ABSTRACT
BACKGROUND: Clinical and experimental evidence suggests that a localized decrease in oxygen brain tissue availability contributes to the neurological deficit in patients with cerebrovascular disease (CVD) who also present with frontal leukoaraiosis (LA) (periventricular hypodensity on CT scan) and lacunar infarcts. In a prospective controlled trial blinded to patients but not to investigators, we tested the effect of HBO2 on this group of patients. METHODS: Selected patients with symptomatic CVD, LA and lacunar infarcts received daily exposures of 45 minutes for 10 days to hyperbaric oxygen (n=18, HBO2 group) or hyperbaric air (n=8, control group). The control group subsequently received HBO2. Scores of conventional scales for motor and cognitive functions were obtained and videotaped before and after exposure. After the exposures, participants were followed on a monthly basis with systematic clinical neurological examination for up to 6 months. Results. There was a statistically significant improvement in all scales for the HBO2 group compared with the placebo group and in the placebo group after receiving HBO2 (p<0.05). Neurological improvement persisted in the majority of patients for up to 6 months. Repetition of the HBO2 protocol in 9 patients in whom symptoms recurred after 6 months resulted in improvement of symptoms. CONCLUSIONS: These data provide evidence consistent with the notion that HBO2 improves neurological function in patients with CVD, lacunar infarcts and frontal LA. Because of the lack of investigator blinding and a relatively small sample size in this study, larger, randomized controlled studies are needed to further test this hypothesis and to further define the role of oxygen therapy for brain repair in chronic brain disease.
Subject(s)
Basal Ganglia Diseases/therapy , Cerebrovascular Disorders/complications , Cognition Disorders/therapy , Gait Disorders, Neurologic/therapy , Hyperbaric Oxygenation , Urination Disorders/therapy , Aged , Basal Ganglia Diseases/etiology , Cerebral Infarction/complications , Cognition Disorders/etiology , Female , Gait Disorders, Neurologic/etiology , Humans , Leukoaraiosis , Male , Middle Aged , Oxygen/metabolism , Prospective Studies , Single-Blind Method , Urination Disorders/etiologyABSTRACT
INTRODUCTION: Frontal leukoaraiosis (LA) is a common finding in patients with subcortical small-vessel disease and currently its pathogenesis is attributed to ischemic-hypoxic mechanisms. It associates to a vascular subcortical frontal syndrome (VSFS) for which an effective treatment does not exist. CLINICAL CASES: We present four subjects from a prospective patient-blind controlled pilot trial to study efficacy and safety of hyperbaric oxygen therapy (HBO) vs hyperbaric air in VSFS with LA. All of them had frontal or extended LA on computed tomography scan and lacunes in basal ganglia and centrum ovale, with moderate to severe gait disorders, urinary dysfunction, cognitive impairment, and dependence in the daily living activities. Deficits had begun two to ten years before and had remained stable three months previous to the treatment. Patients were assessed with validated scales and tests one week before and after being administrated ten daily sessions of HBO at 2.5 atmospheres absolute for 45 minutes with a multiplace chamber. Serious adverse effects did not occur. After treatment a noticeable gait, urinary and cognitive improvement was observed in all subjects, increasing their independence. They remained clinically improved during four to five months, after which the previous deficits reappeared. Then, three patients received ten daily sessions of air at 1.1 atmospheres absolute for 45 minutes (controls) and the other a new HBO regimen, which improved as the first time. From the controls, there were no changes in two, while the other did only improve cognitively. CONCLUSION: These patients show that HBO is effective and safety in reversing, at least partially, although at great length, chronic neurological deficits associated to vascular frontal LA, highlighting that a functional reserve therapeutically useful exists.
Subject(s)
Arterial Occlusive Diseases/complications , Brain Ischemia/etiology , Brain Ischemia/therapy , Frontal Lobe/blood supply , Frontal Lobe/metabolism , Hyperbaric Oxygenation/methods , Oxygen/metabolism , Activities of Daily Living , Aged , Brain Ischemia/diagnosis , Cognition Disorders/diagnosis , Frontal Lobe/diagnostic imaging , Humans , Male , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Urinary Incontinence/diagnosisABSTRACT
Se comunican 2 casos de infarto en el territorio de la Arteria Coroidea Anterior. Ambas pacientes, mujeres de 19 y 47 años, fueron admitidas por clínica y tomografía computada (TC) de hemorragia subaracnoidea. En el postquirúrgico inmediato, de ectasia pediculada carotídea, vimos: desviación de cabeza y ojos a derecha,disartria,negligencia, así como hemiparesia con disestesias a izquierda. La angiografía (AG) verificadora de vasos de cuello y cerebro, mostró la correcta aplicación del clip en el cuello de sendos aneurismas. Ambas completaron la recuperación clínica antes del séptimo día y meses más tarde padecieron la primera crisis parcial compleja. Se observaron imágenes hipodensas temporales profundas y posteriores en TC. Nuestras pacientes continúan asintomáticas con carbamazepina. De 80 casos reportados, 38 fueron por cirugía adrede, ninguno casual y el resto ictales. Nuestros casos serían los únicos impensados. Consideramos que estos infartos tienen la suficiente categoría como para conformar una entidad clínica independiente
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Postoperative Complications/diagnosis , Subarachnoid Hemorrhage/complications , Intracranial Aneurysm/complications , Cerebral Infarction/etiology , Choroid Plexus/pathology , Carotid Arteries/surgery , Aphasia/etiology , Postoperative Complications/drug therapy , Postoperative Complications/therapy , Carbamazepine/administration & dosage , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnosis , Cerebral Infarction/diagnosis , Cerebral Infarction/therapy , Hemianopsia/etiology , Dysarthria/etiology , Hemiplegia/etiology , Tomography, X-Ray ComputedABSTRACT
Se comunican 2 casos de infarto en el territorio de la Arteria Coroidea Anterior. Ambas pacientes, mujeres de 19 y 47 años, fueron admitidas por clínica y tomografía computada (TC) de hemorragia subaracnoidea. En el postquirúrgico inmediato, de ectasia pediculada carotídea, vimos: desviación de cabeza y ojos a derecha,disartria,negligencia, así como hemiparesia con disestesias a izquierda. La angiografía (AG) verificadora de vasos de cuello y cerebro, mostró la correcta aplicación del clip en el cuello de sendos aneurismas. Ambas completaron la recuperación clínica antes del séptimo día y meses más tarde padecieron la primera crisis parcial compleja. Se observaron imágenes hipodensas temporales profundas y posteriores en TC. Nuestras pacientes continúan asintomáticas con carbamazepina. De 80 casos reportados, 38 fueron por cirugía adrede, ninguno casual y el resto ictales. Nuestros casos serían los únicos impensados. Consideramos que estos infartos tienen la suficiente categoría como para conformar una entidad clínica independiente
