The value of transcranial Doppler sonography and digital subtraction angiography in evaluating collateral circulation in ischemic stroke and its correlation with prognosis / 中国医师进修杂志

Objective:To explore the value of transcranial Doppler sonography (TCD) and digital subtraction angiography (DSA) in evaluating collateral circulation in ischemic stroke (IS) and its correlation with prognosis.Methods:The 350 IS patients admitted to Shaoxing People′s Hospital from January 2017 to December 2020 were selected as the research objects. According to the results of DSA, they were divided into collateral circulation group and non-collateral circulation group. According to the prognosis, they were divided into good prognosis group and poor prognosis group. The consistency between the evaluation results of collateral circulation on IS of TCD and DSA was analyzed, and its correlation with prognosis was analyzed.Results:The DSA results showed that among 350 patients, 118 had no collateral circulation and 232 had collateral circulation, including 130 cases of grade 1 collateral circulation and 102 cases of grade 2 collateral circulation. TCD results showed that there were 117 cases without collateral circulation and 233 cases with collateral circulation, including 131 cases with grade 1 collateral circulation and 102 cases with grade 2 collateral circulation. The consistency test showed that the evaluation results of TCD on collateral circulation was highly consistent with the gold standard DSA ( Kappa>0.9, P<0.05). Repeated measures analysis of variance showed that time-point effects, inter-group effects, time-point and inter-group interaction effects can significantly affect the changes in modified Rankin scale(mRS) scores ( P<0.05); and the mRS scores in the collateral circulation group were less than those in the non-collateral circulation group at admission the hospital, discharge of the hospital and 3 months after discharge the hospital: (1.89 ± 0.82) scores vs. (2.98 ± 0.98) scores, (1.13 ± 0.53) scores vs. (2.45 ± 0.80) scores, (0.50 ± 0.45) scores vs. (1.86 ± 0.80) scores, there were statistical differences ( P<0.05). The collateral circulation rate in the good prognosis group was higher than that in the poor prognosis group: 78.95%(150/190) vs. 47.50%(76/160), there was statistical difference ( P<0.05). Conclusions:The evaluation value of TCD for IS collateral circulation is high, and collateral circulation is closely related to prognosis.

Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review / Risco de acidente vascular cerebral perioperatório e monitoramento de autorregulação cerebral: uma revisão sistemática

Abstract Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98;p < 0.0001).

Resumo Antecedentes Acidente vascular cerebral (AVC) perioperatório, delírio e comprometimento cognitivo podem estar relacionados ao manejo e à variações no controle da pressão arterial, à hipoperfusão cerebral, e ao aumento do volume sanguíneo. A autorregulação cerebral (ARC) é um mecanismo para manter a perfusão cerebral por meio do controle do tônus vascular e das reações hemodinâmicas na circulação. Objetivo Este trabalho aborda sistematicamente a determinação da relação entre a falha da ARC e o AVC perioperatório, com uma avaliação da taxa de complicações neurológicas pós-cirúrgicas em estudos em que a ARC perioperatória foi monitorada. Métodos Esta revisão sistemática incluiu ensaios clínicos randomizados e estudos observacionais prospectivos. Todos os estudos ajustaram o risco relativo, a razão de risco ou os valores de intervalo de confiança de 95% (IC95%). Esses efeitos de estimativas foram testados usando modelos de efeitos aleatórios. A heterogeneidade entre os diferentes estudos foi avaliada por meio das estatísticas de Higgins e Thompson I2. Resultados As bases de dados eletrônicas Web of Science, PubMed e Embase foram pesquisadas para selecionar os artigos. Um total de 4.476 estudos publicados entre 1983 e 2019 foram analisados, mas apenas 5 se qualificavam para a extração de dados e foram incluídos na análise final. A coorte combinada do estudo foi composta por 941 pacientes. Todos os estudos forneceram informações sobre AVC perioperatório, o que equivaleu a 16% (158 de 941) da população geral de pacientes. Conclusão Esta meta-análise mostrou evidências do impacto do prejuízo da ARC no risco de AVC perioperatório. Na análise conjunta, as flutuações sanguíneas ou outros insultos cerebrais grandes o suficiente para comprometer a ARC foram associados ao resultado do AVC (razão de probabilidades [RP]: 2,26; IC95%: 1,54-2,98;p < 0,0001).

Evaluation of cerebral hemodynamics by transcranial Doppler ultrasonography and its correlation with intracranial pressure in an animal model of intracranial hypertension / Avaliação da hemodinâmica encefálica utilizando Doppler transcraniano e sua correlação com a pressão intracraniana em um modelo animal de hipertensão intracraniana

ABSTRACT Background: Transcranial Doppler has been tested in the evaluation of cerebral hemodynamics as a non-invasive assessment of intracranial pressure (ICP), but there is controversy in the literature about its actual benefit and usefulness in this situation. Objective: To investigate cerebral blood flow assessed by Doppler technique and correlate with the variations of the ICP in the acute phase of intracranial hypertension in an animal model. Methods: An experimental animal model of intracranial hypertension was used. The experiment consisted of two groups of animals in which intracranial balloons were implanted and inflated with 4 mL (A) and 7 mL (B) for controlled simulation of different volumes of hematoma. The values of ICP and Doppler parameters (systolic [FVs], diastolic [FVd], and mean [FVm] cerebral blood flow velocities and pulsatility index [PI]) were collected during the entire procedure (before and during hematoma simulations and venous hypertonic saline infusion intervention). Comparisons between Doppler parameters and ICP monitoring were performed. Results: Twenty pigs were studied, 10 in group A and 10 in group B. A significant correlation between PI and ICP was obtained, especially shortly after abrupt elevation of ICP. There was no correlation between ICP and FVs, FVd or FVm separately. There was also no significant change in ICP after intravenous infusion of hypertonic saline solution. Conclusions: These results demonstrate the potential of PI as a parameter for the evaluation of patients with suspected ICP elevation.

RESUMO Antecedentes: O Doppler transcraniano (DTC) é uma técnica não invasiva para a avaliação da hemodinâmica cerebral, porém existem controvérsias na literatura sobre sua aplicabilidade preditiva em situações de elevada pressão intracraniana (PIC). Objetivo: Investigar o fluxo sanguíneo cerebral pelo DTC e correlacioná-lo com as variações da PIC na fase aguda da hipertensão intracraniana em modelo animal. Métodos: Dois grupos de animais (suínos) foram submetidos a hipertensão intracraniana secundária à indução de diferentes volumes de hematoma, por meio da insuflação de balão intracraniano controlado com 4 e 7 mL de solução salina fisiológica (grupos A e B, respectivamente). Em seguida, administrou-se infusão venosa de solução salina hipertônica (SSH 3%). Foram coletados os valores dos parâmetros de PIC e DTC (velocidade sistólica [FVs], diastólica [FVd] e média [FVm] do fluxo sanguíneo cerebral), bem como o índice de pulsatilidade (IP). Comparações entre os parâmetros do DTC e o monitoramento da PIC foram realizadas. Resultados: Vinte porcos foram estudados, dez no grupo A e dez no grupo B. Correlação significativa entre IP e PIC foi obtida, principalmente logo após a elevação abrupta da PIC. Não houve correlação entre PIC e FVs, FVd ou FVm separadamente. Também não houve alteração significativa na PIC após a infusão de SSH. Conclusões: Esses resultados demonstram o potencial do IP como um bom parâmetro para a avaliação de pacientes com suspeita de elevação da PIC.

Dialysis headache: characteristics, impact and cerebrovascular evaluation / Cefaleia da diálise: características, impacto e avaliação cerebrovascular

ABSTRACT Background: Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. Objective: To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. Methods: This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. Results: A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. Conclusions: Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.

RESUMO Antecedentes: A cefaleia é um dos sintomas mais frequentes que ocorrem durante as sessões de hemodiálise. Apesar da alta prevalência, essa cefaleia é pouco estudada. Objetivo: Avaliar as características, impacto e fatores associados à cefaleia da diálise. O comportamento da vasculatura cerebral também foi comparado entre pacientes com e sem cefaleia da diálise. Métodos: Este foi um estudo transversal. Pacientes consecutivos submetidos à hemodiálise foram avaliados por meio de questionário semiestruturado, do Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale e Short Form-36 Health Survey (SF-36). Foi realizada ultrassonografia Doppler transcraniana na primeira e na quarta horas de hemodiálise. Resultados: Foram incluídos 100 pacientes, 49 deles tinham cefaleia da diálise. Mulheres (OR=5,04; IC95% 1,95-13,04), indivíduos mais jovens (OR=1,05; IC95% 1,01-1,08), com maior escolaridade (OR=3,86; IC95% 1,4-10,7) e que passaram mais tempo em programas de diálise (OR=0,99, IC95% 0,98-1) tiveram mais cefaleia da diálise (regressão logística). Indivíduos com cefaleia dialítica tiveram pior qualidade de vida nos domínios dor e estado geral de saúde (56,9 versus 76,4, p=0,01; 49,7 versus 60,2, p=0,03, respectivamente). A cefaleia da diálise foi associada a um impacto significativamente maior na vida (OR=24,4; IC95% 2,6-226,6; regressão logística). O índice de pulsatilidade (ultrassonografia Doppler transcraniana) foi menor entre os pacientes com cefaleia da diálise do que entre aqueles sem. Conclusões: A cefaleia da diálise ocorre com frequência e está associada a pior qualidade de vida e a padrões de vasodilatação cerebral.

Ultrasonographic evaluation of cerebrovascular reactivity in flight crew after simulated acute altitude hypoxia / 中华超声影像学杂志

Objective:To monitor the cerebral vascular blood flow parameters in the early stage of simulated acute exposure to high altitude hypoxia by transcranial color Doppler (TCCD), and to evaluate the change trend of cerebral hemodynamics and cerebrovascular reactivity.Methods:Sixty-four healthy volunteers were selected to observe the changes of peak systolic flow velocity(Vs), end diastolic flow velocity(Vd), mean flow velocity(Vm), resistance index (RI) and pulsatility index (PI) of middle cerebral artery (MCA) 30 minutes after they quickly entered the simulated altitude of 4 500 meters. Combined with breath holding test, breath holding index (BHI) was used to evaluate cerebrovascular reactivity (CVR), and subjects were divided into ≤30 years old group and >30 years old group, and the changes of CVR after hypoxia of the two groups were compared.Results:In the early stage of hypoxic environment, compared with baseline, SpO 2 decreased, heart rate increased, and blood flow velocity of middle cerebral artery(Vs, Vd, Vm) increased significantly, BHI showed a decreasing trend (all P<0.01). After hypoxia, the BHI rate of change in >30 years old was lower than that of the subjects ≤30 years old ( P<0.05). After breath holding, cerebral blood flow velocity increased significantly, PI and RI decreased significantly (all P<0.01). Conclusions:Cerebral blood flow is very sensitive to hypoxia. The application of TCCD technology can evaluate the trend of cerebral blood flow dynamics and cerebrovascular reserve capacity in real time and accurately, which is helpful to provide objective basis and research basis for the prevention and treatment of high altitude hypoxia.

Clinical value of transcranial Dopler ultrasound in the detection of intracranial artery stenosis in patients with cerebral infarction / 中国基层医药

Objective:To evaluate the application value of transcranial Doppler in the detection of intracranial artery stenosis in patients with cerebral infarction.Methods:120 patients with cerebral infarction who received treatment in Zhuji Hospital of Traditional Chinese Medicine from December 2018 to December 2020 were included in this study. The patients underwent CT angiography and transcranial Doppler examination. The results of CT angiography and transcranial Doppler examination for screening intracranial artery stenosis at different locations were evaluated. Taking CT angiography results as the gold standard, the efficacy of transcranial Doppler examination for screening intracranial artery stenosis at different locations was determined. The consistency of transcranial Doppler examination versus CT angiography in screening intracranial necrosis at different locations was evaluated. Results:The sensitivity of transcranial Doppler examination in the detection of intracranial artery stenosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 89.47%, 91.18%, 85.00%, 90.62%, 81.82%, 96.55%, respectively. The specificity of transcranial Doppler examination in the detection of intracranial necrosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 87.30%, 95.35%, 91.25%, 94.32%, 96.33%, and 87.88%, respectively. The Kappa value for judging the consistency between transcranial Doppler examination and CT angiography in the detection of intracranial artery stenosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 0.766, 0.858, 0.758, 0.833, 0.800, and 0.852, respectively.Conclusion:Transcranial Doppler examination has high sensitivity and specificity in the detection of intracranial artery stenosis at different locations. Its screening results are highly consistent with those from CT angiography. Transcranial Doppler examination is of high clinical application value.

Application of ultrasound monitoring optic nerve sheath diameter in diagnosis and treatment of adult patients with intracranial hypertension / 中国医师进修杂志

Objective:To investigate the effect of ultrasound measurement of optic nerve sheath diameter (ONSD) in adult patients with elevated intracranial pressure (ICP).Method:From June 2017 to March 2020, A total of 64 patients (32 patients with elevated ICP and 32 patients with normal ICP) were placed with invasive intracranial pressure monitoring probe in Beijing Pinggu Hospital. Their ICP and ONSD were continuously monitored. Thirty-two healthy volunteers were recruited as control group to check ONSD. The correlation between ONSD and ICP, and the changes of ICP and ONSD after osmotic therapy were observed.Results:The ONSD in ICP increased group was significantly higher than that in normal ICP group: (5.77 ± 0.3) mm vs. (5.01 ± 0.1) mm, with statistical difference ( P<0.05), and there was a positive correlation between ONSD and ICP. There was no significant difference in ONSD between normal ICP group and control group ( P>0.05). Conclusions:Ultrasound monitoring ONSD can reflect the level of ICP and evaluate the effect of osmotic therapy and the prognosis of patients. Bedside ultrasound examination of optic nerve sheath diameter could be used to judge ICP and to evaluate the curative effect of osmotic therapy, with high clinical application value.

Patent foramen ovale in patients with cryptogenic stroke: evaluation and secondary prevention / 国际脑血管病杂志

Cryptogenic stroke (CS) is a type of stroke that can not find the exact cause after using the standard clinical examination procedure of stroke. In recent years, many studies have shown that patent foramen ovale (PFO) is closely associated with CS, and its main pathogenesis is paradoxical embolism. In clinical practice, ultrasound is often used for PFO screening. In the context of PFO, the secondary prevention of CS includes drug therapy and PFO closure, but the choice of treatment is still controversial. Screening and evaluation of possible PFO will help to develop secondary prevention strategies for patients with CS, especially those who can benefit from PFO closure.

Predictive role of transcranial Doppler ultrasound in patients with acute ischemic stroke treated with endovascular therapy / 国际脑血管病杂志

Acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) accounts for about 20% of all patients with AIS. Endovascular treatment (EVT) is the gold standard for the treatment of LVO-AIS. It is necessary to evaluate the cerebral hemodynamics after EVT, and individualized blood pressure and cerebral blood flow management can be carried out accordingly. Transcranial Doppler ultrasound (TCD) is a method that can evaluate the changes of cerebral hemodynamics in real time at the bedside. It has the advantages of being reliable, safe, cheap, and non-invasive. This article reviews the predictive role of TCD in patients with AIS treated with EVT

Transcranial Doppler ultrasound for assessment of dynamic cerebral autoregulation in patients with acute ischemic stroke / 国际脑血管病杂志

Transcranial Doppler (TCD) is a method for measuring cerebral artery blood flow velocity, which has the advantages of low cost, non-invasive, high temporal resolution. Dynamic cerebral autoregulation (dCA) is to study the instantaneous change of cerebral blood flow (CBF) at the moment of arterial blood pressure or intracranial pressure change, that is, the ability to recover CBF in the face of sudden change of perfusion pressure. After the onset of acute ischemic stroke (AIS), effective dCA can maintain the stability of cerebral hemodynamics and avoid excessive or insufficient perfusion at the injured site. Therefore, it is of great significance to evaluate dCA in patients with AIS. However, at present, there is no recognized optimal evaluation method for dCA. This article mainly summarizes the advantages of TCD in evaluating dCA compared with other methods and the application of TCD combined with transfer function analysis (TFA) in evaluating dCA in AIS.

Comparison of right-to-left shunt characteristics in cryptogenic embolic ischemic stroke and non-cardioembolic ischemic stroke / Comparação das características do shunt direita-esquerda em pacientes com AVC isquêmico criptogênio e AVC não cardioembólico

Abstract Background: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. Objective: The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. Methods: A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. Results: Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). According to the moment of the cardiac cycle, 75 patients (78.1%) in the UES group had a positive test at rest compared to 42 (58.3%) in the NCES group (p=0.007). Conclusions: The current study demonstrated that almost 70% of patients with undetermined embolic stroke and PFO presented a large RLS and more than 75% had RLS at rest. These findings suggest that the size of the shunt should be taken into account when evaluating whether PFO could be a possible mechanism underlying cryptogenic stroke.

RESUMO Antecedentes: Uma das potenciais fontes embólicas no acidente vascular cerebral (AVC) de origem indeterminada é o forame oval patente (FOP). Objetivo: O objetivo do presente estudo foi identificar as características do shunt direita-esquerda em paciente com AVC de etiologia indeterminada, presumidamente embólica, e comparar tais características com pacientes apresentando AVC por outras causas não embólicas. Métodos: Trata-se de um estudo retrospectivo com 168 pacientes com AVC e forame oval patente, separados em dois grupos: AVC embólico de etiologia indeterminada e AVC por outras causas não embólicas. Todos os pacientes foram submetidos a Doppler transcraniano, para avaliar a presença de shunt direita-esquerda por meio do teste de embolia paradoxal. Além da quantificação de microbolhas, também foi avaliada a presença de shunt em repouso e sob manobra de Valsalva. Resultado: Do total, 96 pacientes foram incluídos no primeiro grupo (AVC indeterminado) e 72, no segundo grupo (AVC não embólico). No primeiro grupo, 65 pacientes exibiram shunt com passagem de mais de 10 microbolhas (67,5%), enquanto no segundo grupo isso aconteceu em 51,4% (p=0,038) dos casos. Além disso, 75 pacientes (78,1%) do primeiro grupo tiveram teste positivo ao repouso, comparados com 42 pacientes (58,3%) no segundo grupo (p=0,007). Conclusão: O presente estudo demonstrou que até 70% dos pacientes com AVC de etiologia indeterminada e forame oval apresentaram shunts maiores; em mais de 75%, houve passagem de microbolhas ao repouso. Esses achados sugerem que as características do shunt, como quantidade de microbolhas e passagem ao repouso, devem ser levadas em consideração na avaliação do FOP como possível mecanismo subjacente ao AVC.

Transcranial color Doppler ultrasound quantitative analysis of the risk of early neurological deterioration in acute ischemic stroke patients and its effectiveness in predicting poor prognosis / 中国医师进修杂志

Objective:To investigate the ability of predicting poor prognosis and the diagnosis efficacy of transcranial color Doppler ultrasound (TCCD) in acute ischemic stroke patients.Methods:A total of 264 AIS patients admitted to the Second Hospital of Dalian Medical University from January 2018 to March 2020 were selected and divided into early neurological deterioration (END) group (55 patients) and no END group (209 patients). The optic nerve sheath diameter (ONSD)/transverse eyeball diameter (ETD), middle cerebral artery pulsatility index (PI) and midline shift were detected by TCCD, and the results were analyzed.Results:The values of ONSD/ETD, PI and midline shift in the END group were higher than those in the no END group: 0.24 ± 0.02 vs. 0.22 ± 0.03, 1.26 ± 0.14 vs. 1.10 ± 0.12, (4.97 ± 1.13) mm vs. (3.41 ± 1.05) mm, and the differences were statistically significant ( P<0.05). The values of ONSD/ETD, PI, midline shift in the brain were positively correlated with the National Institutes of Health Stroke Scale (NIHSS) scores ( r1 = 0.531, r2 = 0.599, r3 = 0.566, all P<0.001). Multivariate analysis showed that NIHSS scores, blood glucose, ONSD/ETD, PI, brain midline shift values were related to END ( P<0.05). The prognostic area under the curve of the ONSD/ETD, PI, combined with brain midline shift values in assessing prognosis was 0.896, which was greater than any single index. The sensitivity was 84.62%, and the specificity was 89.08%. Conclusions:The detection of ONSD/ETD, PI and midline shift values by TCCD can provide important information for clinical assessment of the risk of END in AIS patients.

Evaluation of middle cerebral artery blood flow velocity in children with electrical status epilepticus during sleep by transcranial Doppler-video electroencephalography and its significance / 中国医师进修杂志

Objective:To evaluate the middle cerebral artery blood flow velocity in children with electrical status epileptic during sleep (ESES) by transcranial Doppler (TCD)-video electroencephalography (VEEG), and analyze its clinical significance.Methods:The clinical data of 40 children with ESES (ESES group) in Zhangjiakou First Hospital of Hebei Province from January 2019 to January 2021 were retrospectively analyzed. The mean flow velocity of middle cerebral artery (MCA mean) and middle cerebral artery (MCA) flow fluctuation value during deep sleep were measured by TCD-VEEG, and the results were compared with 40 healthy children (healthy control group) during the same period. The relationship between MCA mean, MCA flow fluctuation value during deep sleep and clinical characteristics was analyzed by multivariate stepwise regression. Results:The MCA mean and MCA flow fluctuation value during deep sleep in ESES group were significantly higher than those in healthy control group: (17.87 ± 7.38)% vs. (2.07 ± 1.11)% and (92.92 ± 21.64) cm/s vs. (58.11 ± 8.04) cm/s, and there were statistical differences ( t = 13.389 and 9.536, P<0.01). There was no statistical difference in MCA mean and MCA flow fluctuation value during deep sleep in children with benign epilepsy with central temporal spinous wave (16 cases), benign epilepsy variant with central temporal spinous wave (13 cases) and acquired epileptic aphasia (11 cases) ( P>0.05). There was no statistical difference in MCA mean and MCA flow fluctuation value during deep sleep in children with multifocal epileptic foci (16 cases), bilateral asymmetric epileptic foci (16 cases) and bilateral synchronous symmetric epileptic foci (8 cases)( P>0.05). The MCA flow fluctuation value during deep sleep in children with absolute synchronization and fully generalized ESES (16 cases) was significantly higher than that in children with asymmetric ESES (24 cases): (22.37 ± 2.37)% vs. (15.37 ± 5.37)%, and there was statistical difference ( t = 4.890, P<0.01); there was no statistical difference in MCA mean during deep sleep between 2 types of children ( P>0.05). The MCA flow fluctuation value during deep sleep in children with non obvious cognitive impairment (14 cases), mild cognitive impairment (13 cases) and severe cognitive impairment (13 cases) was (14.21 ± 5.20)%, (17.97 ± 7.45)% and (22.10 ± 7.94)%, and there was statistical difference ( F = 4.376, P<0.05); there was no statistical difference in MCA mean during deep sleep in 3 types of children ( P>0.05). Multivariate stepwise regression analysis result showed that the MCA flow fluctuation value during deep sleep had positive correlation with the degree of cognitive impairment in children with ESES ( r = 0.391, P<0.05). Conclusions:The fluctuation value of MCA during deep sleep by TCD-VEEG examination is positively correlated with the degree of cognitive impairment in children with ESES, which may be a reliable way for clinical evaluation of the degree of cognitive impairment in children with ESES.

Índice de resistencia de la arteria cerebral anterior en el neonato muy prematuro / Resistance index of the anterior cerebral artery in the very premature neonate

RESUMEN Introducción. El índice de resistencia (IR) de la arteria cerebral anterior (ACA) permite evaluar el flujo sanguíneo y se utiliza para determinar el bienestar fetal. Objetivo. Determinar el flujo de la arteria cerebral anterior en muy prematuros durante las primeras 72 horas de vida. Métodos. Se revisaron historias clínicas de muy prematuros atendidos en la Unidad de Cuidados Intensivos Neonatales del Hospital Nacional Edgardo Rebagliati Martins (HNERM), EsSalud, Lima-Perú, entre los años 2011-2019. Resultados. Se revisaron 56 historias clínicas que reportaron el índice de resistencia de la arteria cerebral anterior en muy prematuros del HNERM. Los valores promedio del IR de la ACA fueron: 0,695 a las 24 horas; 0,69 a las 48 horas; y 0,667 a las 72 horas. El flujo sistólico promedio de la arteria cerebral anterior a las 48 horas de vida fue similar al de la vida intrauterina; a las 72 horas, el flujo diastólico promedio fue menor. Conclusiones. En muy prematuros atendidos en la Unidad de Cuidados Intensivos Neonatales del HNHRM, los valores promedio del IR de la ACA fueron: 0,695 a las 24 horas; 0,69 a las 48 horas; y 0,667 a las 72 horas.

ABSTRACT Introduction. The anterior cerebral artery (ACA) resistance index (IR) is used to assess blood flow and is used to determine fetal well-being. Objective. To determine the flow of the anterior cerebral artery in very preterm infants during the first 72 hours of life. Methods. Medical records of very preterm infants treated in the Neonatal Intensive Care Unit of Edgardo Rebagliati Martins National Hospital (HNERM), EsSalud, Lima-Peru, between the years 2011-2019 were reviewed. Results. 56 medical records were reviewed that reported the index of resistance of the anterior cerebral artery in very premature infants of the HNERM. The mean values of the IR of the ACA were: 0,695 at 24 hours; 0,69 at 48 hours; and 0,667 at 72 hours. The mean systolic flow of the cerebral artery prior to 48 hours of life was similar to that of intrauterine life; at 72 hours, the mean diastolic flow was lower. Conclusions. In very preterm infants treated in the Neonatal Intensive Care Unit of the HNHRM, the average RI values of the ACA were: 0,695 at 24 hours; 0,69 at 48 hours; and 0,667 at 72 hours.

Terapia endovascular múltiple para el manejo del vasoespasmo cerebral refractario / Repeated endovascular therapy for refractory cerebral vasospasm

Resumen El vasoespasmo cerebral es una complicación severa de la hemorragia subaracnoidea. La monitorización y la detección del vasoespasmo por mé- todos no invasivos, así como la terapia endovascular, han revolucionado la atención médica tradicional. Se presenta el caso de un paciente masculino de 45 años con aneurisma roto de la arteria comunicante anterior, quien desarrolló vasoespasmo severo refractario desde el octavo día de hemorragia subaracnoidea. El vasoespasmo fue detectado oportunamente con técnicas no invasivas y tratado en cinco ocasiones mediante terapia endovascular, logrando mejoría inmediata de los síntomas y sin secuelas neurológicas. Este reporte contribuye a demostrar el beneficio de la terapia endovascular múltiple para el manejo del vasoespasmo cerebral refractario, en combinación con la utilización de técnicas no invasivas para la monitorización y detección oportuna del vasoespasmo. Adicionalmente, se revisan las recomendaciones actuales de medicina basada en la evidencia sobre el uso del Doppler transcraneal para la detección del vasoespasmo cerebral.

Abstract Cerebral vasospasm is a severe complication of subarachnoid hemorrhage. Monitoring and detection of vasospasm by non-invasive methods as well as the endovascular therapy have revolutionized healthcare. A 45-years-old male patient presented with a ruptured aneurysm in the anterior communicating artery and developed severe refractory vasospasm since the eighth day of aneurysm rupture. Vasospasm was timely detected with non-invasive techniques and successfully endovascular therapy was provided five times with neurological and radiological recovery each time and no neurological sequelae. This report contributes to current practice as it demonstrates the benefit of repeated endovascular therapy for refractory cerebral vasospasm, especially when clinical and non-invasive monitoring shows persistence of this complication. Furthermore, we review the current evidence-based medicine recommendations about Transcranial Doppler Ultrasonography that support the monitoring and detection of cerebral vasospasm.

Application value of intracranial vascular hemodynamics in neonatal subependymal hemorrhage / 中国医师杂志

Objective@#To explore the related factors of subependymal hemorrhage (SEH) and cerebral hemodynamic changes.@*Methods@#From October 2012 to October 2017, 200 cases of children with subependymal hemorrhage diagnosed by ultrasound in our department of pediatrics were selected as the observation group , and a total of 150 children who were admitted to the Department of Pediatrics in the same period due to craniocerebral diseases and other serious diseases were selected as control group. The independent risk factors of the children in the observation group were analyzed, and the difference of the maximum systolic blood flow velocity (SV), the diastolic maximum flow velocity (DV), the systolic and diastolic velocity ratio (S/D), the resistance index (RI), and the pulsatile index (PI) were compared between the two groups.@*Results@#Neonatal asphyxia, preterm birth, acidosis, neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus and coagulation dysfunction were independent risk factors for subependymal hemorrhage. The bleeding side SV and DV of the observation group were higher than those of the control group, with statistically significant difference (P<0.001). In the observation group, the bleeding side SV and DV were higher than those of the healthy side, with statistically significant difference (P<0.001). There was no significant difference in bleeding side SV, DV, S/D, RI and PI in 110 cases of single side ependymal hemorrhage (P>0.05).@*Conclusions@#Children with ependymal hemorrhage can observe the hemodynamic indexes of anterior cerebral artery (ACA) dynamically by craniocerebral ultrasound, and judge the therapeutic effect by evaluating the systolic and diastolic blood flow velocity, so as to prevent the further aggravation of subependymal hemorrhage

Application value of intracranial vascular hemodynamics in neonatal subependymal hemorrhage / 中国医师杂志

Objective To explore the related factors of subependymal hemorrhage (SEH) and cerebral hemodynamic changes.Methods From October 2012 to October 2017,200 cases of children with subependymal hemorrhage diagnosed by ultrasound in our department of pediatrics were selected as the observation group,and a total of 150 children who were admitted to the Department of Pediatrics in the same period due to craniocerebral diseases and other serious diseases were selected as control group.The independent risk factors of the children in the observation group were analyzed,and the difference of the maximum systolic blood flow velocity (SV),the diastolic maximum flow velocity (DV),the systolic and diastolic velocity ratio (S/D),the resistance index (RI),and the pulsatile index (PI) were compared between the two groups.Results Neonatal asphyxia,preterm birth,acidosis,neonatal respiratory distress syndrome (NRDS),patent ductus arteriosus and coagulation dysfunction were independent risk factors for subependymal hemorrhage.The bleeding side SV and DV of the observation group were higher than those of the control group,with statistically significant difference (P ＜ 0.001).In the observation group,the bleeding side SV and DV were higher than those of the healthy side,with statistically significant difference (P ＜0.001).There was no significant difference in bleeding side SV,DV,S/D,RI and PI in 110 cases of single side ependymal hemorrhage (P ＞ 0.05).Conclusions Children with ependymal hemorrhage can observe the hemodynamic indexes of anterior cerebral artery (ACA) dynamically by craniocerebral ultrasound,and judge the therapeutic effect by evaluating the systolic and diastolic blood flow velocity,so as to prevent the further aggravation of subependymal hemorrhage

Correlation of substantia nigra hyperecho with essential tremor and Parkinson disease / 中华全科医师杂志

Objective To investigate the correlation of substantia nigra hyperecho with essential tremor (ET) and Parkinson disease (PD).Methods The clinical data of 158 patients with ET or PD who underwent transcranial ultrasonography in Tongji Hospital from March 2016 to March 2018 were retrospectively analyzed.There were 35 patients with ET (ET group),113 patients with PD who had no previous history of ET (PD group),and 10 PD patients with previous history of ET (ET-PD group).And 58 healthy subjects served as controls (control group).The hyperechoic area of substantia nigra in different groups was compared.Results The hyperechoic areas of the substantia nigra were [0 (0,0)]cm2 (control group),[0.27(0,0.41)]cm2 (ET group),[0.33(0.21,0.40)]cm2 (ET-PD group) and [0.35(0.29,0.45)]cm2 (PD group);the differences between control group and ET group,between the ET group and PD group were statistically significant (Z=-5.24,P=0.01;Z=-3.09,P=0.02),and there were no significant difference between the ET group and ET-PD group,between ET-PD group and PD group (Z=-0.98,P=0.32;t=-0.98,P=0.33).The ratio of substantia nigra hyperechoic positive to negative in ET-PD group was 9.00 (9/1),while that in ET group was 0.94 (17/18) (OR=9.53,95％ CI:1.09-83.43,x2=3.91,P=0.04).Conclusion Substantia nigra hyperecho is an objective imaging indicator for patients with ET and PD,and has a certain differential value for their diagnosis.

Assessment of cerebrovascular reactivity in obstructive sleep apnea hypopnea syndrome with transcranial Doppler ultrasonography / 中华老年心脑血管病杂志

Objective To investigate the value of transcranial Doppler ultrasonography(TCD)for assessing the cerebrovascular reactivity (CVR)in obstructive sleep apneahypopnea syndrome (OSAHS)patients.Methods Sixty OSAHS outpatients and inpatients admitted to our neurology department from August 2015to December 2016served as an OSAHS group,then further divided into mild group(n=15),moderate group(n=27)and severe group(n=18)according to apneahypopnea index(AHI).Meanwhile,20healthy individuals served as a control group.They underwent TCD on admission to detect their CVR,including the average velocity of cerebral artery blood flow(Vm)during calm breathing and after breath holding.The breath holding index(BHI) was calculed.The relationship between BHI and CVR was analized by pearson linear correlation analysis. Results There was no statistically significant difference in Vm during calm breathing between the OSAHS and control groups(73.64±9.87cm/s vs 72.79±8.68cm/s,P＞0.05).Both of Vm after breath holding and BHI of the OSAHS group were lower than those of the control group(88.63±6.65cm/s vs 93.26±7.12cm/s,0.71±0.16 vs 0.93±0.37,P＜0.01).Both of Vm after breath holding and BHI of the mild group were the highest,while the severe group had the lowest values and the moderate group was in between(P＜0.05).No significant correlation was found between AHI and Vm during calm breathing(r=0.197,P=0.052),while AHI was negatively correlated with Vm after breath holding and BHI(r=-0.557,P =0.011;r=-0.605,P=0.000).Conclusion TCD can detect CVR changes in OSAHS patients,whose Vm after breath holding and BHI decrease significantly.The more severe the OSAHS is,the lower the CVR is.

Application of transcranial doppler ultrasound in hemodynamic follow-up after thrombectomy of acute anterior circulation arterial occlusion / 中国脑血管病杂志

Objective To investigate the application of transcranial Doppler ultrasonography (TCD) in middle cerebral artery (MCA) hemodynamic follow-up after thrombectomy of acute anterior circulation arterial occlusion. Methods From December 2013 to May 2018,45 consecutive patients with acute anterior circulation arterial occlusion treated with Solitaire stent thrombectomy at the Department of Neurology, the Third People's Hospital of Hubei Province were enrolled retrospectively. There werel7 females and 28 males. According to PSV on the 1st day after operation ,45 patients were divided into high-flow rate (> 140cm/s) group and normal-flow rate (140 cm/s) group. The baseline and clinical data of both groups were collected and their differences were compared. The baseline data included age, gender, general risk factors for cardio-cerebrovascular diseases (hypertension,hyperlipidemia,diabetes,history of atrial fibrillation, and history of smoking and drinking). The clinical data included the National Institutes of Health Stroke Scale (NIHSS) score on admission,times of intraoperative thrombectomy,time from admission to recanalization, preoperative intravenous thrombolysis rate,modified Rankin scale (MRS) score. TCD was used to monitor and record the peak systolic velocity (PSV) and the end diastolic velocity (EDV) of the MCA at the 1st day,7th day,and 3rd month after operation. The correlation between high velocity of PSV on the 1st day after operation and intracranial hemorrhage and good prognosis was evaluated Results (1) Hyperlipidemia occurred in 5 of 13 patients in the high-flow rate group .and the incidence of hyperlipidemia in the normal-flow rate group was 6. 2% (2/32). Atrial fibrillation occurred in 2 of 13 patients in the high-flow rate group,and the incidence of atrial fibrillation in the normal flow rate group was 53.1% (17/32). There were statistically differences between the two groups (all P 0.05). (2) The residual stenosis rate after thrombectomy in the high-flow rate group was higher than that in the normal-flow rate group. There was significant difference between the two groups (30.0% [12. 5% ,45. 0%] vs. 0 [0,10. 0%] ,P 0.05). (3) The PSV of the high-flow rate group on the 1st day,the 7th day,and 3rd month after operation were 222 ±50,168 ±27, and 138 ± 24 cm/s, respectively, and those of the normal-flow rate group were 96 ±21,95 ±22,and 98 ± 17 cm/s,respectively. The interaction between groups and time points had statistical significance (F = 40. 659,P 0.05). (4) The EDV of the high-flow rate group on the 1st day,7th day and 3rd month after operation were 118 ±40,83 ± 15,and 67 ± 14cm/s,and those of the nonnal-flow rate group were 45 ± 10,44 ± 10,and 46 ± 8 cm/s,respectively. Hie interaction between groups and time points had statistical significance (F = 34. 699 ,P 0. 05). Conclusions TCD can be used for hemodynamic monitoring after thrombectomy of acute anterior circulation artery occlusion. There was elevated blood flow velocity in MCA after thrombectomy for the occlusion caused by atherosclerotic stenosis, and lead to intracerebral hemorrhage, however, a study with large sample is needed to cofirm it.