Objective duplex ultrasound evaluation of the extracranial circulation in multiple sclerosis patients undergoing venoplasty of internal jugular vein stenoses: A pilot study

2013 ◽  
Vol 30 (2) ◽  
pp. 98-104 ◽  
Author(s):  
P Thibault ◽  
W Lewis ◽  
S Niblett
Keyword(s):  
Multiple Sclerosis ◽  
Blood Flow ◽  
Cerebral Perfusion ◽  
Objective Assessment ◽  
Duplex Ultrasound ◽  
Additional Parameter ◽  
Non Invasive ◽  
Venous Circulation ◽  
Ultrasound Evaluation ◽  
Multiple Sclerosis Patients

Objective Chronic cerebrospinal venous insufficiency (CCSVI) is a condition associated with multiple sclerosis (MS) and manifested by stenoses in the extracranial venous circulation. There is a need for an objective non-invasive assessment of CCSVI that is able to accurately identify the location of stenoses and quantify physiological changes in blood flows following treatment. Method A duplex ultrasound method, extracranial duplex ultrasound (ECDU), is described where the internal jugular veins (IJVs) and vertebral veins (VVs) were examined in the supine and sitting position before and after venoplasty in eight patients with clinically diagnosed MS. High-resolution B-mode imaging was used to detect obvious stenoses, intra-luminal membranes, valve abnormalities and vein wall thickening. ECDU was then used to assess blood flow including reflux. To assess obstruction, venous blood volume flows (BVFs) were taken bilaterally from the proximal (J1), mid (J2) and distal (J3) segments of the IJVs and the mid cervical VVs. To assess cerebral perfusion, bilateral BVF measurements were taken, in the supine position only, from the proximal internal carotid arteries (ICA) and mid cervical vertebral arteries (VA). The global arterial cerebral blood flow (GACBF) was then calculated as the sum of the ICA and VA measurements. Results Pre-venography ECDU detected IJV stenoses or obstruction in all patients. Venography findings were consistent with those of the pre-treatment ECDU with the exception of the detection of bilateral IJV stenoses in two patients diagnosed with unilateral IJV stenosis by ECDU. A significant improvement in GACBF was evident following venoplasty ( p < 0.05). A trend to improvement in the post-treatment BVFs of both the IJVs and the mid cervical VVs was also observed. This improvement was most marked in the left VVs ( p = 0.052) and the J2 segment of right IJVs ( p < 0.05). Conclusion The ECDU examination described provides a reliable objective assessment of IJV and VV stenoses and, with the use of BVFs, can quantify the degree of obstruction. These results support the use of ECDU as a non-invasive post-operative assessment of the success of venoplasty. The ability of ECDU to measure GACBF provides an additional parameter to monitor vascular pathophysiology in MS patients. The current findings support the view that the early symptomatic benefits observed after venoplasty for stenoses in the extracranial venous circulation may be the result of increased cerebral perfusion.

scholarly journals Multiple Sclerosis - A Vascular Etiology?

2010 ◽  
Vol 37 (6) ◽  
pp. 745-757 ◽  
Author(s):  
Bryce Weir
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Clinical Improvement ◽  
Biological Plausibility ◽  
Venous Flow ◽  
Non Invasive ◽  
Venous Circulation ◽  
Venous Valves ◽  
Multiple Sclerosis Patients

AbstractFrom the earliest pathological studies the perivenular localization of the demyelination in multiple sclerosis (MS) has been observed. It has recently been suggested that obstructions to venous flow or inadequate venous valves in the great veins in the neck, thorax and abdomen can cause damaging backflow into the cerebral and spinal cord circulations. Paolo Zamboni and colleagues have demonstrated abnormal venous circulation in some multiple sclerosis patients using non-invasive sonography and invasive venography. Furthermore, they have obtained apparent clinical improvement or stabilization by endovascular ballooning of points of obstruction in the great veins in some, at least temporarily. If non-invasive observations by others validate their initial observations of a significantly increased prevalence of venous obstructions in MS then trials of angioplasty/stenting would be justified in selected cases in view of the biological plausibility of the concept.

Abstract WP432: Non-invasive Respiratory Impedance Enhances Cerebral Perfusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Christopher G Favilla ◽  
Ashwin B Parthasarathy ◽  
John A Detre ◽  
Michael T Mullen ◽  
Scott E Kasner ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Flow Velocity ◽  
Cerebral Perfusion ◽  
Respiratory Impedance ◽  
Mean Flow ◽  
Non Invasive ◽  
End Tidal ◽  
High Level ◽  
Mean Flow Velocity

Background: Optimization of cerebral blood flow is the cornerstone of clinical management in a number of neurologic diseases, most notably ischemic stroke. Intra-thoracic pressure influences cardiac output and has the potential to impact cerebral blood flow (CBF). Here we aim to quantify cerebral hemodynamic changes in response to increased respiratory impedance using a non-invasive respiratory device. Methods: Cerebral perfusion was measured under varying levels of respiratory impedance (6cm H 2 0, 9cm H 2 0, and 12 cm H 2 0) in 20 healthy volunteers. Simultaneous measurements of microvascular CBF and middle cerebral artery mean flow velocity (MFV), respectively, were performed with optical diffuse correlation spectroscopy (DCS) and transcranial Doppler ultrasound (TCD). Results: At the high level of respiratory impedance, mean flow velocity increased by 6.4% compared to baseline (p=0.004), but changes in cortical CBF were smaller and non-significant (Figure). Heart rate, cardiac output, respiratory rate, and end tidal CO 2 remained stable during all levels of respiratory impedance. There was small increase in mean arterial blood pressure, 1.7% (p=0.006), at the high level of respiratory impedance. In a multivariable linear regression model accounting for end tidal CO 2 and individual variability, respiratory impedance was associated with increases in both mean flow velocity (coefficient: 0.49, p<0.001) and cortical CBF (coefficient: 0.13, p<0.001). Conclusions: Manipulating intrathoracic pressure via non-invasive respiratory impedance was well tolerated and produced a small but measurable increase in cerebral perfusion in healthy individuals. Future studies in acute ischemic stroke patients with impaired cerebral autoregulation is warranted in order to assess whether respiratory impedance is feasible as a novel non-invasive therapy for stroke.

scholarly journals Non-invasive evaluation of cerebral hemodynamic and intracranial pressure in pediatric neuroinfections

2018 ◽  
Vol 9 (4) ◽  
pp. 485-490
Author(s):  
М. А. Georgiynts ◽  
V. А. Коrsunov ◽  
О. М. Оlkhovska ◽  
К. E. Stoliarov
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Output ◽  
Intensive Care ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Flow Index ◽  
Non Invasive ◽  
Group I ◽  
Group Ii

The study of intracranial pressure (eICP), cerebral perfusion pressure (eCPP), cerebral blood flow index (CFI), zero flow pressure (ZFP) in 49 children hospitalized in the intensive care unit with severe course of neuroinfections was carried out. The level of consciousness was determined by the Glasgow pediatric scale. Monitoring of central and peripheral hemodynamics (ECG, heart rate, systolic, diastolic and mean blood pressure, and cardiac output), pulse oximetry, capnography, hemoglobin, hematocrit, total protein, urea, creatinine, lactate, glucose and serum electrolytes was done. An ultrasound scanner was used to perform ultrasound duplex scanning of blood flow in the left and middle cerebral artery (MCA), measuring maximum, minimum and average blood flow velocities, pulsation index (PI), and resistance index (RI). Based on the formulae of Edouard et al. indicators of eCPP, ZFP, CFI, eICP were calculated. The eSCP was also determined by the formulae of Kligenchöfer et al. and Bellner et al. All patients were divided into group I with RI > 1.3 and group II with RI < 1.3. It was found that eCPP in the group I was significantly less (29.5 ± 1.3 mm Hg) than in the II group (41.6 ± 1.7 mm Hg). Despite the lack of a reliable difference in blood pressure between groups I and II, the difference in eCPP was found due to a significant difference in eICP 34.6 ± 1.4 and 27.6 ± 0.89 mm Hg in I and II groups respectively. ZFP in group I was significantly higher than in group II. The indexes of the Glasgow coma scale was significantly lower in group I and 7.8 ± 0.6 points. There were observed direct moderate correlations between systolic blood pressure, cardiac output and eSRP and CFI, presumably associated with a loss of autoregulation. CFI in the group I was lower than in the group II. Thus, non-invasive examination of cerebral flow in MCA by duplex sonography revealed that PI > 1.3 is an informative marker of intracranial hypertension and reduction of cerebral perfusion, which is common in children with neuroinfections. To determine the eSRP and CFI it is advisable to use the formula of Edouard et al. and to determine the eICP the formula of Kligenchöfer et al. The obtained data can be useful for objectifying the severity of the condition, predicting the outcomes of neuroinfections, choosing the directions of intensive care and evaluating its effectiveness.

scholarly journals Internal Jugular Vein Blood Flow in Multiple Sclerosis Patients and Matched Controls

PLoS ONE ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. e92730 ◽  
Author(s):  
Marcello Mancini ◽  
Roberta Lanzillo ◽  
Raffaele Liuzzi ◽  
Orlando Di Donato ◽  
Monica Ragucci ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Blood Flow ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Multiple Sclerosis Patients

Cerebral arterial and venous blood flow in adolescent multiple sclerosis patients and age-matched controls using phase contrast MRI

2013 ◽  
Vol 40 (2) ◽  
pp. 341-347 ◽  
Author(s):  
Christopher K. Macgowan ◽  
Katherine Y. Chan ◽  
Suzanne Laughlin ◽  
Ruth Ann Marrie ◽  
Brenda Banwell
Keyword(s):  
Multiple Sclerosis ◽  
Blood Flow ◽  
Phase Contrast ◽  
Venous Blood ◽  
Venous Blood Flow ◽  
Phase Contrast Mri ◽  
Multiple Sclerosis Patients

scholarly journals Assessment of the optic nerve and its arterial supply by ultrasound imaging in multiple sclerosis patients

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Manal Mahmoud Al Kattan ◽  
Amira Ahmed Labib ◽  
Rania Shehata Ismail ◽  
Alshaimaa M. Aboul fotouh ◽  
Emad El Din Mostafa Mohammed
Keyword(s):  
Multiple Sclerosis ◽  
Blood Flow ◽  
Optic Nerve ◽  
Assessment Tool ◽  
Arterial Supply ◽  
Healthy Controls ◽  
Mean Velocity ◽  
Blood Flow Velocities ◽  
Multiple Sclerosis Patients ◽  
Flow Velocities

Abstract Background Transorbital sonography (TOS) has emerged as a promising assessment tool of the optic nerve and orbital arterial supply in multiple sclerosis (MS) patients. Objective To evaluate optic nerve diameter (OND), optic nerve sheath diameter (ONSD), and orbital hemodynamics using TOS in MS patients. Methods Forty MS patients and 28 matched healthy controls were included. Thirty-three eyes with previous optic neuritis (ON) and 47 eyes without previous ON of MS patients were examined. All subjects were submitted to assessment of OND, ONSD, and parameters of orbital hemodynamics using orbital ultrasound. Results OND and ONSD were smaller in MS eyes with previous ON than in controls. MS eyes with and without previous ON had statistically significant higher peak systolic and mean velocity of posterior ciliary arteries than the control eyes. Orbital blood flow velocities were negatively correlated with the duration of disease and Expanded Disability Status Scale (EDSS). A statistically significant decrease in blood flow velocities of the central retinal artery was detected in secondary progressive MS (SPMS) patients than in relapsing-remitting MS patients (RRMS). Conclusion TOS can be used as a feasible tool to detect optic atrophy in MS patients. MS patients may have abnormal retrobulbar hemodynamics compared to healthy controls.

scholarly journals Cerebral blood flow modulation insufficiency in brain networks in multiple sclerosis: A hypercapnia MRI study

2016 ◽  
Vol 36 (12) ◽  
pp. 2087-2095 ◽  
Author(s):  
Olga Marshall ◽  
Sanjeev Chawla ◽  
Hanzhang Lu ◽  
Louise Pape ◽  
Yulin Ge
Keyword(s):  
Multiple Sclerosis ◽  
Carbon Dioxide ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Networks ◽  
Cerebrovascular Reactivity ◽  
Functional Networks ◽  
Attention Networks ◽  
Default Mode ◽  
Multiple Sclerosis Patients

Cerebrovascular reactivity measures vascular regulation of cerebral blood flow and is responsible for maintaining healthy neurovascular coupling. Multiple sclerosis exhibits progressive neurodegeneration and global cerebrovascular reactivity deficits. This study investigates varied degrees of cerebrovascular reactivity impairment in different brain networks, which may be an underlying cause for functional changes in the brain, affecting long-distance projection integrity and cognitive function; 28 multiple sclerosis and 28 control subjects underwent pseudocontinuous arterial spin labeling perfusion MRI to measure cerebral blood flow under normocapnia (room air) and hypercapnia (5% carbon dioxide gas mixture) breathing. Cerebrovascular reactivity, measured as normocapnic to hypercapnic cerebral blood flow percent increase normalized by end-tidal carbon dioxide change, was determined from seven functional networks (default mode, frontoparietal, somatomotor, visual, limbic, dorsal, and ventral attention networks). Group analysis showed significantly decreased cerebrovascular reactivity in patients compared to controls within the default mode, frontoparietal, somatomotor, and ventral attention networks after multiple comparison correction. Regression analysis showed a significant correlation of cerebrovascular reactivity with lesion load in the default mode and ventral attention networks and with gray matter atrophy in the default mode network. Functional networks in multiple sclerosis patients exhibit varied amounts of cerebrovascular reactivity deficits. Such blood flow regulation abnormalities may contribute to functional communication disruption in multiple sclerosis.

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