Vasoreactivity in patients with periventricular white matter lucency.

OBJECTIVES: Cerebral hypoperfusion has been evidenced in patients with periventricular white matter lucency (PWML), however, our knowledge is limited regarding vasoreactivity (VR) changes in these patients. Therefore, we compared the cerebral blood flow velocity (CBFV) responses during different vasoregulatory challenges in healthy volunteers, to those in patients with PWML. MATERIAL AND METHODS: In 20 patients with PWML and in 20 healthy volunteers the VR of the middle cerebral artery (MCA) system was measured by analyzing the changes of CBFV during different stimulation paradigms (ventilation, tilting and acetazolamide tests). During transcranial Doppler (TCD) registration the systemic blood pressure, the expiratory partial CO(2) pressure (pCO(2)) and the electroencephalograph (EEG) were monitored. RESULTS: The relative velocity change was significantly smaller in the PWML group than in the normal control group during hypercapnia (16 +/- 12% vs 32 +/- 17%; P < 0.001) and this finding was confirmed by assessment of pCO(2)-corrected velocity change (4.7 +/- 3.7 cm/s/kPa vs 18.4 +/- 6.8 cm/s/KPa; P < 0.001). Although CBFV measurements during acetazolamide test tended to support these findings, the changes of other parameters measured did not reach the level of significance. One patient showed considerable orthostatic reaction (mean arterial blood pressure decrease by 70 mmHg) but it was not associated with significant changes in CBFV. CONCLUSION: Patients with PWML showed an impaired VR in the MCA flow territory supporting the concept of the microangiopathic origin of leukoaraiotic changes.

Evidences of vascular origin of cochleovestibular dysfunction.

OBJECTIVES: When the vascular disorder of the cochleovestibular system is mentioned, the diagnosis is based on exclusion of other diseases. Since arteries of the cochleovestibular system cannot be directly visualized, physicians must deduce from the vascular risk factors and the vascular lesion of other territories to the vascular cochleovestibular disease. MATERIALS AND METHODS: Authors analyzed the data of 19 patients with vertigo. Detailed blood tests, complete neurootological and audiological examination including ABR, carotid and vertebral artery Doppler sonography, MRI and MRA was performed. RESULTS: Cochleovestibular examination and ABR showed abnormalities in 73.7%, either carotid and vertebral artery Doppler or MRI showed abnormalities in 57.9%. MRA was abnormal in 47.4%. In most of the patients multiple risk factors of cerebrovascular disorder could be found. CONCLUSIONS: The cochleovestibular system disorders can be considered to be of vascular origin if the examinations exclude other diseases, if the patients have vascular risk factors and if other territories of brain accessible for imaging methods show vascular disorders.

[Zafirlukast therapy of patients with mild-to-moderate bronchial asthma]. / Zafirlukast alkalmazása enyhe-középsúlyos asthma bronchialéban szenvedö betegeken.

The recently compiled clinical experiences support the previous theory, that the cysteinil-leukotriens have an important role in the pathomechanism of bronchial asthma. Zafirlukast is a selective antagonist of the receptor 1 of cysteinil-leukotriens, and its use reduces the severity of asthma symptoms. The effect of 20 mg zafirlukast b.i.d was studied in 31 patients with mild-moderate asthma bronchiale. During the 6 week treatment period, even several hours after the first zafirlukast dose the pulmonary function improved significantly. This effect sustained during the whole treatment period, the patients' symptoms lessened and there was a significant reduction in the frequency of beta-2 agonist's use. No adverse events causally related to zafirlukast's use were detected. Zafirlukast is an efficient therapy of mild to moderate asthma bronchiale.

Impaired vasoreactivity of the basilar artery system in patients with brainstem lacunar infarcts.

BACKGROUND AND PURPOSE: Diminished vasoreactivity (VR) has been evidenced in patients with hemispheric small vessel disease, however, there is no data regarding vertebrobasilar (VB) territory VR changes in patients with subcortical vascular encephalopathy located in the brainstem. Therefore, we compared the cerebral blood flow velocity (CBFV) responses of the VB system during different vasoregulatory challenges in healthy volunteers to those in patients with brainstem lacunar infarcts. METHODS: In 20 patients with brainstem lacunar infarcts and in 10 healthy volunteers the VR of the VB system was measured by analyzing the CBFV changes during different stimulation paradigms (ventilation, tilting and acetazolamide tests). During transcranial Doppler registration the systemic blood pressure and the expiratory partial CO2 pressure were monitored. RESULTS: During hypercapnia the VR was significantly higher in the control group than in the patient group (10.1 +/- 4.9 vs. 3.4 +/- 5.0 cm/s/kPa, p = 0.0025). In a subgroup of patients with mean baseline CBFV <25 cm/s the VR was 1.5 +/- 2.4 cm/ s/kPa, while patients with mean baseline CBFV >25 cm/s showed a significantly higher value (7.8 +/- 6.9 cm/s/kPa). Furthermore, in patients with mean baseline CBFV <25 cm/s the pulsatility index was significantly higher than in patients with mean baseline CBFV >25 cm/s (1.11 +/- 0.26 vs. 0.86 +/- 0.19, p = 0.0325), reflecting significantly higher vascular resistance in the former group. Although CBFV measurements during tilting and acetazolamide tests tended to support these findings, they showed no significant differences between patients and controls. CONCLUSION: Patients with cerebral microangiopathy involving the brainstem showed impaired VR in the VB flow territory in association with baseline CBFV.

Age and stimulus dependency of visually evoked cerebral blood flow responses.

BACKGROUND AND PURPOSE: During visual stimulation, the increased metabolic demand is coupled with an increase of cerebral blood flow velocity (pCBFV) in the posterior cerebral artery (PCA). Investigation of the visually evoked flow responses (VEFR, expressed as percentage of increase from baseline pCBFV values) was suggested for different conditions of vasoneuronal disorders in the absence of any systematic investigation in healthy subjects. METHODS: We investigated VEFRs from both PCAs to various increasingly complex paradigms (diffuse light, alternating checkerboard patterns, and a color video movie stimulation; 5, 10, 20, and 30-second intervals) in 60 healthy volunteers (mean age, 41.5+/-14.9 years; range, 24 to 80 years; 28 male, 32 female) at different recording sites (P1 versus P2 segments of PCAs). RESULTS: With increasing complexity of stimulation, the VEFRs increased significantly (24.3+/-10.3%, 28.5+/-13.5%, and 43.4+/-10.7%, respectively). Twenty-second stimulation intervals yielded maximal responses (41.5+/-13.2%) compared with 5-, 10-, and 30-second intervals (22.6+/-14.1%, P=0.001; 34.4+/-11.7%, P=0.0042; and 35.5+/-9.9%, P=0.0032, respectively). Significantly higher responses were gained from P2 segments than from P1 segments (42.7+/-7.2% versus 28.2+/-7.1%). Although VEFRs tended to decrease in amplitude with age (mean, 41. 7+/-10.5% [20 to 40 years], 35+/-9.2% [40 to 60 years], and 33.9+/-8.6% [60 to 80 years]); without significant sex-related differences, only the percentage decrement of the pulsatility indices during stimulation were significant (mean, 24+/-10.7% [20 to 40 years], 20+/-7.3% [40 to 60 years], and 13+/-11.2% [60 to 80 years]). CONCLUSIONS: For optimal stimulus conditions for maximum VEFRs, a colored video stimulation of 20-second intervals should be used to combine responses not only from the primary visual projection fields (V1 and V2) but also from temporal lobe areas (V3 through V5) often supplied by the PCA.

Vascular disease risk factors and findings in patients with Alzheimer's disease.

Vascular risk factors and data of different examinations relating to extracerebral vascular conditions were analysed in demented patients. Data of demented patients subsequently admitted to the Memory Clinic of the National Institute of Psychiatry and Neurology between March 1995 and February 1996 were registered in a specially designed data sheet. Three vascular examinations (ECG, Doppler examination of main extracerebral arteries on the neck, ophthalmoneurological examination) were carried out. The risk factors and vascular alterations were condensed in two factors. Neither the descriptive data nor the two factors showed statistically significant differences in the main groups (probable Alzheimer's disease--n=24, vascular dementia--n=23, mixed forms--n=15). Based on our results: vascular risk factors and pathological changes can occur in probable form of Alzheimer's disease; they can be present in early onset form as well; the most marked changes are in the vascular dementia group; relevant findings lack any correlation with each other in the point of severity of vascular changes. The extremely high cardio-cerebrovascular morbidity in Hungary seems to be reflected in the results. The role of vascular risk factors and (subclinical) pathological findings seem worth exploring further in Alzheimer's disease.

SPECT and TCD studies in cluster headache patients.

We investigated regional cerebral blood flow (rCBF) with Tc99m-HMPAO single photon emission computed tomography (SPECT) and blood flow velocity in the middle cerebral artery (MCA) with transcranial Doppler (TCD) ultrasound. Nineteen cluster headache patients participated in the study, 9 of them underwent both examinations, whereas in 6 patients only SPECT and in 4 patients only TCD was performed. Patients were examined during spontaneous and/or provoked attacks and when symptom-free in a cluster period. Six patients showed moderate frontal hyperperfusion, 2 had frontal hypoperfusion whereas no change from headache-free rCBF occurred in 7 patients. Statistical analysis of MCA velocities in 13 patients showed a significant decrease in the mean flow velocity compared with the headache-free values on the symptomatic side. Our findings suggest that the alteration of cerebral circulation during cluster attacks might be of secondary nature.

Obstruction of cerebral arteries in childhood stroke.

Middle cerebral artery obstruction in children is reviewed by our two cases. Ischemic childhood stroke was caused by moyamoya disease in the first, and by fibromuscular dysplasia in the second patient. In both cases transcranial Doppler sonography and cranial CT were performed, but the final diagnosis was made by angiography. The importance of angiography in childhood stroke is emphasized.