ABSTRACT
Objective To assess the association of cerebrovascular reserve(CVR) with diabetes(DM)、hypertensive atherosclerotic lacunar infarction(HALI),hypertension(HT) and diabetic lacunar infarction(DLI) by means of transcranial Doppler ultrasonography (TCD) with breath-holding maneuver.Methods The breath-holding index (BHI), which was the percentage increase in middle cerebral artery(MCA) blood flow velocity as index of CVR assessment,was detected during breath-holding by TCD and breath-holding technique in 30 diabetic patients,30 hypertensive atherosclerotic lacunar infarction patients,30 hypertension patients and 30 diabetic lacunar infarction patients. Results There was significant difference in the ascending rates of Vm and BHI between diabetic group and diabetic lacunar infarction group,diabete lacunar infarction group and hypertensive atherosclerotic lacunar infarction group,hypertension group and diabetic group (all P<0.05). Conclusions Diabetes can more significantly impair CVR than hypertension. Diabetic lacunar infarction can more significantly impair CVR than diabetes. Diabetic lacunar infarction can more significantly impair CVR than hypertensive atherosclerotic lacunar infarction .
ABSTRACT
Objective: This study was designed to analyze the results from ICP and TCD monitoring in patients with traumatic brain injury (TBI) in order to further evaluate the clinical significance of noninvasive ICP monitoring with TCD. Methods:The monitoring and measurements with TCD were performed beside beds on the following day of surgery to record the spectral atlas and parameter of the middle cerebral artery (MCA) of suffering side in 32 patients with TBI. The values of ICP were recorded at the same time. The patients were divided into four groups according to ICP. The comparative analyses of results of TCD and ICP monitoring were carried out.Results:(1)Spectral atlas: The spectral atlas of Mild ICP Increase Group showed no visible differences from those of Normal ICP Group.A phenomenon of deepened notch before reaching D peak was found in some cases of Moderate ICP Increase Group while occurrence of single cusp peak and disappearance of S2 peak with decreased diastolic velocity were observed in Severe ICP Increase Group. (2) Parameter of TCD: With the increase of ICP,Vs,Vd and Vm were decreased accordingly with the most significant dropping in Vd while PI and RI were elevated gradually. Conclusion:This study suggests that TCD can be applied to monitor noninvasively ICP and indicate the significant increase of ICP in patients with TBI,but fail to detect mild increase of ICP. Spectral atlas is superior to parameters of TCD in judgment of increased ICP
ABSTRACT
OBJECTIVE: The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow(CBF) and cerebrovascular reserve capacity(CVRC), and to investigate the usefulness of single photon emission computed tomography (SPECT) as a prognostic factor for neurological improvement after cranioplasty. METHODS: Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery(MCA) and internal carotid artery (ICA) were obtained by transcranial Doppler ultrasonography(TCD). The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT (Group 1, n=7) and hypoactivity to acetazolamide-activated SPECT (Group 2, n=17). These measurements were obtained two weeks prior to and two weeks after cranioplasty. RESULTS: The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased (P<0.05). Compared with Group 2, there was significant increase in CBF and neurological imrovement after cranioplasty in Group 1. CONCLUSION: Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.
Subject(s)
Humans , Acetazolamide , Blood Flow Velocity , Carotid Artery, Internal , Prospective Studies , Tomography, Emission-Computed, Single-PhotonABSTRACT
Blood flow velocity changes induced by the focal brain activation can be assessed by using Transcranial Doppler sonography (TCD). To explore the hemispheric dominant hemodynamic effect by performing calculation, we applied TCD technique to detect cerebral blood velocity asymmetry. METHODS Twenty healthy right-handed subjects were tested. We measured mean flow velocities (MFV) in the middle and posterior cerebral arteries (MCA, PCA). Photic stimulation was given separately as a control task for calculation. RESULTS While the photic stimulation increased the blood velocity only in PCAs, performing calculation increased the velocity in MCAs. Right-left difference was noted by performing calculation with greater increase in left MCA (right: 8.8 %; left: 21.2 %). CONCLUSION Application of TCD enabled us to measure the hemodynamic changes supporting the left hemispheric dominance of calculation task. Futhermore, increase in non-dominant right hemisphere suggests the functional interaction of cerebral activity.