Abstract TMP86: Early Microvascular Cerebral Blood Flow Response to Head-of-bed Elevation is Related to Outcome in Acute Ischemic Stroke: A Diffuse Correlation Spectroscopy Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Clara Gregori-Pla ◽  
Raquel Delgado-Mederos ◽  
Pol Camps-Renom ◽  
Peyman Zirak ◽  
Igor Blanco ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Correlation Spectroscopy ◽  
Stroke Onset ◽  
Diffuse Correlation Spectroscopy ◽  
Blood Flow Response ◽  
Poor Outcome ◽  
Flow Response

Introduction: The microvascular cerebral blood flow response (rCBF) to orthostatic stress has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS). However, its relevance to the outcome is unknown. Hypothesis: CBF response to head-of-the-bed (HOB) elevation within the first hours after AIS is related to outcome. Methods: Patients with a large anterior circulation stroke of less than 48h from the stroke onset were monitored with DCS to follow rCBF in the frontal lobes during a HOB elevation from supine to 30°. All patients were placed flat during the first 24 hours and later, mobilization was initiated depending on the clinical condition. We categorized measurements as early (<12h) or late (>12h) from stroke onset. NIHSS was recorded at baseline, during HOB, at 24h and 48h. The modified Rankin scale (mRS) score was utilized as the outcome measure (favorable when 0-2). Results: We studied 34 patients (age 78±13y, male 47%, median NIHSS 19 (14-21)) at 16±11 hours from stroke. Ipsilateral extracranial and/or intracranial occlusion was present in 61%. Frontal CBF decreased in both hemispheres after HOB (-5±14%). A paradoxical response (increase/no change) was observed in 18%. rCBF was not correlated to NIHSS and age. Unfavorable outcome was found in 85%. Only at early hours (<12h, n=16), rCBF to HOB elevation in the ipsilateral (not in contralateral) hemisphere (p=0.04, Figure 1) and NIHSS HOB (p=0.008) were associated with poor outcome. Conclusions: This result suggests that paradoxical CBF response to a mild HOB elevation in the early hours of stroke onset is associated with a poor outcome in patients with AIS. Optical continuous monitoring in the bedside may help to individualize management strategies in the early hours of AIS. Figure 1: rCBF due to HOB elevation versus mRS for the ipsi-lateral side in patients measured <12h after stroke.

scholarly journals Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke

2019 ◽  
Vol 266 (4) ◽  
pp. 990-997 ◽  
Author(s):  
Clara Gregori-Pla ◽  
Igor Blanco ◽  
Pol Camps-Renom ◽  
Peyman Zirak ◽  
Isabel Serra ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Flow Response ◽  
Bed Elevation ◽  
Flow Response ◽  
Head Of Bed Elevation

scholarly journals Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clara Gregori-Pla ◽  
Rickson C. Mesquita ◽  
Christopher G. Favilla ◽  
David R. Busch ◽  
Igor Blanco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Autoregulation ◽  
Cerebrovascular Disorders ◽  
Blood Flow Response ◽  
Flow Response ◽  
Ica Stenosis

Abstract Background The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Methods Transcranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol. Results After elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p < 0.001) or ICA stenosis (8.6% [3.1,14.0], p = 0.003)). MAP in AIS patients did not return to baseline values (2.6 mmHg [0.5, 4.7], p = 0.018), but in ICA stenosis patients and controls did. Instead ipsilesional but not contralesional CBF was correlated with MAP (AIS 6.0%/mmHg [− 2.4,14.3], p = 0.038; ICA stenosis 11.0%/mmHg [2.4,19.5], p < 0.001). Conclusions The observed associations between ipsilateral CBF and MAP suggest that short HOB position changes may elicit deficits in cerebral autoregulation in cerebrovascular disorders. Additional research is required to further characterize this phenomenon.

scholarly journals Cerebral Blood Flow Response During Bolus Normal Saline Infusion After Ischemic Stroke

2019 ◽  
Vol 28 (11) ◽  
pp. 104294
Author(s):  
Michael T. Mullen ◽  
Ashwin B. Parthasarathy ◽  
Ali Zandieh ◽  
Wesley B. Baker ◽  
Rickson C. Mesquita ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Normal Saline ◽  
Saline Infusion ◽  
Blood Flow Response ◽  
Flow Response

Effect of caffeine on theophyliine on cerebral blood flow response to brain activation: In vitro and in vivo studies

2005 ◽  
Vol 25 (1_suppl) ◽  
pp. S198-S198
Author(s):  
Joseph R Meno ◽  
Thien-son K Nguyen ◽  
Elise M Jensen ◽  
G Alexander West ◽  
Leonid Groysman ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Activation ◽  
In Vivo Studies ◽  
Blood Flow Response ◽  
Flow Response

scholarly journals Hypoxia and Hypotension Transform the Blood Flow Response to Cortical Spreading Depression from Hyperemia into Hypoperfusion in the Rat

2008 ◽  
Vol 28 (7) ◽  
pp. 1369-1376 ◽  
Author(s):  
Inna Sukhotinsky ◽  
Ergin Dilekoz ◽  
Michael A Moskowitz ◽  
Cenk Ayata
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cortical Spreading Depression ◽  
Spreading Depression ◽  
Ischemic Penumbra ◽  
Doppler Flowmetry ◽  
Blood Flow Response ◽  
Flow Response ◽  
Normal Rat ◽  
Cortex Cérébral

Cortical spreading depression (CSD) evokes a large cerebral blood flow (CBF) increase in normal rat brain. In contrast, in focal ischemic penumbra, CSD-like periinfarct depolarizations (PID) are mainly associated with hypoperfusion. Because PIDs electrophysiologically closely resemble CSD, we tested whether conditions present in ischemic penumbra, such as tissue hypoxia or reduced perfusion pressure, transform the CSD-induced CBF response in nonischemic rat cortex. Cerebral blood flow changes were recorded using laser Doppler flowmetry in rats subjected to hypoxia, hypotension, or both. Under normoxic normotensive conditions, CSD caused a characteristic transient CBF increase (74 ± 7%) occasionally preceded by a small hypoperfusion (−4 ± 2%). Both hypoxia ( pO2 45 ± 3 mm Hg) and hypotension (blood pressure 42 ± 2 mm Hg) independently augmented this initial hypoperfusion (−14 ± 2% normoxic hypotension; −16 ± 6% hypoxic normotension; −21 ± 5% hypoxic hypotension) and diminished the magnitude of hyperemia (44 ± 10% normoxic hypotension; 43 ± 9% hypoxic normotension; 27 ± 6% hypoxic hypotension). Hypotension and, to a much lesser extent, hypoxia increased the duration of hypoperfusion and the DC shift, whereas CSD amplitude remained unchanged. These results suggest that hypoxia and/or hypotension unmask a vasoconstrictive response during CSD in the rat such that, under nonphysiologic conditions (i.e., mimicking ischemic penumbra), the hyperemic response to CSD becomes attenuated resembling the blood flow response during PIDs.

Regional heterogeneity of cerebral blood flow response to graded volume-controlled hemorrhage

1996 ◽  
Vol 22 (10) ◽  
pp. 1026-1033 ◽  
Author(s):  
K. F. Waschke ◽  
M. Riedel ◽  
D. M. Albrecht ◽  
K. van Ackern ◽  
W. Kuschinsky
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Regional Heterogeneity ◽  
Blood Flow Response ◽  
Flow Response ◽  
Volume Controlled
Sign in / Sign up

Export Citation Format

Share Document