scholarly journals Cerebral misery perfusion due to carotid occlusive disease

2017 ◽  
Vol 2 (2) ◽  
pp. 88-93 ◽  
Author(s):  
Mohana Maddula ◽  
Nikola Sprigg ◽  
Philip M Bath ◽  
Sunil Munshi
Keyword(s):  
Clinical Manifestations ◽  
Occlusive Disease ◽  
Metabolic Demand ◽  
Transient Ischaemic Attacks ◽  
Cerebral Blood Supply ◽  
Positron Emission ◽  
Local Experience ◽  
Misery Perfusion ◽  
Carotid Occlusive Disease

PurposeCerebral misery perfusion (CMP) is a condition where cerebral autoregulatory capacity is exhausted, and cerebral blood supply in insufficient to meet metabolic demand.We present an educational review of this important condition, which has a range of clinical manifestations.MethodA non-systematic review of published literature was undertaken on CMP and major cerebral artery occlusive disease, using Pubmed and Sciencedirect.FindingsPatients with CMP may present with strokes in watershed territories, collapses and transient ischaemic attacks or episodic movements associated with an orthostatic component. While positron emission tomography is the gold standard investigation for misery perfusion, advanced MRI is being increasingly used as an alternative investigation modality. The presence of CMP increases the risk of strokes. In addition to the devastating effect of stroke, there is accumulating evidence of impaired cognition and quality of life with carotid occlusive disease (COD) and misery perfusion. The evidence for revascularisation in the setting of complete carotid occlusion is weak. Medical management constitutes careful blood pressure management while addressing other vascular risk factors.DiscussionThe evidence for the management of patients with COD and CMP is discussed, together with recommendations based on our local experience. In this review, we focus on misery perfusion due to COD.ConclusionPatients with CMP and COD may present with a wide-ranging clinical phenotype and therefore to many specialties. Early identification of patients with misery perfusion may allow appropriate management and focus on strategies to maintain or improve cerebral blood flow, while avoiding potentially harmful treatment.

Abstract TP114: Cognition Independently Affects Quality of Life in Carotid Occlusive Disease

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marykay Pavol ◽  
Kathryn M Sundheim ◽  
Joanne R Festa ◽  
Y. K Cheung ◽  
Kevin Slane ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Regression Model ◽  
Severe Depression ◽  
Occlusive Disease ◽  
Minor Stroke ◽  
Stroke Severity ◽  
Normal Range ◽  
History Of ◽  
Carotid Occlusive Disease

Objective: To determine whether cognition among those with carotid occlusive disease independently affects Quality of Life (QoL). Introduction: Carotid occlusion may result in stroke, TIA, and reduction in cognition. QoL has been studied in stroke patients but less is known about QoL in patients with carotid occlusive disease without stroke or significant depression. Methods: Subjects, selected from an NIH study of carotid occlusive treatment, included those with with history of TIA or a remote history of minor stroke, and excluded those with a history of stroke within 4 months prior, major deficits in ADL’s, and dementia. Because the relationship between depression and OoL is well-established, we excluded with moderate-severe depression. Patients underwent cognitive examination (memory, language, motor, executive function skills), completed depression and QOL questionnaires (Center for Epidemiological Studies-Depression (CES-D), Stroke Specific Quality of Life (SSQOL), and were rated for stroke severity (NIHSS). Age-corrected Z-scores for cognitive tests were calculated and averaged into a composite cognitive Z-score (Cog-Z). The SSQOL scores were averaged across subgroup domains. Correlation analyses were performed to determine univariate relationships between the variables, with significant values put into in a regression model to predict SSQOL. Results: Among 24 subjects (mean age=58.38 (2.01); 10 women), mean Cog-Z was –1.06 SD (Low Average range), mean CES-D score was 10.77 (normal range), mean NIHSS was 0.46 (normal range), and the mean SSQOL score was 3.92 (needing “a little help”). The correlations between NIHSS, history of prior stroke, and SSQOL were nonsignificant. In a regression model including Cog-Z and CES-D, Cog-Z was an independent predictor of SSQOL (Beta=.389, p=.038). Conclusions: In patients with carotid occlusive disease without major stroke, cognitive scores were independently associated with QOL. Even minor reductions in cognition influenced QoL and were distinct from the influence of depression. These data further establish the clinical relevance of cognitive decline among patients with cerebrovascular conditions.

scholarly journals The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease—A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 773
Author(s):  
Wei-Ting Wu ◽  
Tsung-Min Lee ◽  
Der-Sheng Han ◽  
Ke-Vin Chang
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Current Evidence ◽  
Degenerative Spine ◽  
Degenerative Spine Disease ◽  
Spine Disease

The association of sarcopenia with poor clinical outcomes has been identified in various medical conditions, although there is a lack of quantitative analysis to validate the influence of sarcopenia on patients with lumbar degenerative spine disease (LDSD) from the available literature. Therefore, this systematic review and meta-analysis aimed to summarize the prevalence of sarcopenia in patients with LDSD and examine its impact on clinical outcomes. The electronic databases (PubMed and Embase) were systematically searched from inception through December 2020 for clinical studies investigating the association of sarcopenia with clinical outcomes in patients with LDSD. A random-effects model meta-analysis was carried out for data synthesis. This meta-analysis included 14 studies, comprising 1953 participants. The overall prevalence of sarcopenia among patients with LDSD was 24.8% (95% confidence interval [CI], 17.3%–34.3%). The relative risk of sarcopenia was not significantly increased in patients with LDSD compared with controls (risk ratio, 1.605; 95% CI, 0.321–8.022). The patients with sarcopenia did not experience an increase in low back and leg pain. However, lower quality of life (SMD, −0.627; 95% CI, −0.844–−0.410) were identified postoperatively. Sarcopenia did not lead to an elevated rate of complications after lumbar surgeries. Sarcopenia accounts for approximately one-quarter of the population with LDSD. The clinical manifestations are less influenced by sarcopenia, whereas sarcopenia is associated with poorer quality of life after lumbar surgeries. The current evidence is still insufficient to support sarcopenia as a predictor of postoperative complications.

scholarly journals Splenic uptake on FDG PET/CT correlates with Kikuchi-Fujimoto disease severity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hye Seong ◽  
Yong Hyu Jeong ◽  
Woon Ji Lee ◽  
Jun Hyoung Kim ◽  
Jung Ho Kim ◽  
...  
Keyword(s):  
Disease Severity ◽  
Fdg Pet ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Standardized Uptake Value ◽  
Total Lesion Glycolysis ◽  
Positron Emission ◽  
Pet Ct ◽  
Systemic Symptoms ◽  
Fdg Pet Ct

AbstractKikuchi-Fujimoto disease (KFD) is usually self-limiting, but prolonged systemic symptoms often result in frequent hospital visits, long admission durations, or missed workdays. We investigated the role of fluorine-18 fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing KFD severity. We reviewed the records of 31 adult patients with pathologically confirmed KFD who underwent 18F-FDG PET/CT between November 2007 and April 2018 at a tertiary-care referral hospital. Disease severity was assessed using criteria based on clinical manifestations of advanced KFD. Systemic activated lymph nodes and severity of splenic activation were determined using semi-quantitative and volumetric PET/CT parameters. The median of the mean splenic standardized uptake value (SUVmean) was higher in patients with severe KFD than those with mild KFD (2.38 ± 1.18 vs. 1.79 ± 0.99, p = 0.058). Patients with severe KFD had more systemically activated volume and glycolytic activity than those with mild KFD (total lesion glycolysis: 473.5 ± 504.4 vs. 201.6 ± 363.5, p = 0.024). Multivariate logistic regression showed that myalgia (odds ratio [OR] 0.035; 95% confidence interval [CI] 0.001–0.792; p = 0.035), total lymph node SUVmax (cutoff 9.27; OR 24.734; 95% CI 1.323–462.407; p = 0.032), and spleen SUVmean (cutoff 1.79; OR 37.770; 95% CI 1.769–806.583; p = 0.020) were significantly associated with severe KFD. 18F-FDG PET/CT could be useful in assessing KFD severity.

Reversal of Focal Misery Perfusion after Intracranial Angioplasty: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 436-440 ◽  
Author(s):  
Colin P. Derdeyn ◽  
DeWitte T. Cross ◽  
Christopher J. Moran ◽  
Ralph G. Dacey
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Intracranial Stenosis ◽  
Oxygen Extraction Fraction ◽  
Oxygen Extraction ◽  
Positron Emission ◽  
Misery Perfusion ◽  
Before And After ◽  
Hemodynamic Measurements

Abstract OBJECTIVE AND IMPORTANCE The presence of reduced blood flow and increased oxygen extraction fraction (OEF) (misery perfusion) in the hemisphere distal to an occluded carotid artery is a proven risk factor for subsequent stroke. Whether angioplasty of intracranial stenosis is sufficient to reverse this condition has not been documented. CLINICAL PRESENTATION A 67-year-old man exhibited progressive right hemispheric ischemic symptoms despite maximal antiplatelet and antithrombotic therapy. Angiography demonstrated focal 80% stenosis of the supraclinoid segment of the ipsilateral internal carotid artery. TECHNIQUE 15O positron emission tomographic measurements of cerebral blood flow and OEF were made before and after transfemoral percutaneous angioplasty. OEF values measured before angioplasty were elevated in the middle cerebral artery distal to the stenosis. Angioplasty reduced the degree of luminal stenosis to 40% (linear diameter). OEF values measured 36 hours after angioplasty were normal. CONCLUSION Angioplasty of intracranial stenosis can restore normal cerebral blood flow and oxygen extraction, despite mild residual stenosis after the procedure. Hemodynamic measurements may be useful for the identification of patients with the greatest potential to benefit from angioplasty.

Blood Flow Asymmetry in Carotid Occlusive Disease

Angiology ◽  
1992 ◽  
Vol 43 (2) ◽  
pp. 100-109 ◽  
Author(s):  
Ross L. Levine ◽  
Jack M. Rozental ◽  
Robert J. Nickles
Keyword(s):  
Blood Flow ◽  
Occlusive Disease ◽  
Flow Asymmetry ◽  
Carotid Occlusive Disease

Strengthening the pharmacological potential of drug therapy in treatment of patients with chronic pancreatitis by using therapeutic physical factors

2020 ◽  
pp. 8-14
Author(s):  
R. M. Mallaeva ◽  
A. N. Makhinko ◽  
M. B. Uzdenov
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Drug Therapy ◽  
Clinical Manifestations ◽  
Medical Rehabilitation ◽  
Control Group ◽  
Physical Factors ◽  
Standard Drug ◽  
Pharmacological Potential

The purpose of the study is to improve rehabilitation treatment of patients with chronic pancreatitis (CP) at inpatient stage by strengthening pharmacological potential of drug therapy due to inclusion of therapeutic physical factors (TPF) in therapeutic programs. Materials and methods. 159 patients with acute CP were observed. By simple randomization, 4 groups were formed: the control group (MG, 39 people) received standard drug therapy; 1st comparison group (GC1; 38 people) additionally received TPF; GC2 (40 people) in addition to treatment in GC1 had drinking mineral water «Slavyanovskaya»; in main group (42 people) in addition to the treatment in GC2 got preformed peloidotherapy on the cervical-collar zone. All the patients underwent the evaluation of clinical score and quality of life before and after medical rehabilitation. Results. In MG, clinical symptomatology leveling was by 78,2% (p<0,01), in GC1 — by 71,5% (p<0,01), GC2 — by 62,3% (p<0,01), CG — by 57,2% (p<0,01) on average immediately after the treatment, which was in a clear correlation with indicators of quality of life. In the long term (in 6 and 12 months), the advantage of combination therapy was noted with the same validity, the preservation of the achieved positive result was mostly noted in the MG: after 6 months the improvement in physical health compared to the initial values was noted by 34,4% (p<0,01), after 12 months — by 24,0% (p<0,05); mental — by 32,3% (p<0,01) and 22,5% (p<0,05), respectively. In both comparison groups, positive dynamics was 10–12% lower, and in the control group, after 6 months, there was only a tendency to improve quality of life indicators. Conclusion. The inclusion of TPF in the programs of the inpatient stage of medical rehabilitation of patients with chronic pancreatitis by strengthening the pharmacological potential of drug therapy contributes to the leveling of clinical manifestations (abdominal pain, dyspepsia and diarrhea), the result of which is an improvement in the quality of life of this category of patients.

Sign in / Sign up

Export Citation Format

Share Document