Abstract TP115: Cerebral Hemodynamic Changes in Military Personnel With Long-term Effects of Concussions

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alexander Razumovsky ◽  
Melissa Rampino ◽  
Efim Kouperberg ◽  
Donna M Neuges ◽  
Thomas J DeGraba ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Head Injuries ◽  
Vascular Wall ◽  
Cerebral Hemodynamics ◽  
Long Term Effects ◽  
Luminal Narrowing ◽  
Lumen Narrowing ◽  
Blood Flow Velocities

Service members (SMs) suffer from repeated exposure to concussions or mild TBI, which can disrupt cerebral blood flow. This effect is seen in the acute phase of TBI, but the development of vascular wall abnormalities, which can lead to luminal narrowing and abnormally elevated cerebral blood flow velocities (CBFV), has not been studied in the post concussive phase. The purpose of this study was to evaluate the transcranial Doppler (TCD) determined incidence of abnormal cerebral hemodynamics in patients with long-term effects of mTBI. Material and Methods: TCD recordings of mean CBFV in cm/sec and Pulsatility Indices (PI) were recorded from 431 SMs (9 females; ages 24-54, mean age 39.2 ± 6.4 years) who were admitted to the National Intrepid Center of Excellence 4-week Interdisciplinary Outpatient Program. TCD data were analyzed to determine whether SMs exhibited abnormal CBFV s in the middle cerebral artery, internal carotid artery (ICA), and basilar artery. All subjects consented to protocol #362504 prior to any data collection or analysis. Two standard deviation from the mean CBFV in any direction labeled as an abnormal and PI was assumed normal with values between 0.7 and 0.9 Patients with one or more vessels with abnormal CBFV’s and PI’s were labeled as abnormal. Results: Average time since last TBI was 5.1 ± 3.4 years. We observed abnormal CBFV values in 33% of SMs. 149 (35%) and 48 (11%) demonstrated abnormally high CBFV and PIs in one or more vessels, respectively. Abnormal CBFV was observed most frequently in the ICA (48%). Majority of studied patients had patchy pattern of abnormal data presented in one or few vessels. The presence of abnormal cerebral hemodynamics was inversely related to the time since the last mTBI exposure: the likelihood of abnormal CBFV values deceased with increasing time since last head injury was sustained but was still present. Conclusions: Our data reveal that a large proportion of SMs have elevated CBFVs following mTBI exposure in many years after last mTBI. We believe that head injuries due to combat and training blast and blunt force trauma exposure cause early atherosclerotic or fibrotic changes in the large vessel walls of the Circle of Willis, which results in vascular lumen narrowing and increased CBFV’s.

Abstract 224: Cerebral Hemodynamic Changes in Patients With Long-term Effects of War-time TBI

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Alexander Razumovsky ◽  
Ephim Kouperberg ◽  
Thomas DeGraba ◽  
Donna Neuges
Keyword(s):  
Medical Center ◽  
Demographic Data ◽  
Cerebral Hemodynamics ◽  
Long Term Effects ◽  
Outpatient Program ◽  
Data Collection And Analysis ◽  
Blood Flow Velocities ◽  
Family Based ◽  
Effects Of War

Many patients with mild TBI (mTBI) will have post-concussive syndrome and the evaluation of post-concussive symptoms requires an understanding of the multiple factors relevant to the production and maintenance of symptoms following TBI. The purpose of this study was to evaluate the transcranial Doppler (TCD) determined incidence of abnormal cerebral hemodynamics in patients with long-term effects of wartime mTBI. Material and Methods: The National Intrepid Center of Excellence (NiCoE) at the Walter Reed National Military Medical Center has advanced a 4-week intensive outpatient program that leverages an interdisciplinary holistic patient and family based approach to evaluate and treat service members (SMs) with unremitting symptoms from combat related mTBI. A retrospective review of TCD studies was performed on 174 SMs (4 females) admitted to the NiCoE with post-concussive headaches (mean 38.5± 6.9 years, range 24 to 52). Demographic data was collected by patient self-reports at time of TCD examinations. The average time after last mTBI was 4.6 ± 3.7 years and there were 151 (87%) and 23 (13%) patients with multiple and single mTBI, respectively. All subjects were consented to Protocol #362504 prior to any data collection and analysis. TCD recordings of mean cerebral blood flow velocities (CBFV in cm/sec) and Pulsatility Indices (PI) were recorded. Comprehensive TCD protocol was applied in all cases. Results: In our cohort there were 46 (26%) with normal cerebral hemodynamics and 128 (74%) patients with abnormal cerebral hemodynamics. 31(18%) and 28 (16%) demonstrated abnormally high CBFV and PIs in one or more vessels, respectively. Abnormally low CBFV’s and PI’s were in one or more vessels observed in 20 (11.5%) and 75 (43%) of patients, respectively. Majority of studied patients had patchy pattern of abnormal data presented in one or few vessels. There were only 2 (1%) and one (0.5%) patients with abnormally high CBFV’s and PI’s present in all studied vessels. Conclusion: These findings demonstrate that cerebral hemodynamics disturbances are frequent findings in the majority of patients with long-term effects of combat mTBI, therefore utilization of TCD examination is recommended for their recognition and subsequent management.

Interleukin-1β and adverse effects on cerebral blood flow during long-term global hypoperfusion

2003 ◽  
Vol 99 (5) ◽  
pp. 907-912 ◽  
Author(s):  
Cormac O. Maher ◽  
Robert E. Anderson ◽  
Heidi S. Martin ◽  
Robyn L. McClelland ◽  
Fredric B. Meyer
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Proinflammatory Cytokine ◽  
Cerebral Hypoperfusion ◽  
Sprague Dawley ◽  
Long Term Effects ◽  
Content Type ◽  
Long Term Treatment ◽  
Fine Print

Object. The effects of interleukin (IL)-1β on the cerebral vasculature are complex and incompletely understood. Many pathophysiological states in which inflammatory cascades have been implicated also have varying degrees of cerebral hypoperfusion. The purpose of this investigation was to examine the long-term effects of this proinflammatory cytokine and its antagonist on cerebral blood flow (CBF) following global cerebral hypoperfusion. Methods. Sprague—Dawley rats were randomly assigned to 12 groups and given continuous intracerebroventricular (ICV) infusions of IL-1β, the IL-1 receptor antagonist (IL-1ra), or saline vehicle (control). Global cerebral hypoperfusion was produced by occlusion of both carotid arteries and one vertebral artery. Cerebral blood flow was measured at baseline and again after initiation of the infusions by performing a 133Xe clearance study. Prolonged ICV administration of IL-1β resulted in a significant decrease in CBF compared with that in controls. Prolonged administration of the antagonist IL-1ra resulted in significant increases in CBF compared with that in both IL-1β—treated animals and controls. Conclusions. This experiment demonstrates that long-term treatment with the proinflammatory cytokine IL-1β adversely affects CBF.

102. Long-term effects of ECT on cerebral blood flow in antidepressant resistant severe depression in late life

1998 ◽  
Vol 43 (8) ◽  
pp. S31
Author(s):  
M. Konno ◽  
S. Awata ◽  
S. Haowei ◽  
R. Kawashima ◽  
H. Fukuda ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Severe Depression ◽  
Late Life ◽  
Long Term Effects

Patterns of Cerebral Blood Flow and Systemic Hemodynamics During Arithmetic Processing

2008 ◽  
Vol 22 (2) ◽  
pp. 81-90 ◽  
Author(s):  
Natalie Werner ◽  
Neval Kapan ◽  
Gustavo A. Reyes del Paso
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Time Course ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Systemic Hemodynamics ◽  
Heart Period ◽  
Blood Flow Velocities ◽  
Flow Velocities

The present study explored modulations in cerebral blood flow and systemic hemodynamics during the execution of a mental calculation task in 41 healthy subjects. Time course and lateralization of blood flow velocities in the medial cerebral arteries of both hemispheres were assessed using functional transcranial Doppler sonography. Indices of systemic hemodynamics were obtained using continuous blood pressure recordings. Doppler sonography revealed a biphasic left dominant rise in cerebral blood flow velocities during task execution. Systemic blood pressure increased, whereas heart period, heart period variability, and baroreflex sensitivity declined. Blood pressure and heart period proved predictive of the magnitude of the cerebral blood flow response, particularly of its initial component. Various physiological mechanisms may be assumed to be involved in cardiovascular adjustment to cognitive demands. While specific contributions of the sympathetic and parasympathetic systems may account for the observed pattern of systemic hemodynamics, flow metabolism coupling, fast neurogenic vasodilation, and cerebral autoregulation may be involved in mediating cerebral blood flow modulations. Furthermore, during conditions of high cardiovascular reactivity, systemic hemodynamic changes exert a marked influence on cerebral blood perfusion.

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