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1.
Rev. cuba. oftalmol ; 34(1): e957, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289533

ABSTRACT

La enfermedad cerebrovascular isquémica tiene una elevada incidencia y prevalencia en Cuba, y constituye la tercera causa de muerte en el país. Existen diferencias anatómicas y clínicas entre el infarto de la circulación anterior y la posterior. En ocasiones, los elementos distintivos que ayudan al diagnóstico topográfico de la enfermedad cerebrovascular isquémica son las manifestaciones neuroftalmológicas. Con el objetivo de profundizar en el conocimiento actual sobre las alteraciones neuroftalmológicas que se asocian a la enfermedad cerebrovascular isquémica, se realizó una revisión bibliográfica, donde se consultaron un total de 69 fuentes de información digital de los últimos 5 años. La circulación cerebral se divide de manera general en anterior y posterior. Los síntomas y signos principales del ictus que afecta la circulación anterior son la desviación conjugada de la mirada, la afectación de las sácadas, la hemianopsia homónima, la heminegligencia y la apraxia de la apertura ocular; mientras que las alteraciones asociadas a la afectación de la circulación posterior son el nistagmo, las anormalidades en la alineación y los movimientos oculares, así como la hemianopsia homónima con conservación macular. Se concluye que en la enfermedad cerebrovascular isquémica aparecen síntomas y signos como consecuencia de la afectación, tanto de la vía visual aferente, como de la eferente. La hemianopsia homónima es el signo más frecuente reportado(AU)


Ischemic cerebrovascular disease has a high incidence and prevalence in Cuba, and it is the third cause of death in the country. A number of anatomical and clinical differences distinguish anterior from posterior circulation infarction. On certain occasions the distinguishing elements that aid in the topographic diagnosis of ischemic cerebrovascular disease are its neuro-ophthalmological manifestations. With the purpose of gaining insight into the current knowledge about the neuro-ophthalmological alterations associated to ischemic cerebrovascular disease, a bibliographic review was conducted based on the analysis of 69 digital information sources from the last five years. Cerebral circulation is generally divided into anterior and posterior. The main symptoms and signs of the stroke that affects anterior circulation are conjugate gaze deviation, altered saccades, homonymous hemianopsia, heminegligence and eyelid opening apraxia, whereas the alterations associated to posterior circulation involvement are nystagmus, eye movement and alignment abnormalities, and homonymous hemianopsia with macular preservation. It is concluded that ischemic cerebrovascular disease presents symptoms and signs related to both the afferent and the efferent visual pathways. Homonymous hemianopsia is the most common sign reported(AU)


Subject(s)
Humans , Cerebrovascular Circulation , Cerebrovascular Disorders/epidemiology , Hemianopsia/etiology , Review Literature as Topic , Neurologic Manifestations
2.
Article in Chinese | WPRIM | ID: wpr-877629

ABSTRACT

OBJECTIVE@#To observe the clinical curative effect on attention deficit hyperactivity disorder (ADHD) and explore the relevant mechanism of acupuncture in treatment.@*METHODS@#A total of 100 ADHD children were randomized into an observation group (50 cases, 2 cases dropped off) and a control group (50 cases, 1 case dropped off). In the control group, the routine psychological intervention was used. In the observation group, on the base of the treatment as the control group, acupuncture was applied to Taichong (LR 3), Neiguan (PC 6), Shenmen (HT 7), Sanyinjiao (SP 6), Baihui (GV 20), Sishencong (EX-HN 1), etc., once daily, for 3 months. The Cambridge neuropsychological tests automated battery (CANTAB) was adopted to evaluate attention and response inhibition in two groups before and after treatment. Digi-Lite color transcranial Doppler was used to measure cerebral arterial blood velocity. The therapeutic effect was compared between the two groups.@*RESULTS@#Regarding evaluation of attention, the mean delay time in the observation group after treatment was shorter than that before treatment and that in the control group separately (@*CONCLUSION@#Acupuncture combined with psychological intervention may improve attention and response inhibition in ADHD children, which is possibly related to the regulation of cerebral blood flow.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Attention Deficit Disorder with Hyperactivity/therapy , Cerebrovascular Circulation , Child , Humans , Psychosocial Intervention
3.
Rev. bras. cir. cardiovasc ; 35(4): 465-470, July-Aug. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1137307

ABSTRACT

Abstract Objectives: Stroke is an important cause of mortality and morbidity in surgery. In the present study, we examined the cerebral oximetry values of patients with carotid artery stenosis who did not present surgical indications and those who did not present carotid artery stenosis in coronary artery bypass grafting (CABG) surgery by comparing their cerebral oximetry values with cerebrovascular disease (CVD). Methods: Between January and May 2014, 40 patients who underwent isolated CABG were included in the study. Cerebral oximetry probes were placed prior to induction of anesthesia. Cerebral oximetry values were recorded before induction, in the pump (cardiopulmonary bypass) inlet period, in the post-clamp period, in the pump outlet period, and in the intensive care unit and neurological complications. Results: There was no difference between the groups in terms of demographic data and routine follow-up parameters. Intraoperative surgical data and early postoperative results were similar in both groups. When comparing the groups, there were no statistically significant results in cerebral oximetry values and CVD development. Only one patient in group 2 had postoperative CVD and this patient was discharged from the hospital with right hemiplegia. Mean arterial pressure (MAP)levels were significantly higher in Group 2 (P<0.05). Conclusion: The follow-up of cerebral perfusion with a method like near-infrared spectroscopy (NIRS) will ensure that MAP is adjusted with interventions that will be made according to changes in NIRS. Thus, it will be possible to avoid unnecessary medication and flow-rate increase with cerebral oxygen saturation (rSO2) follow-up.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Carotid Stenosis/surgery , Carotid Stenosis/diagnostic imaging , Oxygen , Oximetry , Cerebrovascular Circulation , Coronary Artery Bypass , Spectroscopy, Near-Infrared , Margins of Excision
4.
Biociencias ; 15(1): 73-78, jun.2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1122956

ABSTRACT

Introducción: La oximetría cerebral no invasiva utiliza la tecnología NIRS ("near infrared spectroscopy") para medir la saturación de oxígeno en una pequeña región de los vasos cerebrales corticales. Refleja el 75% volumen de oxigenación cerebral venosa y el 25% volumen de oxigenación cerebral arterial. Objetivo: Hacer una descripción breve sobre oximetría cerebral no invasiva mediante la tecnología NIRS ("near infrared spectroscopy"). Aunque esta técnica se describió hace más de 25 años, su uso es cada vez más frecuente siendo un fenómeno reciente. Comentarios: La saturación regional cerebral de oxígeno (rSO2c), al igual que la saturación pulsátil arterial periférica de oxígeno, se mide por espectrometría. Se basa en el hecho de que la hemoglobina oxigenada absorbe menos luz roja y más luz infrarroja que la hemoglobina. Es un método sencillo para identificar el límite inferior de la autorregulación, el punto por debajo del cual el flujo sanguíneo cerebral y la oxigenación tisular se hacen dependientes de la presión. Conclusiones: Los valores obtenidos de rSO2c representan el estado de oxigenación de los cromóforos del lecho vascular cerebral del compartimento venoso. Los cambios en la oximetría cerebral dependen del balance entre aporte y consumo de oxígeno.


Introduction: Non-invasive cerebral oximetry uses NIRS ("near infrared spectroscopy") technology to measure oxygen saturation in a small region of cortical cerebral vessels. It reflects 75% volume of venous cerebral oxygenation and 25% volume of arterial cerebral oxygenation. Objective: To make a brief description about non-invasive cerebral oximetry using NIRS technology ("near infrared spectroscopy"). Although this technique was described more than 25 years ago, its use is increasingly frequent being a recent phenomenon. Comments: Regional cerebral oxygen saturation (rSO2c), like peripheral arterial pulsatile oxygen saturation, is measured by spectrometry. It is based on the fact that oxygenated hemoglobin absorbs less red light and more infrared light than hemoglobin. It is a simple method to identify the lower limit of self-regulation, the point below which cerebral blood flow and tissue oxygenation become pressure dependent. Conclusions: The values ​​obtained from rSO2c represent the oxygenation state of the chromophores of the cerebral vascular bed of the venous compartment. Changes in cerebral oximetry depend on the balance between oxygen intake and consumption.


Subject(s)
Humans , Child, Preschool , Child , Spectrum Analysis , Bacteria , Cerebrovascular Circulation , Environment and Public Health
5.
Article in Chinese | WPRIM | ID: wpr-826361

ABSTRACT

To investigate cerebral autoregulation(CA)in patients with severe unilateral carotid artery stenosis by near infrared spectroscopy. Thirty patients who underwent general anesthesia in our hospital from January 2015 to February 2017 were enrolled in this study.The stenosis group included 15 patients with severe unilateral internal carotid artery stenosis,and the control group included 15 patients without carotid artery stenosis.Both groups were matched in sex and age.Cerebral tissue oxygenation index(TOI)and mean arterial pressure were recorded continuously under stable general anesthesia.The Pearson correlation coefficient()was calculated to judge the CA status. TOI was not significantly different between the stenosis side and the non-stenosis side in the stenosis group(66.52±6.50 65.23±4.50;=0.93, =0.368)or between the stenosis side in the stenosis group and the stenosis side in the control group(66.52±6.50 64.22±3.87;=1.18, =0.248).The values of stenosis side and non-stenosis side in the stenosis group were 0.36±0.12 and 0.17±0.11,respectively,and the values of the stenosis side in the stenosis group and the stenosis side of the control group were 0.36±0.12 and 0.13±0.08,respectively.In the stenosis group,5 patients had transient ischemic attack and 2 patients had a history of stroke within 3 months before operation.When an value of 0.342 was used as the judgment point of CA abnormality,the sensitivity and specificity were 0.625 and 0.909,respectively. Within the range of normal blood pressure fluctuation,cerebral blood flow is linked to blood pressure at the stenosis side in patients with severe unilateral carotid artery stenosis.


Subject(s)
Blood Pressure , Carotid Stenosis , Cerebrovascular Circulation , Homeostasis , Humans , Ischemic Attack, Transient
6.
Med. UIS ; 32(2): 53-58, mayo-ago. 2019. graf
Article in Spanish | LILACS | ID: biblio-1114968

ABSTRACT

Resumen El accidente cerebrovascular en adultos jóvenes es un evento raro presente en menos del 5% de los casos a nivel mundial, representando un reto diagnóstico debido a las múltiples etiologías posibles, entre ellas las infecciones. Del 15% al 40% de los pacientes con sífilis no tratada pueden desarrollar sífilis terciaria con manifestaciones principalmente neurodestructivas, descritas en la sífilis tardía pero con meningitis crónica y accidente cerebrovascular de tipo meningovascular en su fase temprana. Se presenta el caso de un paciente masculino de 40 años con antecedente de cambios de comportamiento, alucinaciones auditivas e insomnio, quien consulta a urgencias por presentar hemiplejia derecha, afasia motora, lesiones palmo-plantares y roseta en glande asociada a adenopatías inguinales. Dados los hallazgos imagenológicos y de líquido cefalorraquídeo se estableció diagnóstico de accidente cerebrovascular isquémico de circulación cerebral anterior izquierda secundario a neurosífilis meningovascular, con confirmación de inmunosupresión por virus de inmunodeficiencia humana. MÉD.UIS.2019;32(2):53-8


Abstract Stroke in young adults is a rare event present in less than 5% of cases worldwide, representing a diagnostic challenge due to the multiple possible etiologies, including infections. 15% to 40% of patients with untreated syphilis may develop tertiary syphilis; with mainly neurodestructive manifestations, described in late syphilis, but in its early stage with chronic meningitis and meningovascular stroke. The case of a 40-year-old male patient with a history of behavior changes, auditory hallucinations and insomnia is presented, who consults the emergency department for presenting right hemiplegia, motor aphasia, palmoplantar lesions and rosette in glans associated with inguinal adenopathies. Given the imaging and cerebrospinal fluid findings, a diagnosis of ischemic stroke of the left anterior cerebral circulation was established, secondary to meningovascular neurosyphilis, with confirmation of immunosuppression due to human immunodeficiency virus. MÉD.UIS.2019;32(2):53-8


Subject(s)
Humans , Male , Adult , Neurosyphilis , Aphasia, Broca , Patients , Penicillins , Treponema pallidum , Wounds and Injuries , Male , Syphilis , Cerebrospinal Fluid , Cerebrovascular Circulation , Adolescent , Acquired Immunodeficiency Syndrome , HIV , Immunosuppression , Stroke , Young Adult , Lymphadenopathy , Hallucinations , Hemiplegia , Infections , Sleep Initiation and Maintenance Disorders , Meningitis
7.
Cambios rev. méd ; 18(1): 58-62, 28/06/2019. tabs
Article in Spanish | LILACS | ID: biblio-1015162

ABSTRACT

INTRODUCCIÓN. La medición del diámetro de la vaina del nervio óptico a través de la ventana ocular puede ser un método no invasivo para la detección de hipertensión endocraneana. OBJETIVO. De este trabajo fue validar una fórmula de cuantificación de la presión intracraneana a partir de la evaluación por ultrasonido de la vaina del nervio óptico en una ciudad de gran altitud. MATERIALES Y MÉTODOS. Estudio prospectivo de 27 pacientes con trauma craneoencefalico grave en quienes se les colocó un sensor de presión intracraneana intraventricular y se realizó el cálculo de la PIC no invasiva mediante correlación utilizando la evaluación de la vaina del nervio óptico a través de ultrasonido y aplicando una fórmula de cálculo. RESULTADOS. Correlación positiva débil con significancia estadística. CONCLUSIÓN. La cuantificación de la presión intracraneana no invasiva a través de la evaluación de la vaina del nervio óptico por ultrasonido podría ser una herramienta útil en ciudades de gran altitud sobre el nivel del mar.


INTRODUCTION. Measuring the diameter of the optic nerve sheath through the eye window can be a non-invasive method for the detection of endocranial hypertension. OBJECTIVE. This work was to validate a formula for quantifying intracranial pressure from the ultrasound evaluation of the optic nerve sheath in a high-altitude city. MATERIALS AND METHODS. Prospective study of 27 patients with severe cranioencephalic trauma in whom an intraventricular intracranial pressure sensor was placed and the calculation of non-invasive ICP was performed by correlation using the evaluation of the optic nerve sheath through ultrasound and applying a formula of calculation. RESULTS. Weak positive correlation with statistical significance. CONCLUSION. Quantification of non-invasive intracranial pressure through the evaluation of the optic nerve sheath by ultrasound could be a useful tool in high altitude cities above sea level.


Subject(s)
Humans , Adult , Optic Nerve , Ultrasonic Therapy , Observational Study , Craniocerebral Trauma , Hypertension , Intracranial Pressure , Cerebrovascular Circulation , Ecuador
8.
Prensa méd. argent ; 105(1): 24-33, mar 2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1026329

ABSTRACT

La presión intracraneal elevada es una complicación devastadora de la lesión neurológica, que puede complicar el trauma, los tumores del sistema nervioso central, la hidrocefalia, la encefalopatía hepática y el flujo venoso del SNC alterado. El adecuado tratamiento consta de un rápido reconocimiento, utilizar material de monitoreo neurológico invasivo y su manejo para reducir la hipertensión intracraneal y sus múltiples causas subyacente. A continuación presentamos una revisión de sus principales características y principios de abordaje diagnóstico-terapéutico


Intracranial pressure is a devastating complication of neurological damage, which can complicate trauma, central nervous system disorders, hydrocephalus, hepatic encephalopathy, and altered CNS venous flow. The appropriate treatment consists of a rapid recognition, the use of an invasive neurological system and its management to reduce intracranial hypertension and its multiple underlying causes. Below we present a review of its main characteristics and principles of diagnostic-therapeutic approach.


Subject(s)
Humans , Perfusion , Intracranial Pressure , Cerebrovascular Circulation , Ultrasonography, Doppler/methods , Intracranial Hypertension/diagnosis , Intracranial Hypertension/prevention & control , Intracranial Hypertension/therapy , Craniotomy , Conservative Treatment
9.
Article in English | WPRIM | ID: wpr-785923

ABSTRACT

OBJECTIVE: Selecting an appropriate guiding catheter to provide both sufficient supportability for working devices and sufficient distal navigability is essential for ensuring the success of a procedure. This study aimed to evaluate the advantages and disadvantages of using the ENVOY 6F distal access (DA) guiding catheter in coil embolization of anterior circulation cerebral aneurysms.METHODS: We included 98 patients (72 [73.5%] women, median age: 63 [range: 25–84] years) who underwent endovascular coiling with the ENVOY 6F DA guiding catheter from May to November 2016. We analyzed data on patient demographics and the number of co-axial techniques to position the guiding catheter, initial and final location of the catheter, and complications related to the catheter.RESULTS: The co-axial technique was used to position the ENVOY 6F DA guiding catheter in the internal carotid artery (ICA) in 20 cases (20.41%). The initial position of the ENVOY 6F DA guiding catheter involved the cervical ICA (79.6%), horizontal petrous ICA (17.3%), and vertical petrous ICA (3.1%). Final control angiograms after endovascular coiling showed proximal change in the final, compared to the initial, position of the ENVOY 6F DA guiding catheter in 25 cases (25.51%). Procedure-related complications were observed in nine patients (9.18%), involving vasospasm in all cases; however, there was no symptomatic case.CONCLUSION: The ENVOY 6F DA guiding catheter had relatively sufficient distal navigability without symptomatic procedural complications. However, the change in the catheter position after endovascular coiling denoted insufficient supportability.


Subject(s)
Aneurysm , Carotid Arteries , Carotid Artery, Internal , Catheterization , Catheters , Cerebrovascular Circulation , Demography , Embolization, Therapeutic , Female , Humans , Intracranial Aneurysm
10.
Article in Chinese | WPRIM | ID: wpr-773557

ABSTRACT

OBJECTIVE@#To investigate the relationship between Toll-like receptor 4 (TLR4) and collateral circulation in patients with acute cerebral infarction (AIS) after thrombolytic therapy.@*METHODS@#This retrospective, observational cohort study was conducted among 65 patients with AIS receiving thrombolytic therapy, who were divided according to findings by computed tomographic angiography (CTA) into good collateral circulation (group A, = 34) and poor collateral circulation (group B, = 31). Serum samples were collected from all the patients and the levels of TLR4 were measured with ELISA.@*RESULTS@#The patients in group A had significantly better outcomes than those in group B. The NIHSS scores at 24 h and 30 days after thrombolytic therapy, mRS scores at 90 days and serum TLR4 levels were significantly lower in group A than in group B ( < 0.05); the percentages of patients with symptomatic intracerebral hemorrhage were comparable between the two groups. The serum levels of TLR4 were negatively correlated with the rMLC score ( < 0.05). Multivariate logistic regression analysis showed that a high level of TLR4 was associated with a poor collateral circulation after thrombolysis.@*CONCLUSIONS@#Good collateral circulation can increase the benefit of intravenous thrombolysis in patients with ACI, and the level of TLR4 is a predictive factor for the compensation of collateral circulation following ACI.


Subject(s)
Biomarkers , Brain Ischemia , Cerebral Infarction , Cerebrovascular Circulation , Cohort Studies , Collateral Circulation , Fibrinolytic Agents , Humans , Retrospective Studies , Stroke , Metabolism , Therapeutics , Thrombolytic Therapy , Toll-Like Receptor 4 , Metabolism , Treatment Outcome
11.
Article in Chinese | WPRIM | ID: wpr-776279

ABSTRACT

OBJECTIVE@#To observe the characteristics of carotid intima-media thickness (IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery.@*METHODS@#A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with acupuncture method proposed by academician . The acupoints of Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity.@*RESULTS@#Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment (>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved (all <0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased (all <0.05).@*CONCLUSION@#Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.


Subject(s)
Acupuncture Therapy , Adult , Aged , Blood Flow Velocity , Carotid Intima-Media Thickness , Cerebrovascular Circulation , Female , Humans , Hypertension , Male , Middle Aged
12.
Article in Chinese | WPRIM | ID: wpr-775526

ABSTRACT

simultaneous monitoring of blood flow and changes of concentration of oxyhemoglobin (ΔHbO) in brain is a key important method for the research of cerebrovascular disease. In this study, a new monitoring system, combining laser speckle contrast imaging method and spectral analysis method, was proposed, which could be utilized to measure the cerebral blood flow and ΔHbO on mice during traumatic brain injury. The principle of the present system was studied and the hardware platform of the detection system was built. Then, user interface software and algorithms were implemented based on Labview and Matlab software. Finally, the performance of the present system was verified by the experiments.


Subject(s)
Algorithms , Animals , Blood Gas Analysis , Brain , Cerebrovascular Circulation , Lasers , Mice , Oxygen
13.
Article in English | WPRIM | ID: wpr-764375

ABSTRACT

BACKGROUND AND PURPOSE: Shift work disrupts the body's circadian rhythms and increases the risk of health problems. Despite evidence of neuropsychological disturbances in shift workers (SW), the brain functional status as measured by brain perfusion in chronic shift work has not been evaluated previously. We investigated the regional cerebral blood flow (rCBF) in SW using perfusion MRI (pMRI) and evaluated the relationships between altered rCBF and sleep, mood, psychometric measures, and quality of life. METHODS: Fifteen rotational SW and 15 day workers (DW) were enrolled. The participants were all female nurses working at a university-affiliated hospital. During 2 weeks of actigraphy they underwent pMRI scanning and psychometric testing on the last day immediately after working. Demographic characteristics, insomnia, daytime sleepiness, and mood were compared between the groups. RESULTS: The participants were aged 35.3±2.9 years (mean±SD) and had been performing their current work for more than 2 years. The demographic characteristics did not differ between SW and DW, but the levels of insomnia, anxiety, depression, and hyperactivity-restlessness in psychometric measures were higher in SW than in DW. Cerebral perfusion in SW was significantly decreased in the cuneus, fusiform/parahippocampal gyri, and cerebellum of the right hemisphere, while it was increased in the inferior occipital gyrus of the left hemisphere. Perfusion changes in SW were significantly correlated with depression and insomnia severity. The onset and duration irregularity of sleep among SW were related to insomnia, mood, hyperactivity/ restlessness, and quality of life. CONCLUSIONS: SW experience considerably more insomnia and mood disturbances than do DW, and this is significantly related to perfusion changes in multiple brain areas.


Subject(s)
Actigraphy , Anxiety , Brain , Cerebellum , Cerebrovascular Circulation , Circadian Rhythm , Depression , Female , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Occipital Lobe , Perfusion , Psychometrics , Psychomotor Agitation , Quality of Life , Sleep Initiation and Maintenance Disorders
14.
Article | WPRIM | ID: wpr-763549

ABSTRACT

OBJECTIVE: The aims of this study were to investigate the effects of daily low-dose tadalafil on cognitive function and to examine whether there was a change in cerebral blood flow (CBF) in patients with erectile dysfunction (ED) and mild cognitive impairment. METHODS: Male patients aged 50 to 75 years with at least three months of ED (International Index of Erectile Function [IIEF]-5 score ≤ 21) and mild cognitive impairment (Montreal Cognitive Assessment [MoCA] score ≤ 22) were included in the study. The subjects were prescribed a low-dose PDE5 inhibitor (tadalafil 5 mg) to be taken once daily for eight weeks. Changes in MoCA score and single-photon emission computed tomography (SPECT) study between the two time-points were assessed by paired t tests. RESULTS: Overall, 30 male patients were assigned to the treatment group in this study and 25 patients completed the eight-week treatment course. Five patients were withdrawn due to adverse events such as myalgia and dizziness. Mean baseline IIEF and MoCA scores were 7.52 ± 4.84 and 18.92 ± 1.78. After the eight-week treatment, mean IIEF and MoCA scores were increased to 12.92 ± 7.27 (p < 0.05) and 21.8 ± 1.71 (p < 0.05), respectively. Patients showed increased relative regional CBF in the postcentral gyrus, precuneus, and brainstem after tadalafil administration versus at baseline (p < 0.001). CONCLUSION: The results of this prospective clinical study suggest that daily use of tadalafil 5 mg increases some regional CBF and improves cognitive function in patients with ED and mild cognitive impairment.


Subject(s)
Brain Stem , Cerebrovascular Circulation , Clinical Study , Cognition , Dizziness , Erectile Dysfunction , Humans , Male , Methylenebis(chloroaniline) , Cognitive Dysfunction , Myalgia , Parietal Lobe , Perfusion , Phosphodiesterase Inhibitors , Prospective Studies , Somatosensory Cortex , Tadalafil , Tomography, Emission-Computed
15.
Article in Korean | WPRIM | ID: wpr-766555

ABSTRACT

Moyamoya disease (MMD) refers to a chronic progressive steno-occlusive disease at the distal portion of the internal carotid artery with abnormal collateral vessel formation of unknown etiology. The definite diagnosis of MMD requires cerebral angiography or magnetic resonance angiography and/or magnetic resonance imaging after excluding other underlying diseases, particularly in adult patients. The treatment aims to improve regional cerebral blood flow to prevent cerebral ischemic events and alleviate hemodynamic instability that can provoke cerebral hemorrhage. Although various surgical revascularization methods have been introduced, combined revascularization surgery including direct revascularization is preferred over indirect revascularization only in adult MMD patients. Several recent studies have shown that surgical treatment has better outcomes and prognosis for symptomatic hemodynamically unstable MMD patients with both ischemic and hemorrhagic presentations. For asymptomatic patients, follow up with appropriate imaging is recommended. Surgery should be considered when new symptoms emerge with hemodynamic aggravation.


Subject(s)
Adult , Carotid Artery, Internal , Cerebral Angiography , Cerebral Hemorrhage , Cerebrovascular Circulation , Diagnosis , Follow-Up Studies , Hemodynamics , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Moyamoya Disease , Prognosis
16.
Article in English | WPRIM | ID: wpr-765340

ABSTRACT

Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral stenoocclusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki’s angiographic staging. Insufficiency of this ‘IC-EC conversion system’ could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.


Subject(s)
Angiography , Brain , Brain Ischemia , Carotid Artery, Internal , Cerebrovascular Circulation , Cerebrovascular Disorders , Choroid , Dilatation , Hemorrhage , Humans , Intracranial Hemorrhages , Moyamoya Disease , Posterior Cerebral Artery
17.
Neurointervention ; : 43-52, 2019.
Article in English | WPRIM | ID: wpr-741674

ABSTRACT

PURPOSE: Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors. MATERIALS AND METHODS: All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups. RESULTS: Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup. CONCLUSION: In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.


Subject(s)
Atherosclerosis , Blood Sedimentation , Cerebrovascular Circulation , Constriction, Pathologic , Coronary Disease , Humans , Intracranial Arteriosclerosis , Logistic Models , Male , Multivariate Analysis , Risk Factors , Smoking , Tobacco Products
18.
Article in English | WPRIM | ID: wpr-741399

ABSTRACT

OBJECTIVE: Alternate ascending/descending directional navigation (ALADDIN) is a novel arterial spin labeling technique that does not require a separate spin preparation pulse. We sought to compare the normalized cerebral blood flow (nCBF) values obtained by ALADDIN and dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) in patients with primary brain tumors. MATERIALS AND METHODS: Sixteen patients with primary brain tumors underwent MRI scans including contrast-enhanced T1-weighted imaging, DSC perfusion MRI, and ALADDIN. The nCBF values of normal gray matter (GM) and tumor areas were measured by both DSC perfusion MRI and ALADDIN, which were compared by the Wilcoxon signed rank test. Subgroup analyses according to pathology were performed with the Wilcoxon signed rank test. RESULTS: Higher mean nCBF values of GM regions in the bilateral frontal lobe, temporal lobe, and caudate were detected by ALADDIN than by DSC perfusion MRI (p <0.05). In terms of the mean or median nCBF values and the mean of the top 10% nCBF values from tumors, DSC perfusion MRI and ALADDIN did not statistically significantly differ either overall or in each tumor group. CONCLUSION: ALADDIN tended to detect higher nCBF values in normal GM, as well as higher perfusion portions of primary brain tumors, than did DSC perfusion MRI. We believe that the high perfusion signal on ALADDIN can be beneficial in lesion detection and characterization.


Subject(s)
Brain Neoplasms , Cerebrovascular Circulation , Frontal Lobe , Glioma , Gray Matter , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Pathology , Perfusion , Temporal Lobe
19.
Article in Korean | WPRIM | ID: wpr-740980

ABSTRACT

BACKGROUND: The cerebral blood flow velocity (CBFV) has been known to increase in response to acute hypoxia. However, how CBFV might respond to exercise in hypoxic conditions and be associated with electroencephalogram (EEG) remains unclear. The purpose of this study was to evaluate the effect of exercise in hypoxic conditions corresponding to altitudes of 4,000 m on CBFV and EEG. METHODS: In a randomized, double-blind, balanced crossover study, ten healthy volunteers (19.8±0.4 years) were asked to perform the incremental bicycle ergometer exercise twice in hypoxic and control (sea level) conditions with a 1-week interval, respectively. Exercise intensity was set initially at 50 W and increased by 25 W every 2 minutes to 125 W. Acute normobaric hypoxic condition was maintained for 45 minutes using low oxygen gas mixture. CBFV in the middle cerebral artery (MCA) and EEG were measured at rest 5 minutes, rest 15 minutes, immediately after exercise, and 15 minutes recovery using transcranial-Doppler sonography and EEG signal was recorded from 6 scalp sites leading to analysis of alpha and beta wave relative activities. All data were analyzed using two-way repeated-measures analysis of variance and Pearson's correlation. RESULTS: CBFV in the MCA in the hypoxic condition was significantly higher than that in the control condition at rest 5 minutes (83±9 vs. 69±9 cm/s, P<0.01), rest 15 minutes (87±8 vs. 67±7 cm/s, P<0.001), immediately after exercise (112±9 vs. 97±9 cm/s, P<0.01), and 15 minutes recovery (91±11 vs. 74±7 cm/s, P<0.01). However, no significant correlation was found between the changes of CBFV and EEG wave activities. CONCLUSIONS: These results suggest that the drastic change of CBFV observed during exercise with hypoxia might appear independently with EEG wave activities.


Subject(s)
Altitude , Hypoxia , Cerebrovascular Circulation , Cross-Over Studies , Electroencephalography , Healthy Volunteers , Middle Cerebral Artery , Oxygen , Scalp
20.
Neonatal Medicine ; : 121-127, 2019.
Article in English | WPRIM | ID: wpr-760590

ABSTRACT

The incidence of cerebral palsy has not decreased despite advances in neonatal care. Preterm infants are at a high risk of cerebral palsy. Moreover, preterm infants might experience permanent neurological sequelae due to injury in the preterm brain. Although the etiology of preterm brain injury is not fully understood, preterm brain injury is strongly associated with abnormal cerebral perfusion and oxygenation. Monitoring systemic blood pressure or arterial oxygen saturation using pulse oximetry is not enough to guarantee proper cerebral perfusion or oxygenation. Early detection of improper cerebral perfusion can prevent irreversible cerebral damage. To decrease brain injury through the early detection of under-perfusion and deoxygenation, other diagnostic modalities are needed. Near-infrared spectroscopy can continuously and noninvasively monitor regional oxygen saturation (rSO₂), which reflects the perfusion and oxygenation status of tissues at bedside. Near-infrared spectroscopy represents a balance between tissue oxygen supply and demand. Cerebral rSO₂ monitoring has been used most frequently in neonatal cardiac surgery to monitor cerebral oxygenation and prevent hypoxic damage or shock. Recently, cerebral, renal, or splanchnic rSO₂ in neonates is frequently monitored. The progression of a disease, brain injury, and death can be prevented by detecting changes in rSO₂ values using near-infrared spectroscopy. In this article, the basic principles, usefulness, and applications of near-infrared spectroscopy in neonates are discussed.


Subject(s)
Blood Pressure , Brain , Brain Injuries , Cerebral Palsy , Cerebrovascular Circulation , Humans , Incidence , Infant, Newborn , Infant, Premature , Oximetry , Oxygen , Perfusion , Shock , Spectroscopy, Near-Infrared , Splanchnic Circulation , Thoracic Surgery
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