Cerebral blood flow of children with vasovagal syncope

2014 ◽  
Vol 25 (2) ◽  
pp. 267-273 ◽  
Author(s):  
Barsan Tugba ◽  
Kilic Zubeyir ◽  
Uzuner Nevzat ◽  
Yildirim Ali ◽  
Ucar Birsen ◽  
...  
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Flow Rate ◽  
Vasovagal Syncope ◽  
Blood Flow Rate ◽  
Tilt Test ◽  
Control Group ◽  
Group 2 ◽  
Group 1

AbstractIntroduction: We aimed to evaluate changes in the cerebral blood supply in children during vasovagal syncope and to clarify the diagnostic value of transcranial Doppler for vasovagal syncope. Materials and methods: Patients were divided into three groups. Group 1 consisted of 31 patients who were symptomatic and whose head-up tilt test was positive. Group 2 comprised 21 patients who were symptomatic but whose tilt test was negative. Group 3 included 22 healthy children. For the diagnosis of vasovagal syncope, the tilt test was applied. For the subjects of the patient and control groups, the tilt test was repeated. The flow rates of bilateral middle cerebral arteries were continuously and simultaneously recorded with temporal window transcranial Doppler. Results: There were no statistically significant differences between the three groups with respect to age and gender distribution (p>0.05). When the bed was at an upright position, the maximum blood flow rate of the right middle cerebral artery was lower in Group 1 than in Group 2, although the decrease was more significant in comparison to the healthy control group (p<0.05). The minimum blood flow rate of the right middle cerebral artery was lower in Group 1 than the Group 2, although the decrease was more significant in comparison with the healthy control group (p<0.05). The maximum blood flow rate of the left middle cerebral artery was significantly lower in Group 1 than in the control group (p<0.05). Conclusion: Minimum and maximum blood flow rates are significantly decreased in patients tilt test (+) patients with vasovagal syncope during orthostatic stress.

Effects of Sufentanil on Cerebral Hemodynamics and Intracranial Pressure in Patients with Brain Injury

1995 ◽  
Vol 83 (4) ◽  
pp. 721-726. ◽  
Author(s):  
Christian Werner ◽  
Eberhard Kochs ◽  
Hanswerner Bause ◽  
William E. Hoffman ◽  
Jochen Schulte am Esch
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Blood Flow Velocity ◽  
Artery Blood Flow ◽  
Arterial Blood ◽  
Norepinephrine Infusion ◽  
Group 2 ◽  
Group 1

Background The current study investigates the effects of sufentanil on cerebral blood flow velocity and intracranial pressure (ICP) in 30 patients with intracranial hypertension after severe brain trauma (Glasgow coma scale &lt; 6). Methods Mechanical ventilation (FIO2 0.25-0.4) was adjusted to maintain arterial carbon dioxide tensions of 28-30 mmHg. Continuous infusion of midazolam (200 micrograms/kg/h intravenous) and fentanyl (2 micrograms/kg/h intravenous) was used for sedation. Mean arterial blood pressure (MAP, mmHg) was adjusted using norepinephrine infusion (1-5 micrograms/min). Mean blood flow velocity (Vmean, cm/s) was measured in the middle cerebral artery using a 2-MHz transcranial Doppler sonography system. ICP (mmHg) was measured using an epidural probe. After baseline measurements, a bolus of 3 micrograms/kg sufentanil was injected, and all parameters were continuously recorded for 30 min. The patients were assigned retrospectively to the following groups according to their blood pressure responses to sufentanil: group 1, MAP decrease of less than 10 mmHg, and group 2, MAP decrease of more than 10 mmHg. Results Heart rate, arterial blood gases, and esophageal temperature did not change over time in all patients. In 18 patients, MAP did not decrease after sufentanil (group 1). In 12 patients, sufentanil decreased MAP &gt; 10 mmHg from baseline despite norepinephrine infusion (group 2). ICP was constant in patients with maintained MAP (group 1) but was significantly increased in patients with decreased MAP. Vmean did not change with sufentanil injection regardless of changes in MAP. Conclusions The current data show that sufentanil (3 micrograms/kg intravenous) has no significant effect on middle cerebral artery blood flow velocity and ICP in patients with brain injury, intracranial hypertension, and controlled MAP. However, transient increases in ICP without changes in middle cerebral artery blood flow velocity may occur concomitant with decreases in MAP. This suggests that increases in ICP seen with sufentanil may be due to autoregulatory decreases in cerebral vascular resistance secondary to systemic hypotension.

Dopamine-1 receptor stimulation impairs intestinal oxygen utilization during critical hypoperfusion

2003 ◽  
Vol 284 (2) ◽  
pp. H668-H675 ◽  
Author(s):  
Jorge A. Guzman ◽  
Ariosto E. Rosado ◽  
James A. Kruse
Keyword(s):  
Blood Flow ◽  
Mucosal Blood Flow ◽  
Control Group ◽  
Oxygen Utilization ◽  
Hemorrhage Control ◽  
Receptor Stimulation ◽  
Anesthetized Dogs ◽  
Group 2 ◽  
Increased Susceptibility ◽  
Group 1

Effects of a dopamine-1 (DA-1) receptor agonist on systemic and intestinal oxygen delivery (D˙o 2)-uptake relationships were studied in anesthetized dogs during sequential hemorrhage. Control ( group 1) and experimental animals ( group 2) were treated similarly except for the addition of fenoldopam (1.0 μg · kg−1 · min−1) in group 2. Both groups had comparable systemic criticalD˙o 2(D˙o 2crit), but animals in group 2 had a higher gut D˙o 2crit(1.12 ± 1.13 vs. 0.80 ± 0.09 ml · kg−1 · min−1, P < 0.05). At the mucosal level, a clear biphasic delivery-uptake relationship was not observed in group 1; thus oxygen consumption by the mucosa may be supply dependent under physiological conditions. Group 2 demonstrated higher peak mucosal blood flow and lack of supply dependency at higher mucosalD˙o 2 levels. Fenoldopam resulted in a more conspicuous biphasic relationship at the mucosa and a rightward shift of overall splanchnic D˙o 2crit despite increased splanchnic blood flow. These findings suggest that DA-1 receptor stimulation results in increased gut perfusion heterogeneity and maldistribution of perfusion, resulting in increased susceptibility to ischemia.

scholarly journals THE ROLE OF MYOCARDIAL REVASCULARIZATION IN THE SURVIVAL OF PATIENTS WITH ALTERED CORONARY BLOOD FLOW DETECTED BY TRANSTHORACIC ULTRASOUND

2019 ◽  
Vol 34 (1) ◽  
pp. 54-60
Author(s):  
M. S. Kamenskikh ◽  
A. V. Zagatina ◽  
N. T. Zhuravskaya ◽  
Yu. N. Fedotov ◽  
D. V. Shmatov
Keyword(s):  
Blood Flow ◽  
Coronary Blood Flow ◽  
Myocardial Revascularization ◽  
Control Group ◽  
P Value ◽  
Coronary Events ◽  
Group 2 ◽  
Group 1 ◽  
Flow Velocities

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

scholarly journals Blood Flow Distribution in Cerebral Arteries

2015 ◽  
Vol 35 (4) ◽  
pp. 648-654 ◽  
Author(s):  
Laleh Zarrinkoob ◽  
Khalid Ambarki ◽  
Anders Wåhlin ◽  
Richard Birgander ◽  
Anders Eklund ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Artery ◽  
Flow Rate ◽  
Cerebral Perfusion ◽  
Brain Volume ◽  
Cerebral Arteries ◽  
Blood Flow Rate ◽  
Collateral Flow ◽  
Vascular Tree

High-resolution phase—contrast magnetic resonance imaging can now assess flow in proximal and distal cerebral arteries. The aim of this study was to describe how total cerebral blood flow (tCBF) is distributed into the vascular tree with regard to age, sex and anatomic variations. Forty-nine healthy young (mean 25 years) and 45 elderly (mean 71 years) individuals were included. Blood flow rate (BFR) in 21 intra- and extracerebral arteries was measured. Total cerebral blood flow was defined as BFR in the internal carotid plus vertebral arteries and mean cerebral perfusion as tCBF/brain volume. Carotid/vertebral distribution was 72%/28% and was not related to age, sex, or brain volume. Total cerebral blood flow (717±123 mL/min) was distributed to each side as follows: middle cerebral artery (MCA), 21%; distal MCA, 6%; anterior cerebral artery (ACA), 12%, distal ACA, 4%; ophthalmic artery, 2%; posterior cerebral artery (PCA), 8%; and 20% to basilar artery. Deviating distributions were observed in subjects with ‘fetal’ PCA. Blood flow rate in cerebral arteries decreased with increasing age ( P<0.05) but not in extracerebral arteries. Mean cerebral perfusion was higher in women (women: 61±8; men: 55±6 mL/min/100 mL, P<0.001). The study describes a new method to outline the flow profile of the cerebral vascular tree, including reference values, and should be used for grading the collateral flow system.

scholarly journals Evaluation of fetal condition in uncomplicated pregnancies at 40 weeks and beyond by calculation of amniotic fluid indexes and Doppler in the middle cerebral artery.

2021 ◽  
Author(s):  
elvira semenova ◽  
Nikolai Rukhliada ◽  
Olga Klicenko
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Inclusion Criteria ◽  
Trigger Level ◽  
Hypoxic Brain Damage ◽  
Emergency Cesarean ◽  
Hypoxic Brain ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective. The aim of our data is to reveal the method of prognosis abnormal perinatal outcome, using combination US and Doppler results in uncomplicated pregnancies at 40 weeks and beyond. Design.1020 uncomplicated pregnant women at 40 weeks and beyond were examined 48 hours before delivery. We analyzed fetus’s condition during labor and just after. Setting. According these dates all women were divided into 3 groups after amniotic index(AI)and pulsatility indices(PI) in the middle cerebral artery(MCA). Population.260 women were included in the study because they met the inclusion criteria. Methods.All women were divided into 3 groups (group 1 - PI>0.835, any value of AI, group 2-AI >85, PI ≤ 0.835, group 3- AI ≤ 85 and PI ≤ 0.835).We analyzed fetus’s condition during labor and just after delivery (Apgar score <=7 and >7 on the 1st minute). Result. We’ve got trigger level for pulsatility index (PI) as 0.835, if we had PI less than that threshold cases of emergency cesarean section increases in 2,12 times, if PI less than 0,835 in combination with Amniotic Index(AI) 85 and less in 5,28 times. If PI =<0,835 risk of newborns having Apgar 7 and less increases in 1,18, but in combination with AI =<85 in 4,72 times. Conclusion. In results we found out the following data: low PI in the MCA may be parameter which cans prognoses fetus distress. Combination of PI reduce with low AI increases its specific and can use in practical ways to avoid hypoxic brain damage during labor.

scholarly journals Induction of Spreading Depression in the Ischemic Hemisphere following Experimental Middle Cerebral Artery Occlusion: Effect on Infarct Morphology

1996 ◽  
Vol 16 (2) ◽  
pp. 202-213 ◽  
Author(s):  
Tobias Back ◽  
Myron D. Ginsberg ◽  
W. Dalton Dietrich ◽  
Brant D. Watson
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Spreading Depression ◽  
Ischemic Injury ◽  
Artery Occlusion ◽  
Ischemic Penumbra ◽  
Mca Occlusion ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

This study was undertaken to test whether transient depolarizations occurring in periinfarct regions are important in contributing to infarct spread and maturation. Following middle cerebral artery (MCA) occlusion we stimulated the ischemic penumbra with recurrent waves of spreading depression (SD) and correlated the histopathological changes with the electrophysiological recordings. Halothane-anesthetized, artificially ventilated Sprague–Dawley rats underwent repetitive stimulation of SD in intact brain (Group 1; n = 8) or photothrombotic MCA occlusion coupled with ipsilateral common carotid artery occlusion (Groups 2 and 3, n = 9 each). The electroencephalogram and direct current (DC) potential were recorded for 3 h in the parietal cortex, which represented the periinfarct border zone in ischemic rats. In Group 2, only spontaneously occurring negative DC shifts occurred; in Group 3, the (nonischemic) frontal pole of the ischemic hemisphere was electrically stimulated to increase the frequency of periinfarct DC shifts. Animals underwent perfusion-fixation 24 h later, and volumes of complete infarction and scattered neuronal injury (“incomplete infarction”) were assessed on stained coronal sections by quantitative planimetry. Electrical induction of SD in Group 1 did not cause morphological injury. During the initial 3 h following MCA occlusion, the number of spontaneous periinfarct depolarizations in Group 2 (7.0 ±1.5 DC shifts) was doubled in Group 3 by frontal current application (13.4 ± 2.7 DC shifts; p < 0.001). The duration as well as the integrated negative amplitude of DC shifts over time were significantly greater in Group 3 than in Group 2 rats (duration, 5.7 ± 3.8 vs. 4.1 ± 2.5 min; p < 0.05). Histopathological examination disclosed well-defined areas of pannecrosis surrounded by a cortical rim exhibiting selectively damaged acidophilic neurons and astrocytic swelling in otherwise normal-appearing brain. Induction of SD in the ischemic hemisphere led to a significant increase in the volume of incomplete infarction (19.0 ± 6.1 mm3 in Group 3 vs. 10.3 ± 5.1 mm3 in Group 2; p < 0.01) and of total ischemic injury (100.7 ± 41.0 mm3 in Group 3 vs. 66.5 ± 24.7 mm3 in Group 2; p < 0.05). The integrated magnitude of DC negativity per experiment correlated significantly with the volume of total ischemic injury ( r = 0.780, p < 0.0001). Thus, induction of SD in the ischemic hemisphere accentuated the development of scattered neuronal injury and increased the volume of total ischemic injury. This observation may be explained by the fact that, with limited perfusion reserve, periinfarct depolarizations are associated with episodic energy failure in the acute ischemic penumbra.

Contralateral Clipping of Middle Cerebral Artery Aneurysms

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. ons116-ons124 ◽  
Author(s):  
Ana Rodríguez-Hernández ◽  
Andreu Gabarrós ◽  
Michael T. Lawton
Keyword(s):  
Surgical Technique ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Sylvian Fissure ◽  
Invasive Technique ◽  
Less Invasive ◽  
Aneurysm Clipping ◽  
Group 2 ◽  
Mca Aneurysm ◽  
Group 1

Abstract BACKGROUND: Contralateral clipping of middle cerebral artery (MCA) aneurysms seems dangerous and ill advised but could become an important technique because of the prevalence of MCA aneurysms, the limitations of endovascular therapy, and increasing interest in less invasive techniques. OBJECTIVE: To define patient selection, surgical technique, and results with contralateral MCA aneurysm clipping. METHODS: Forty-two patients with bilateral MCA aneurysms were treated either in 1 stage with a single craniotomy and contralateral aneurysm clipping (group 1, 11 patients) or in 2 stages with bilateral craniotomy (group 2, 31 patients). Surgical technique consisted of ipsilateral sylvian fissure split, subfrontal dissection, contralateral sylvian fissure split, mobilization of medial orbital gyrus, and contralateral aneurysm clipping. RESULTS: Group 1 patients were older than group 2 patients (60.3 vs 55.4 years, respectively). Clinical presentation with subarachnoid hemorrhage was less common in group 1. Nine group 1 patients (82%) had left-sided craniotomies, and the ipsilateral aneurysm was larger than the contralateral aneurysm. All aneurysms were clipped without intraoperative complications (136 aneurysms). Mean neurosurgical charges were decreased by contralateral MCA aneurysm clipping: $39 297 in group 1 vs $57 977 in group 2. CONCLUSION: Contralateral MCA aneurysm clipping can be viewed as an extreme microsurgical technique or as a less invasive technique that spares patients a second craniotomy in the management of bilateral aneurysms. This technique is acceptable in selected patients with contralateral aneurysms that are unruptured, have simple necks, project inferiorly or anteriorly, are associated with short M1 segments, and reside in older patients with sylvian fissures widened by brain atrophy.

scholarly journals Estimation of the Functional Condition of a Fetus of Pregnancy in Chronic Pyelonephritis

2013 ◽  
Vol 68 (12) ◽  
pp. 80-82 ◽  
Author(s):  
Sh.G. Kadimova
Keyword(s):  
Blood Flow ◽  
Pregnant Women ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Umbilical Artery ◽  
Chronic Pyelonephritis ◽  
Performance Ratio ◽  
Control Group ◽  
Placental Blood ◽  
Placental Blood Flow

Aim of this study was to investigate the condition of the fetus and feto placental system in chronic pyelonephritis by identifying features in the feto- placental blood flow and middle cerebral artery system. Patients and methods.  We examined 68 pregnant women with chronic pyelonephritis and 50 healthy pregnant women as a control group . The study conducted a qualitative assessment of fetus and placental blood flow and blood flow in the middle cerebral artery of the fetus . The data on the condition of  feto- placental blood flow and blood flow in the middle cerebral artery in the examined pregnant and control group show a higher incidence of elevated systolic and diastolic performance ratio in the umbilical artery in patients with chronic pyelonephritis than somatically healthy women. Results. Studies have shown that the most accurate and informative indicator of violations feto- placental circulation is an increase in the umbilical artery  whose value ( 2.9 and above) reflects the high degree of suffering of the fetus on a background of chronic pyelonephritis. Conclusions. Diagnostically significant is the indicator of the middle cerebral artery blood flow, which reflects the mechanism of enhancement of cerebral circulation in chronic hypoxia due to violation of feto- placental circulation in patients with renal disease.Key words: placentary insufficiency, nephritic pathology, pregnancy.

Intraprocedural predictors of post-stent retriever thrombectomy subarachnoid hemorrhage in middle cerebral artery stroke

2018 ◽  
Vol 11 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Perry P Ng ◽  
Theodore C Larson ◽  
Christopher W Nichols ◽  
Mark M Murray ◽  
Karen L Salzman ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mass Effect ◽  
Stent Retriever ◽  
Enhanced Ct ◽  
Observational Cohort ◽  
Group 2 ◽  
Angiographic Findings ◽  
Group 1

BackgroundStent retriever thrombectomy (SRT) in acute thromboembolic stroke can result in post-thrombectomy subarachnoid hemorrhage (PTSAH). Intraprocedural findings associated with PTSAH are not well defined.ObjectiveTo identify angiographic findings and procedural factors during SRT that are associated with PTSAH.Materials and methodsThis was a retrospective, observational cohort study of consecutive patients with middle cerebral artery (MCA) acute ischemic stroke treated with SRT. Inclusion criteria were: (1) age ≥18 years; (2) thromboembolic occlusion of the MCA; (3) at least one stent retriever pass beginning in an M2 branch; (4) postprocedural CT or MRI scan within 24 hours; (5) non-enhanced CT Alberta Stroke Program Early CT Score >5. Exclusion criteria included multi-territory stroke before SRT.ResultsEighty-five patients were enrolled; eight patients had PTSAH (group 1) and 77 did not (group 2). Baseline demographic and clinical characteristics were comparable between the two groups. In group 1, a significantly greater proportion of patients had more than two stent retriever passes (62.5% vs 18.2%, P=0.01), a stent retriever positioned ≥2 cm along an M2 branch (100% vs 30.2%, P=0.002), and the presence of severe iatrogenic vasospasm before SRT pass (37.5% vs 5.2%, P=0.02). One patient with PTSAH and associated mass effect deteriorated clinically.ConclusionsAn increased number of stent retriever passes, distal device positioning, and presence of severe vasospasm were associated with PTSAH. Neurological deterioration with PTSAH can occur.

scholarly journals Peculiarities of the reaction of the lower limbs venous blood flow to the orthostatic test in men with arterial hypertension

2019 ◽  
pp. 86-89
Author(s):  
T. F. Vagapov ◽  
V. M. Baev ◽  
S. V. Letyagina
Keyword(s):  
Blood Flow ◽  
Arterial Hypertension ◽  
Flow Rate ◽  
Femoral Vein ◽  
Venous Blood ◽  
Test Group ◽  
Blood Flow Rate ◽  
Lower Limbs ◽  
Control Group ◽  
Venous Blood Flow

A comparative analysis of the dynamics of lower limb vein angioscopy parameters in case of orthostasis between male patients (age 30–50 years) with arterial hypertension (test group – 60 people) and normal arterial pressure (control group – 27 people) was made. Orthostatic sample in all examined patients was characterized by a reliable increase in the diameter and area of vein section at a decrease in blood flow rate. However, in patients with hypertension the increase in the area of vein section was significantly less than in the control group. In orthostasis, the drop in blood flow rate in the total femoral vein was lower in men with hypertension than in men in the control group. In the great saphenous vein, a larger decrease in blood flow velocity was recorded than in the control group. In hypertension, no increase in the number of refluxes was recorded in orthostasis. Thus, hypertension in men is characterized by altered reaction of venous blood flow to orthostasis in both deep and saphenous veins.

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