the ICH, CBF improved between the investigations (36.6 ± 20 vs 40.6 ± 20 mL/100 g/min; P < .05). In total, 1026 MD samples were analyzed for energy metabolic alterations including glucose and the lactate/pyruvate ratio (LPR). The LPR was persistently elevated in the PHZ compared to the SNX region (P < .05). LPR elevations in the PHZ were predominately type II (pyruvate normal-high; indicating mitochondrial dysfunction) as opposed to type I (pyruvate low; indicating ischemia) at 4 to 48 h (70% vs 30%) and at 49 to 84 h (79% vs 21%; P < .05) postsurgery.CONCLUSIONDespite normalization of CBF following ICH evacuation, an energy metabolic disturbance suggestive of mitochondrial dysfunction persists in the perihemorrhagic zone.

Lower Blood Pressure Is Not Associated With Decreased Arterial Spin Labeling Estimates of Perfusion in Intracerebral Hemorrhage.

BackgroundSubacute ischemic lesions in intracerebral hemorrhage (ICH) have been hypothesized to result from hypoperfusion. Although studies of cerebral blood flow (CBF) indicate modest hypoperfusion in ICH, these investigations have been limited to early time points. Arterial spin labeling (ASL), a magnetic resonance imaging technique, can be used to measure CBF without a contrast agent. We assessed CBF in patients with ICH using ASL and tested the hypothesis that CBF is related to systolic blood pressure (SBP).Methods and ResultsIn this cross‐sectional study, patients with ICH were assessed with ASL at 48 hours, 7 days, and/or 30 days after onset. Relative CBF (rCBF; ratio of ipsilateral/contralateral perfusion) was measured in the perihematomal regions, hemispheres, border zones, and the perilesional area in patients with diffusion‐weighted imaging hyperintensities. Twenty‐patients (65% men; mean±SD age, 68.5±12.7 years) underwent imaging with ASL at 48 hours (N=12), day 7 (N=6), and day 30 (N=11). Median (interquartile range) hematoma volume was 13.1 (6.3–19.3) mL. Mean±SD baseline SBP was 185.4±25.5 mm Hg. Mean perihematomal rCBF was 0.9±0.2 at 48 hours at all time points. Baseline SBP and other SBP measurements were not associated with a decrease in rCBF in any of the regions of interest (P≥0.111). rCBF did not differ among time points in any of the regions of interest (P≥0.097). Mean perilesional rCBF was 1.04±0.65 and was unrelated to baseline SBP (P=0.105).Conclusions ASL can be used to measure rCBF in patients with acute and subacute ICH. Perihematomal CBF was not associated with SBP changes at any time point.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00963976.

THE CHARACTERISTICS OF FUNCTIONAL CONDITION OF CENTRAL NERVOUS SYSTEM IN INDIVIDUALS WITH CHRONIC INSOMNIA AND PROGNOSIS OF DEVELOPMENT OF SLEEP DISORDERS

The higher prevalence and variety of clinical manifestation of disorders of falling asleep and sleep maintenance (insomnia) in persons of able-bodied age condition necessity of development of personified prevention programs subject to main pathophysiologic mechanisms conditioning risks of development of sleep disorders and related to them somatic diseases. Purpose of study. To analyze functional state of brain and cerebral blood flow in brain workers with higher level of professional stress and sleep disorders and to determine risk factors of development of established disorders for scientific substantiation of preventive activities. Material and methods. The examination was applied to two groups of brain workers with higher level of work intensity (class 3.3) and professional stress. The main group included 77 individuals stated availability of insomnia (index of insomnia severity 20.4±3.1 points). The control group included 88 individuals without significant sleep disorders. The clinical instrumental examination was implemented including questionnaire survey, night polysome graphic analysis, electroencephalography (EEG) and rheography analysis. Results. The high level of professional stress in workers with sleep disorders was statistically related to decreasing of efficiency of total time of sleep, decreasing of slow-wave sleep шт its structure, increased sleep fragmentation due to increasing of reactions of EEG-activation (r=0.35). The study of cerebral blood flow established that in 50% of individuals with sleep disorders and 32% of individuals without sleep disorders the instability of vascular tone was registered. According data of prospective observation, the signs of sleep disorders continued in 92% of patients with non-specific alterations of EEG with predominance of low-amplitude high-frequency activity and in 65% of patients with absence of similar alterations. The detected alterations can be considered as markers of condition of increased reactivity of central and vegetative nervous system being predisposing factor of changing from acute or transitory insomnia to chronic form.

Frequency-resolved analysis of coherent oscillations of local cerebral blood volume, measured with near-infrared spectroscopy, and systemic arterial pressure in healthy human subjects.

We report a study on twenty-two healthy human subjects of the dynamic relationship between cerebral hemoglobin concentration ([HbT]), measured with near-infrared spectroscopy (NIRS) in the prefrontal cortex, and systemic arterial blood pressure (ABP), measured with finger plethysmography. [HbT] is a measure of local cerebral blood volume (CBV). We induced hemodynamic oscillations at discrete frequencies in the range 0.04–0.20 Hz with cyclic inflation and deflation of pneumatic cuffs wrapped around the subject’s thighs. We modeled the transfer function of ABP and [HbT] in terms of effective arterial (K(a)) and venous (K(v)) compliances, and a cerebral autoregulation time constant (τ(AR)). The mean values (± standard errors) of these parameters across the twenty-two subjects were K(a) = 0.01 ± 0.01 μM/mmHg, K(v) = 0.09 ± 0.05 μM/mmHg, and τ(AR) = 2.2 ± 1.3 s. Spatially resolved measurements in a subset of eight subjects reveal a spatial variability of these parameters that may exceed the inter-subject variability at a set location. This study sheds some light onto the role that ABP and cerebral blood flow (CBF) play in the dynamics of [HbT] measured with NIRS, and paves the way for new non-invasive optical studies of cerebral blood flow and cerebral autoregulation.

Chapter 20 - Vascular cognitive impairment: A preventable component of dementia

For many decades during the 20th century, the common belief was that the slow strangulation of the brains' blood supply from hardening of the brain arteries led to chronic brain ischemia and neuronal death. Not surprisingly, to counter this, vasodilators rapidly became one of the most commonly used and profitable medications worldwide; however, no clinical benefits were ever proven. In the 1970s and early 1980s cerebral blood flow studies strongly disproved the idea of brain failure due to chronic ischemia. It was also shown that infarcts and not chronic ischemia caused dementia, leading to the concept of multiinfarct dementia. In addition to infarcts, it was then realized that other vascular lesions can also cause cognitive decline. Gradually, as "atherosclerotic dementia" lost ground, Alzheimer's disease (AD) that once had been considered a presenile dementia and rare, became almost synonymous with dementia. Subsequent memory-based definitions and evaluations of dementia led to a bias in favor of diagnosing AD, overshadowing vascular contributions. The widespread use of brain imaging in the 1980s and 1990s contributed to the resurgence of evidence of cerebrovascular diseases. Moreover, it was shown that most cognitive impairment of the elderly results from mixed pathologies, emphasizing the need for a change in the traditional categorical diagnosis of dementia, e.g., AD vs vascular dementia. The alternative diagnostic method was named the vascular cognitive impairment approach, meaning identifying any impairment caused by or associated with vascular factors. The importance of this approach is that vascular lesions are currently the most important treatable and preventable components of dementia, even before any symptoms manifest, i.e., at the brain at risk stage. This chapter provides a summary of the vascular cognitive impairment approach to diagnosis, treatment, and prevention of cognitive decline.

Arterial spin labeling provides a reliable neurobiological marker of autism spectrum disorder

BackgroundResearch on neurobiological markers of autism spectrum disorder (ASD) has been elusive. However, radionuclide studies of cerebral blood flow (CBF) have shown decreased blood flow (hypoperfusion) in the temporal lobes of individuals with ASD across ages and intelligence. This observation fits with current neuroscientific models that implicate temporal regions in social perception and social cognition. Arterial spin labeled perfusion MRI allows noninvasive quantification of regional CBF as part of a multimodal MRI protocol. This method is almost entirely absent from ASD research to date. Our a priori hypothesis was that children with ASD would present with hypoperfusion in the temporal lobes—most notably the fusiform gyrus (given its prominent role in ASD social perception deficits). We also sought to examine the reproducibility of CBF measures, and their relationship to individual differences in facial recognition and ASD symptoms.MethodsA total of 58 males (33 with ASD) between the ages of 12 and 17 years participated in the study. All children completed two arterial spin labeling and structural (T1) scans using a 3 T Siemens Verio scanner approximately 8 weeks apart, as well as behavioral testing at time 1 that included diagnostic measures and the Benton Facial Recognition Test. CBF was the key dependent variable, as was facial recognition performance, and ASD symptoms. The two scans were used for reliability analyses.ResultsThe ASD group showed hypoperfusion in the bilateral fusiform gyrus and in right inferior temporal gyrus. Intra-class correlations showed moderate to good reliability across time within both groups, and no diagnostic group × time interactions. CBF in the left fusiform gyrus was significantly positively correlated with facial recognition. No significant correlations were observed with core ASD symptoms.ConclusionsArterial spin labeling revealed hypoperfusion in children with ASD in regions critical to social perception and cognition. The left fusiform gyrus plays an important role in facial recognition, and greater CBF in this region was correlated with more normative facial recognition performance in children with ASD. This study takes an important first step in establishing CBF of the temporal lobes as a reliable marker of ASD.

Obstructive sleep apnea during REM sleep and daytime cerebral functioning: A regional cerebral blood flow study using high-resolution SPECT

Obstructive sleep apnea (OSA) predominantly during rapid eye movement (REM) sleep may have impacts on brain health, even in milder OSA cases. Here, we evaluated whether REM sleep OSA is associated with abnormal daytime cerebral functioning using high-resolution single-photon emission computed tomography (SPECT). We tested 96 subjects (25 F, age: 65.2 ± 6.4) with a wide range of OSA severity from no OSA to severe OSA (apnea–hypopnea index: 0–97 events/h). More respiratory events during REM sleep were associated with reduced daytime regional cerebral blood flow (rCBF) in the bilateral ventromedial prefrontal cortex and in the right insula extending to the frontal cortex. More respiratory events during non-REM (NREM) sleep were associated with reduced daytime rCBF in the left sensorimotor and temporal cortex. In subjects with a lower overall OSA severity (apnea–hypopnea index<15), more respiratory events during REM sleep were also associated with reduced daytime rCBF in the insula and extending to the frontal cortex. Respiratory events that characterized OSA during NREM versus REM sleep are associated with distinct patterns of daytime cerebral perfusion. REM sleep OSA could be more detrimental to brain health, as evidenced by reduced daytime rCBF in milder forms of OSA.

Test-retest reliability of task-based and resting-state blood oxygen level dependence and cerebral blood flow measures.

Despite their wide-spread use, only limited information is available on the comparative test-retest reliability of task-based functional and resting state magnetic resonance imaging measures of blood oxygen level dependence (tb-fMRI and rs-fMRI) and cerebral blood flow (CBF) using arterial spin labeling. This information is critical to designing properly powered longitudinal studies. Here we comprehensively quantified and compared the test-retest reliability and reproducibility performance of 8 commonly applied fMRI tasks, 6 rs-fMRI metrics and CBF in 30 healthy volunteers. We find large variability in test-retest reliability performance across the different tb-fMRI paradigms and rs-fMRI metrics, ranging from poor to excellent. A larger extent of activation in tb-fMRI is linked to higher between-subject reliability of the respective task suggesting that differences in the amount of activation may be used as a first reliability estimate of novel tb-fMRI paradigms. For rs-fMRI, a good reliability of local activity estimates is paralleled by poor performance of global connectivity metrics. Evaluated CBF measures provide in general a good to excellent test-reliability matching or surpassing the best performing tb-fMRI and rs-fMRI metrics. This comprehensive effort allows for direct comparisons of test-retest reliability between the evaluated MRI domains and measures to aid the design of future tb-fMRI, rs-fMRI and CBF studies.

Factors of Delayed Hyperperfusion and the Importance of Repeated Cerebral Blood Flow Evaluation for Hyperperfusion After Direct Bypass for Moyamoya Disease

Postoperative hyperperfusion is an important complication after direct bypass for moyamoya disease, which sometimes occurs late after initial postoperative cerebral blood flow (CBF) measurement. This study aimed to clarify the incidence of hyperperfusion with management using postoperative continuous sedation and repeated postoperative CBF measurement and to identify factors associated with delayed hyperperfusion. This retrospective study evaluated 72 consecutive hemispheres in 56 adult Japanese patients with moyamoya disease who underwent direct bypass. Postoperative continuous sedation was routinely administered based on CBF evaluation. First, the incidence of symptomatic hyperperfusion was investigated. Second, radiologic hyperperfusion (RHP), which was strictly defined as >30% increase in CBF compared with the contralateral side, and factors associated with delayed RHP were statistically analyzed. Postoperative symptomatic hyperperfusion occurred in 3 hemispheres (4.2%), including subarachnoid hemorrhage in 1 hemisphere (1.4%). RHP immediately after surgery was identified in 16 hemispheres (22.2%). In 8 hemispheres (11.1%), RHP appeared or worsened several days after initial CBF study. In univariate logistic regression analysis, decreased preoperative cerebral vasoreactivity was significantly associated with delayed RHP. The incidence of symptomatic hyperperfusion was 4.2% with management. Delayed hyperperfusion was significantly associated with decreased cerebral vasoreactivity. Therefore, repeated CBF measurements evaluating preoperative cerebral vasoreactivity may decrease complications.

Early Evidence of Sepsis-Associated Hyperperfusion-A Study of Cerebral Blood Flow Measured With MRI Arterial Spin Labeling in Critically Ill Septic Patients and Control Subjects.

Mechanisms underlying sepsis-associated encephalopathy remain unclear, but reduced cerebral blood flow, alone or in conjunction with altered autoregulation, is reported as a potential contributor. We compared cerebral blood flow of control subjects and vasopressor-dependent septic patients. Randomized crossover study. MRI with arterial spin labeling. Ten sedated septic patients on mechanical ventilation (four with controlled chronic hypertension) and 12 control subjects (six with controlled chronic hypertension) were enrolled. Mean ± SD ages were 61.4 ± 10.2 and 44.2 ± 12.8 years, respectively (p = 0.003). Mean Acute Physiology and Chronic Health Evaluation II score of septic patients at ICU admission was 27.7 ± 6.6. To assess the potential confounding effects of sedation and mean arterial pressure, we measured cerebral blood flow with and without sedation with propofol in control subjects and at a target mean arterial pressure of 65 mm Hg and greater than or equal to 75 mm Hg in septic patients. The sequence of sedation versus no sedation and mean arterial pressure targets were randomized. In septic patients, cerebral blood flow measured at a mean arterial pressure target of 65 mm Hg (40.4 ± 10.9 mL/100 g/min) was not different from cerebral blood flow measured at a mean arterial pressure target of greater than or equal to 75 mm Hg (41.3 ± 9.8 mL/100 g/min; p = 0.65). In control subjects, we observed no difference in cerebral blood flow measured without and with sedation (24.8 ± 4.2 vs 24.9 ± 5.9 mL/100 g/min; p = 0.93). We found no interaction between chronic hypertension and the effect of sedation or mean arterial pressure targets. Cerebral blood flow measured in sedated septic patients (mean arterial pressure target 65 mm Hg) was 62% higher than in sedated control subjects (p = 0.001). In septic patients, cerebral blood flow was higher than in sedated control subjects and did not vary with mean arterial pressure targets. Further research is required to understand the clinical significance of cerebral hyperperfusion in septic patients on vasopressors and to reassess the neurologic effects of current mean arterial pressure targets in sepsis.

Thirst-Dependent Activity of the Insular Cortex Reflects its Emotion-Related Subdivision: A Cerebral Blood Flow Study

Recent studies investigating neural correlates of human thirst have identified various subcortical and telencephalic brain areas. The experience of thirst represents a homeostatic emotion and a state that slowly evolves over time. Therefore, the present study aims at systematically examining cerebral perfusion during the parametric progression of thirst. We measured subjective thirst ratings, serum parameters and cerebral blood flow in 20 healthy subjects across four different thirst stages: intense thirst, moderate thirst, subjective satiation and physiological satiation. Imaging data revealed dehydration-related perfusion differences in previously identified brain areas, such as the anterior cingulate cortex, the middle temporal gyrus and the insular cortex. However, significant differences across all four thirst stages (including the moderate thirst level), were exclusively found in the posterior insular cortex. The subjective thirst ratings over the different thirst stages, however, were associated with perfusion differences in the right anterior insula. These findings add to our understanding of the insular cortex as a key player in human thirst – both on the level of physiological dehydration and the level of the subjective thirst experience.

Switching Language Modes: Complementary Brain Patterns for Formulaic and Propositional Language.

Language has been modeled as a rule governed behavior for generating an unlimited number of novel utterances using phonological, syntactic, and lexical processes. This view of language as essentially propositional is expanding as a contributory role of formulaic expressions (e.g., you know, have a nice day, how are you?) is increasingly recognized. The basic features of the functional anatomy of this language system have been described by studies of brain damage: left lateralization for propositional language and greater right lateralization and basal ganglia involvement for formulaic expressions. Positron emission tomography (PET) studies of cerebral blood flow (CBF) have established a cortical–subcortical pattern of brain activity predictive of syllable rate during phonological/lexical repetition. The same analytic approach was applied to analyzing brain images obtained during spontaneous monologues. Sixteen normal, right-handed, native English speakers underwent PET scanning during several language tasks. Speech rate for the repetition of phonological/lexical items was predicted by increased CBF in the left inferior frontal region and decreased CBF in the head of the right caudate nucleus, replicating previous results. A complementary cortical–subcortical pattern (CBF increased in the right inferior frontal region and decreased in the left caudate) was predictive of the use of speech formulas during monologue speech. The use of propositional language during the monologues was associated with strong left lateralization (increased CBF at the left inferior frontal region and decreased CBF at the right inferior frontal region). Normal communication involves the integration of two language modes, formulaic and novel, that have different neural substrates.

The Value of Regional Cerebral Blood Flow SPECT and FDG PET in Operculoinsular Epilepsy.

Operculoinsular epilepsy (OIE) can be challenging to diagnose. While the value of SPECT cerebral blood flow and PET F-FDG studies for presurgical evaluation of patients with medial temporal lobe epilepsy (MTLE) is well established, it remains unclear whether they can help identify an operculoinsular epileptic focus. This study assesses the value of interictal/ictal regional cerebral blood flow (rCBF) SPECT and FDG PET for OIE diagnosis. Eighteen patients with proven OIE who underwent interictal/ictal rCBF SPECT and/or FDG-PET prior to epilepsy surgery were identified from our clinical database and were compared with a group of 18 patients who underwent MTLE surgery. Regional cerebral blood flow SPECT and FDG PET images were reevaluated visually by an expert reader blind to clinical data. Interictal/ictal rCBF SPECT correctly identified an operculoinsular focus in 11 (65%) of 17 OIE patients and was misleading in 3 cases (18%). Secondary activation in areas connected to the insula was often observed. In the MTLE group, the area of maximal increased perfusion was congruent in 12 (75%) of 16 patients and extended to the ipsilateral insula in 1 patient. FDG PET findings were concordant with the epileptic focus in 8 (47%) of 17 OIE patients and were misleading in 4 (24%), whereas they were concordant in all MTLE patients. Interictal/ictal rCBF SPECT can identify a concordant operculoinsular focus in a significant proportion of OIE patients and offers a valuable diagnostic tool in nonlesional cases. By contrast, the value of interictal FDG PET in this population is more equivocal.