ABSTRACT
UNLABELLED: The Raynaud's syndrome is an episodic skin ischemia manifested by pallor, cyanosis and erythema of the fingers in response to cold or emotional stress. The exact pathophysiology is unknown but it has been hypothetised that may be due to an autonomic alteration in the sympathetic innervation of skin blood vessels. OBJECTIVE: To study the changes of heart rate and skin blood flow (SBF) in healthy subjects and in patients with secondary Raynaud's syndrome during different respiratory maneuvers: 1. spontaneous respiration; 2. rhythmic respirations (RR), 3. sudden inspirations (SI), and 4. Valsalva maneuver (VM). METHODS: We studied 22 healthy subjects and 22 patients with secondary Raynaud's syndrome. The variables measured were: 1) RR intervals; 2) amplitudes of SBF; 3) percentage of decrease of SBF; 4) latency of the maximum decrease of SBF. RESULTS: In all patients with secondary Raynaud's syndrome the SBF was decreased basally during spontaneous rations and during all respiratory maneuvers (p < 0.001). The mean latency of recovery of the SBF was prolonged during sudden deep inspiration. The patients with Raynaud also had significant basal tachycardia at rest (p < 0.003). CONCLUSIONS: The basal skin blood flow during spontaneous respirations and in asymptomatic periods is decreased in patients with Raynaud's syndrome; this may be related to endothelial arterioral damage. The SBF was also significantly decreased dynamically during sudden inspirations (SI), rhythmic breathing (RR) and Valsalva maneuver (VM). This dynamic change suggests sympathetic hyperactivity.
Subject(s)
Raynaud Disease/physiopathology , Skin/blood supply , Adult , Blood Flow Velocity , Female , Humans , Male , Respiration , Time Factors , Valsalva Maneuver , VasoconstrictionABSTRACT
El síndrome de Raynaud se caracteriza por isquemia cutánea digital episódica, manifestada por palidez, cianosis y rubor de los dedos de manos y pies expuestos al frío o cuando el paciente está sujeto a un estrés emocional. No se conoce el mecanismo fisiopatológico exacto; la hipótesis más invocada es una alteración autonómica en la inervación simpática de los vasos sanguíneos de la piel. Objetivo: Estudiar los cambios de la frecuencia cardíaca y el flujo sanguíneo de la piel (FSP) en sujetos sanos y en pacientes con síndrome de Raynaud durante las siguientes condiciones: 1. respiración espontánea (RE), 2. respiración rítmica (RR), 3. inspiración profunda repentina (IPR), 4. maniobra de Valsalva (MV). Método: Se estudiaron 22 sujetos sanos y 22 pacientes con síndrome de Raynaud secundario. Las variables medidas fueron: 1. intervalo R-R; 2. amplitud de FSP; 3. porcentaje de disminución de FSP; 4. latencia de la máxima disminución del FSP. Resultados: Los pacientes con síndrome de Raynaud presentaron mayor taquicardia basal. La amplitud del FSP se encontró disminuido durante la respiración espontánea y durante las maniobras respiratorias (P < 0.001). La vasoconstricción estuvo prolongada ya que la latencia promedio de recuperación del FSP estuvo prolongada en IPR y MV en comparación de los sujetos controles. Conclusión: La amplitud del FSP basal está disminuida en los pacientes con síndrome de Raynaud, durante períodos asintomáticos; esto sugiere daño endotelial. También se encontró disminuido con las diversas maniobras respiratorias (RR, IPR y MV). Este cambio dinámico sugiere hiperactividad simpática hacia los vasos sanguíneos de la piel.
The Raynaud's syndrome is an episodic skin ischemia manifested by pallor, cyanosis and erythema of the fingers in response to cold or emotional stress. The exact pathophysiology is unknown but it has been hypothetised that may be due to an autonomic alteration in the sympathetic innervation of skin blood vessels. Objective: To study the changes of heart rate and skin bloodflow (SBF) in healthy subjects and in patients with secondary Raynaud's syndrome during different respiratory maneuvers: 1. spontaneous respiration; 2. rhythmic respirations (RR), 3. sudden inspirations (SI), and 4. Valsalva maneuver (VM). Methods: We studied 22 healthy subjects and 22 patients with secondary Raynaud's syndrome. The variables measured were: 1) RR intervals; 2) amplitudes of SBF; 3) percentage of decrease of SBF; 4) latency of the maximum decrease of SBF. Results: In all patients with secondary Raynaud's syndrome the SBF was decreased basally during spontaneous respirations and during all respiratory maneuvers (p < 0.001). The mean latency of recovery of the SBF was prolonged during sudden deep inspiration. The patients with Raynaud also had significant basal tachycardia at rest (p < 0.003). Conclusions: The basal skin blood flow during spontaneous respirations and in asymptomatic periods is decreased in patients with Raynaud's syndrome; this may be related to endothelial arterioral damage. The SBF was also significantly decreased dynamically during sudde3n inspirations (SI), rhythmic breathing (RR) and Valsalva maneuver (VM). This dynamic change suggests sympathetic hyperactivity.
Subject(s)
Adult , Female , Humans , Male , Raynaud Disease/physiopathology , Skin/blood supply , Blood Flow Velocity , Respiration , Time Factors , Valsalva Maneuver , VasoconstrictionABSTRACT
BACKGROUND: Cavernous angiomas represent 9% of the vascular malformations that affect nervous system. The principal mode of onset is cerebral hemorrhage and epilepsy, and can be sporadic of multiple. In the last, there is a familiar factor specially found in Mexician-American. In our Country there is no data of the clinical or demographic characteristics of the disease. The aim of this study is to describe the clinical characteristics and prognosis of 133 patients with cavernous angiomas consecutively attended in the National Institute of Neurology of Mexico City. PATIENTS AND METHODS: Since 1988 we evaluated a total of 146 cases of cavernous angiomas, 133 were confirmed by MRI and included in the analysis of this study. In every case we registered the demographic characteristic, neurological manifestations, and prognosis divided in good o bad outcome, according to the Glasgow outcome scale (1 and > or = 2 respectively). Data were analyzed with descriptive statistics with the Chi square test, and p was set at 0.05 level. RESULTS: The mean age was 34.3 +/- 14.6 years; 50.4% in male. Eighty seven percent were unique, and the principal manifestation was supratentorial in 65%, infratentorial in 24.8%, supra-infratentorial in 6.8%, and spinal in 3.8%. The clinical manifestations were intracerebral hemorrhage in 58.7%, epilepsy in 48.1%, headache in 37.6%, neurological focalization not secondary to hemorrhage in 8.3%, and incidental in 2.3%. The 6 month outcome was good in 80% of patient assessed by the Glasgow outcome scale. CONCLUSIONS: In our serie the mean age or presentation was 34 years old, the mean neurological manifestations were cerebral hemorrhage and epilepsy, and the outcome was good in the majority of the cases.
