Coupling between visual evoked cerebral blood flow velocity responses and visual evoked potentials in migraneurs.

Neurovascular coupling may be altered in migraneurs. Therefore, visual evoked potentials (VEP) and visually evoked cerebral blood flow velocity responses (VEFR) were simultaneously recorded in 30 healthy controls and 30 migraneurs interictally using a checkerboard stimulus with visual contrasts of 1%, 10% and 100%. The VEFR were measured in the posterior cerebral artery using transcranial Doppler and VEP were recorded from occipital leads. We found an increase in VEFR and VEP in both the healthy and migraneur groups (P < 0.01). VEFR were significantly higher in migraneurs (P < 0.01), while VEP did not significantly differ between the groups (P > 0.05). Regression showed a significant association between VEP and VEFR in both healthy controls (r = 0.66, P < 0.01) and migraneurs (r = 0.63, P < 0.01). The regression coefficient of migraneurs (b = 0.88, SE = 0.08) was significantly higher than that of healthy controls (b = 0.55, SE = 0.07) (P = 0.04). We conclude that neurovascular coupling is increased in migraneurs interictally.

The role of alpha1- and alpha2-adrenoceptors in gender differences in cutaneous LD flux response to local cooling.

The present study was designed to assess the hypothesis that alpha2-adrenergic response plays a predominant role in sex differences in cutaneous microvascular response to cold. For this purpose, we studied the effect of the selective alpha1-antagonist prazosin (1 microl of 1.2 mM solution) and the alpha2-antagonist yohimbine (1 microl of 12 mM solution) microinjected into the skin area where the laser-Doppler (LD) flux response to local cooling was measured in healthy male and female subjects. Multiple regression analysis showed correlation between LD flux response at the site of local cooling (direct response) and gender (P = 0.039). The LD flux decrease was smaller in males. The application of the yohimbine significantly diminished the LD flux response at the site of local cooling in females but not in males (P < 0.05). In contrast, the injection of prazosin did not significantly affect the response. These findings strongly support the suggestion of a decisive role of alpha2-adrenoceptors in cold-induced gender difference at the level of cutaneous microvasculature at the site of local cooling. Multiple regression analysis of LD flux response to cold exposure at the site distant to cooling (indirect response) also confirmed correlation between LD flux response and gender (P = 0.022). The LD flux decrease was smaller in males. The alpha1-antagonist abolished the LD flux response to cold exposure (P = 0.000). These results corroborate the importance of alpha1-adrenoceptors in skin microcirculatory response to indirect local cooling mediated by the sympathetic vascular reflex.

Pattern ERG and VEP maturation in schoolchildren.

OBJECTIVE: The maturation of the visual system has been studied with pattern electroretinograms (PERG) and pattern visual evoked potentials (PVEP) mostly in children under the age of 6 years. To address the question of maturation of the visual system in childhood and adolescence we investigated age-dependent PERG and PVEP changes in children aged 7-18 years. METHODS: PERG were recorded with skin electrodes attached to the lower eyelid, and PVEP were recorded with 5 electrodes. Visual stimuli, consisting of pattern-reversal 50' checks to full-field and to half-field stimulation, were applied to obtain macular (N70, P100, N145) and paramacular waves (P80, N105, N135). RESULTS: We found an age-dependent decrease (linear regression P<0.05) of PERG P50 amplitude and full-field PVEP P100 latency to monocular right and left eye stimulation, indicating central retinal and postretinal changes. In addition, waveform changes were found in responses to half-field stimulation. The paramacular wave N105 was typically enhanced in younger schoolchildren and diminished with age. The age-dependent decrease (linear regression P<0.01) of paramacular N105 amplitude indicated the increasing predominance of the macular structures of the visual system. CONCLUSIONS: Our findings suggest that central retinal and postretinal electrophysiological maturation persists throughout childhood. Age-dependent PVEP changes seem to correlate with the morphological and metabolic findings that maturation of the visual cortex continues until puberty and even later.

Microvascular reactivity in normotensive subjects with a familial predisposition to hypertension.

Using the laser-Doppler method we measured blood flow on the nailfold skin to compare the reactivity of cutaneous microcirculation in three groups of normotensive subjects: 11 subjects with a familial predisposition to hypertension without a previous record of high blood pressure, 6 predisposed subjects with a previous record of high blood pressure, and 13 subjects with no predisposition to hypertension. The flow was measured after direct and indirect skin cooling and heating and during postocclusive reactive hyperemia (PRH) after a 10-min occlusion of digital arteries. The frequency of flow oscillations in the second part of the PRH was established. Heart rate spectral analysis was performed based on the monitoring of the peripheral pulse frequency by means of the finapres device. In comparison to the other two groups of subjects, the group with a predisposition and a previous record of high blood pressure displayed a larger surface area in the low frequency band (0.05 to 0.15 Hz) of the heart rate variability power spectrum (the Bonferroni test, P < 0.05). As compared to subjects without predisposition, both groups of predisposed subjects exhibited higher frequency of flow oscillations in the second part of the PRH (the Bonferroni test, P < 0.05). Our results indicate that there could be a change in cutaneous microvascular reactivity of local (most probably myogenic) origin even in normotensive subjects with a predisposition to hypertension, whereas in normotensives with a predisposition and a previous record of high blood pressure there could be also a different cutaneous microvascular reactivity of central (nonvascular) origin.

Role of alpha-adrenoceptors in the cutaneous postocclusive reactive hyperaemia.

Laser-Doppler (LD) flow measurements reveal typical flow oscillations in the descending part of the cutaneous postocclusive reactive hyperaemia (PRH). The origin of these oscillations is still poorly understood. We tested the hypothesis that the high frequency (HF) components within the frequency band 0.06-0.2 Hz are due to the local myogenic mechanism, whereas the low frequency (LF) components within frequency band 0.01-0.05 Hz reflect sympathetic vasomotor activity. LD flow was monitored on fingertips of 11 healthy volunteers before and after an 8-minute occlusion of digital arteries. We studied the effect of intradermal microinjection (1 microl) of alpha-antagonists (prazosine, yohimbine) and alpha-agonists (phenilephrine, clonidine) on PRH oscillations. We analysed the magnitude of peak flow and its duration and performed spectral power analysis to obtain fundamental HF and LF frequencies (defined as components with the highest amplitude in the part of the respective frequency band). The results (mean +/- SE) for each substance were compared to the control values obtained after microinjection (1 microl) of 0.9% NaCl. The fundamental HF significantly decreased from 0.11 +/- 0.008 Hz after an injection of saline solution to 0.08 +/- 0.006 Hz after an application of antagonists (p<0.05). The local application of alpha-antagonists did not abolished HF oscillations what suggests that activity of local sympathetic nervous system is not essential in generation of these oscillations. However, the significant decrease of fundamental frequency in HF band after application of alpha-antagonists supports the hypothesis of their local origin and could be explained by the effect on pacemaker myogenic mechanism.

Gender differences in cutaneous laser doppler flow response to local direct and contralateral cooling.

To investigate the role of sympathetic neurovascular reactivity in the gender differences of cutaneous, cold-induced vasomotor response, we compared direct (at the site of cooling) and indirect (at a site remote from the cooling site) response measured by laser Doppler (LD) flowmetry in 12 healthy males and 12 healthy females. The females underwent testing twice, once in the follicular and once in the luteal phase of the menstrual cycle. We measured LD flow before and during local cooling of one hand at 15 degrees C. We found that local cooling evokes a significantly greater decrease in cutaneous LD flow in females than in males in direct as well as in indirect response conditions (p < 0.05). Comparing the response in females in the different phases of menstrual cycle, we obtained a significantly greater direct response to local cooling in the luteal phase than in the follicular phase (p < 0.05). In contrast, there was no menstrual-cycle-dependent difference in the indirect response to cold. The results of our study strongly indicate that sympathetic neural reactivity, as assessed by way of an indirect response to a cold stimulus, significantly contributes to gender differences in the response to local cooling. In contrast, the variation in microvascular responsiveness to cold exposure due to the menstrual cycle is most probably caused by local vascular mechanisms rather than by variation in sympathetic neural reactivity to local cooling.

Microvascular skin response to local cooling and body tilt early after digital replantation.

To elucidate the alteration in cutaneous microvascular reactivity early after replantation (14-21 days), laser Doppler (LD) flow changes evoked by direct and indirect local cooling and head-up body tilt were studied in the replanted digits (n = 10) and compared with those evoked in the healthy contralateral digits of the same patients (n = 10). During the first 3 minutes of direct cooling of the injured hand, LD flow increased significantly compared with the LD flow before cooling, which confirms that moderate vasodilation is the dominant component of the response to local cooling in skin microcirculation in the early period after replantation. During body tilt, LD flow in the healthy contralateral digit decreased significantly in only the first minute, while LD flow in the replanted digit started to decrease in the second minute after tilting; the decrease was significant from the third to the sixth minute. These results are consistent with the hypothesis that increased human skin alpha-adrenergic receptor sensitivity may be present as early as 2 to 3 weeks after replantation.

Simultaneous pattern electroretinogram and visual evoked potential recordings in dyslexic children.

To help clarify the conflicting evidence of neurophysiologic abnormalities in children with reading problems (dyslexia), we examined pattern electroretinograms and visual evoked potentials to stimulation with checks of 24', 49' and 180', each at 5%, 42% and 100% contrast, in a group of dyslexic children and a group of normal (i.e., normally reading) children. Neurophysiologic difference between the groups was restricted to the visual evoked potential, which showed a significant prolongation of the P100 wave in dyslexic children at the highest contrast (100%) and the smallest checks (24'). There was no significant difference between normal and dyslexic children in the P50 and N95 pattern electroretinogram waves. These results support the assumption of a visual deficit in dyslexic children. However, they are not consistent with the evidence of an isolated deficit of the magnocellular function, which, theoretically, would cause more prominent visual evoked potential changes to lower contrast and the largest check stimuli.

Do visual neurophysiological tests reflect magnocellular deficit in dyslexic children?

To address the question of a possible magnocellular visual deficit in children with reading problems (dyslexia), we examined pattern ERG and VEP responses to stimulation with checks of 24', 49' and 180' in size and of 5%, 42% and 100% contrast level. Neurophysiological difference between children with reading problems and those without them was found confined to VEP which showed a significant prolongation of P100 wave in dyslexic children at highest contrast (100%) and smallest checks (24'). Pattern ERG was normal. These results support the assumption of a visual deficit in dyslexic children. However, they are not consistent with an isolated deficit of the magnocellular function, which, theoretically, would cause VEP changes to lower contrast and largest check stimuli.

Pressure sensitivity of flow oscillations in postocclusive reactive skin hyperemia.

Skin blood flow was monitored using a laser-Doppler (LD) flowmeter in 21 healthy volunteers after an occlusion of the digital arteries. The peripheral vascular bed was exposed to occlusion ischemia of varying duration (1, 4, or 8 min) and to a change in digital arterial pressure produced by different positions of the arm above heart level to characterize the pattern of LD flow oscillations in postocclusive reactive hyperemia (PRH) and to elucidate the relevance of metabolic and myogenic mechanisms in governing its fundamental frequency. The descending part of the hyperemic flow was characterized by the appearance of conspicuous periodic oscillations with a mean fundamental frequency of 7.2 +/- 1.5 cycles/min (SD, n = 9), as assessed by a Fourier transform frequency analysis of 50-s sections of flow. The mean respiratory frequency during the periods of flow frequency analysis was 17.0 +/- 2.2 (SD, n = 9), and the PRH oscillations remained during apnea in all tested subjects. The area under the maximum flow curve increased significantly with prolongation of the occlusion (paired t test, P < 0.001; n = 9), but showed no dependence on the estimated blood pressure in the digital arteries, which suggests the predominant role of a metabolic component in this part of the PRH response. In contrast, the fundamental frequency of PRH oscillations exhibited a significant decrease with a reduction in the estimated digital arterial pressure (linear regression, b = 0.08, P < 0.001; n = 12), but did not change with the prolongation of arterial occlusion despite a significant increase in mean LD flow (paired t test, P < 0.001; n = 9).(ABSTRACT TRUNCATED AT 250 WORDS)

Central fiber contribution to W-shaped visual evoked potentials in patients with optic neuritis.

We studied W-shaped waveforms that occurred in full-field responses to pattern large-field stimulation in patients who had optic neuritis. Affected eyes showed no absolute scotomata; visual acuity was normal at the time of recording. To evaluate the contribution of macular- and paramacular-derived components to the development of the W-shaped waveforms in the patients, half-field and central full-field stimulation was used. The responses were compared with those obtained with the use of experimental scotomata in healthy subjects. The W-shaped waveforms recorded in the patients closely resembled the responses observed in healthy subjects after the introduction of experimental scotomata. In all affected eyes, half-field stimulation showed absence of the ipsilateral P100 component or its interaction with the P135 component. Enhanced paramacular N105 and P135 components were seen over the contralateral hemisphere. Responses to central full-field stimulation were an attenuated and prolonged P100 in the majority of affected eyes. Results of our study showed that W-shaped waveforms in response to large full-field stimulation may reflect impaired function of macular fibers. These electrophysiologic findings, however, were not always associated with evidence of a central field defect demonstrated by Friedmann perimetry.

Pattern electroretinogram recorded by skin electrodes in early ocular hypertension and glaucoma.

Diagnostic value of transient pattern electroretinogram (PERG), recorded by skin electrodes, was compared with Goldmann perimetry in cases of ocular hypertension and glaucoma. According to the assumption that the PERG mostly reflects activity of the retinal ganglion cells, and histological evidence that 30-50% atrophy of the retinal ganglion cells is necessary to cause defects in visual field, we wanted to assess if i) this method could be more sensitive in detecting early glaucomatous damage than routine Goldmann perimetry in eyes with normal or only borderline elevated intraocular pressure in the time of PERG recording (first group of patients), and ii) how the PERG amplitude corresponds to ganglion cell loss, expected in the eyes with already detectable initial glaucomatous visual field defects, according to Goldmann II/2 isopter, with normal or borderline elevated intraocular pressure in the time of PERG recording (second group). In the group with no visual field defects subnormal amplitude of the major positive component of the PERG, N1-P1, was detected in three of 30 eyes (10%), while in the group with initial visual field defects N1-P1 amplitude was subnormal in 6 of 11 eyes (54%). The amplitude of the major negative PERG component, P1-N2, was found normal in all eyes of the first group and subnormal in 5 eyes (45%) of the second group.

Dependence of visual evoked potentials on change of stimulated retinal area associated with different pattern displacements.

An attempt was made to distinguish between the effects of the moving edges and the change in the area of stimulated retina on pattern shift visual potentials, elicited by checkerboard pattern displacements varying through 0.25, 0.50, 0.75 and full pattern reversal. Twelve healthy subjects were stimulated binocularly with a horizontally orientated pattern (whole field 17 degrees, check size 28' of visual angle). Four of them were additionally presented with a diagonally orientated pattern. Two sets of 32 averages were taken for each stimulus condition and peak-to-peak amplitudes P50-N70 and P100-N140 were measured. The change of the stimulated retinal area is a quadratic function of the diagonally orientated pattern. The change in amplitude of P50-N70 fits well with the curve of the area change, but that in the amplitude of P100-N140 does not. Each of the amplitudes also seems to have a different orientation of hypothetical dipole vectors.