scholarly journals Cerebral Hemodynamic Evaluation of Main Cerebral Vessels in Epileptic Patients Based on Transcranial Doppler

2021 ◽  
Vol 12 ◽  
Author(s):  
Jihong Meng ◽  
Chun Li ◽  
Weining Ma
Keyword(s):  
Flow Velocity ◽  
Transcranial Doppler ◽  
Statistical Significance ◽  
Cerebral Vessels ◽  
Epileptogenic Zone ◽  
Mean Flow ◽  
Epileptic Patients ◽  
Interictal Eeg ◽  
Patients With Epilepsy ◽  
Interictal Discharge

Objective: To study whether there is a difference in peak and mean blood flow velocity between the left and right major cerebral vessels in patients with epilepsy.Methods: Sixteen patients with epilepsy underwent FDG18-PET-CT (PET) scan and electroencephalogram (EEG) examinations. Transcranial Doppler (TCD) was used to detect the peak flow velocity (PFV), mean flow velocity (MFV), and other hemodynamic indicators of bilateral anterior, middle, and posterior cerebral arteries in each patient. According to different patterns of the PET or interictal EEG, the differences in PFV, and MFV of corresponding vessels on both sides under different patterns were compared.Results: According to the PET of the low-metabolism region corresponding to the supplying artery, the PFV and MFV of the supplying artery in the low-metabolism region were lower than the value of the corresponding contralateral vessel. The PFV and MFV on the low metabolic side of PET were lower than that of the corresponding vessels on the opposite side. The PFV and MFV on the discharge side of interictal EEG were also lower than the PFV and MFV of the corresponding vessels on the opposite side. The MFV of posterior cerebral artery on the low metabolic side of PET or the interictal discharge side was significantly different from that of the contralateral vessels (P < 0.05). However, the other aforementioned differences in PFV and MFV did not achieve statistical significance.Conclusion: In epileptic patients, the PFV and MFV of main cerebral vessels on the PET hypometabolized side or the interictal discharge side was lower than that of corresponding vessels on the contralateral side. To some extent, the difference in the MFV of PCA between the bilateral sides can facilitate the lateral diagnosis of the epileptogenic zone.

Dynamic variation of the axillary veins due to intrathoracic pressure changes: A prospective sonographic study

2019 ◽  
Vol 21 (1) ◽  
pp. 66-72
Author(s):  
Boris Tufegdzic ◽  
Andrey Khozenko ◽  
Terrence Lee St John ◽  
Timothy R Spencer ◽  
Massimo Lamperti
Keyword(s):  
Mechanical Ventilation ◽  
Flow Velocity ◽  
Central Venous Catheterization ◽  
Elective Surgery ◽  
Statistical Significance ◽  
Axillary Vein ◽  
Mean Flow ◽  
Central Venous ◽  
Dynamic Variation ◽  
Venous Catheterization

Introduction: The ultrasound-guided axillary vein is becoming a compulsory alternative vessel for central venous catheterization and the anatomical position offers several potential advantages over blind, subclavian vein techniques. Objective: To determine the degree of dynamic variation of the axillary vein size measured by ultrasound prior to the induction of general anesthesia and after starting controlled mechanical ventilation. Design: Prospective, observational study. Methods: One hundred ten patients undergoing elective surgery were enrolled and classified according to sex, age, and body mass index. Two-dimensional cross-sectional vein diameter, area, and mean flow velocity were performed using ultrasound on both the left and right axillary veins of each subject before and after induction of anesthesia. Results: There was statistically significant evidence showing that the axillary vein area increases when patients are mechanically ventilated. When considering venous flow velocity as a primary outcome, velocity decreased after patients moved from spontaneous to mechanical ventilation (coefficient = −0.267), but this relationship failed to achieve statistical significance ( t = –1.355, p = 0.179). Conclusions: Anatomical variations in depth and diameter as well as the collapsibility due to intrathoracic pressures changes represent common challenges that face clinicians during central venous catheterization of the axillary vein. A noteworthy increase in vessel size as patients transition from spontaneous to mechanical ventilation may theoretically improve first-pass cannulation success with practitioners skilled in both ultrasound and procedure. As a result, placing a centrally inserted central catheter after the induction of anesthesia may be beneficial.

scholarly journals Hemodynamic correlates of transient cognitive impairment after transient ischemic attack and minor stroke: A transcranial Doppler study

2016 ◽  
Vol 11 (9) ◽  
pp. 978-986 ◽  
Author(s):  
Sara Mazzucco ◽  
Linxin Li ◽  
Maria A Tuna ◽  
Sarah T Pendlebury ◽  
Rose Wharton ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Flow Velocity ◽  
Transient Ischemic Attack ◽  
Transcranial Doppler ◽  
Minor Stroke ◽  
Mean Flow ◽  
Hemodynamic Changes ◽  
Diastolic Velocity ◽  
Ischemic Attack ◽  
Mean Flow Velocity

Background and aims Transient cognitive impairment (TCI) on the Mini Mental State Evaluation score is common after transient ischemic attack/minor stroke and might identify patients at increased risk of dementia. We aimed to replicate TCI using the Montreal Cognitive Assessment (MoCA), compare it with persistent Mild Cognitive Impairment (PMCI), and to determine whether global cerebral hemodynamic changes could explain transient impairment. Methods Consecutive patients with transient ischemic attack/minor stroke (NIHSS ≤ 3) were assessed with the MoCA and transcranial Doppler ultrasound acutely and at 1 month. We compared patients with TCI (baseline MoCA < 26 with ≥ 2 points increase at 1 month), PMCI (MoCA < 26 with < 2 points increase), and no cognitive impairment (NCI; MoCA ≥ 26). Results Of 326 patients, 46 (14.1%) had PMCI, 98 (30.1%) TCI, and 182 (55.8%) NCI. At baseline, TCI patients had higher systolic blood pressure (150.95 ± 21.52 vs 144.86 ± 22.44 mmHg, p = 0.02) and lower cerebral blood flow velocities, particularly end-diastolic velocity (30.16 ± 9.63 vs 35.02 ± 9.01 cm/s, p < 0.001) and mean flow velocity (48.95 ± 12.72 vs 54 ± 12.46 cm/s, p = 0.001) than those with NCI, but similar clinical and hemodynamic profiles to those with PMCI. Systolic BP fell between baseline and 1 month (mean reduction = 14.01 ± 21.26 mmHg) and end-diastolic velocity and mean flow velocity increased (mean increase = + 2.42 ± 6.41 and 1.89 ± 8.77 cm/s, respectively), but these changes did not differ between patients with TCI, PMCI, and NCI. Conclusions TCI is detectable with the MoCA after transient ischemic attack and minor stroke and has similar clinical and hemodynamic profile to PMCI. However, TCI does not appear to be due to exaggerated acute reversible global hemodynamic changes.

The Relevance of Anatomic and Hemodynamic Factors to a Classification of Cerebral Arteriovenous Malformations

Neurosurgery ◽  
1991 ◽  
Vol 28 (3) ◽  
pp. 370-379 ◽  
Author(s):  
Alberto Pasqualin ◽  
Giovanni Barone ◽  
Fabrizia Cioffi ◽  
Luisa Rosta ◽  
Renato Scienza ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Arteriovenous Malformations ◽  
Drainage System ◽  
Morbidity And Mortality ◽  
Mean Flow ◽  
Cerebral Arteriovenous Malformations ◽  
Permanent Morbidity

Abstract Potential prognostic anatomic and hemodynamic factors were evaluated in 248 patients with cerebral arteriovenous malformations (AVMs), all treated by direct microsurgical removal. The size of each AVM was calculated by its volume, obtained by the multiplication of the three AVM diameters by 0.52. A surgical classification of AVM location (in 11 groups) is proposed. Types of feeders and of drainage were classified as superficial or deep; the extent of the drainage system was classified according to a four-degree scale. The mean flow velocity in the main AVM feeder, detected using transcranial Doppler ultrasonography, was used as an indirect measure of AVM shunt flow in a small number of patients (n = 29). AVM volume was a very important prognostic factor: the incidence of hyperemic complications and the morbidity and mortality rate were significantly higher when the volume of the lesion was &gt;20 cm3 (P&lt; 0.0001 for hyperemic complications; P &lt; 0.001 for permanent morbidity and mortality). The incidence of hyperemic complications and the morbidity rate were higher in AVMs in rolandic, inferior limbic, and insular locations than in AVMs in other locations. As for other anatomic factors: a) the presence of deep feeders significantly increased the incidence of hyperemic complications, as well as the morbidity and mortality rate; b) the presence of deep drainage significantly increased permanent morbidity only; c) the extension of the venous system was significantly related to the development of hyperemic complications, and to morbidity and mortality. Transcranial Doppler examination showed that mean flow velocities &gt;120 cm/s in the main feeder were associated with a significantly higher rate of postoperative hematomas and transient deficits. A classification of cerebral AVMs that takes into account AVM volume and location, the type of feeders, the extent of the drainage system, and the main feeder flow velocity is suggested.

scholarly journals Beta-blocker therapy and impact on outcome after aneurysmal subarachnoid hemorrhage: a cohort study

2016 ◽  
Vol 125 (3) ◽  
pp. 730-736 ◽  
Author(s):  
Nohra Chalouhi ◽  
Badih Daou ◽  
Toshimasa Okabe ◽  
Robert M. Starke ◽  
Richard Dalyai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Cardiac Dysfunction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Left Ventricular Ejection ◽  
Mean Flow ◽  
Mean Flow Velocity

OBJECTIVE Cerebral vasospasm (cVSP) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), with a significant impact on outcome. Beta blockers (BBs) may blunt the sympathetic effect and catecholamine surge associated with ruptured cerebral aneurysms and prevent cardiac dysfunction. The purpose of this study was to investigate the association between preadmission BB therapy and cVSP, cardiac dysfunction, and in-hospital mortality following aSAH. METHODS This was a retrospective cohort study of patients with aSAH who were treated at a tertiary high-volume neurovascular referral center. The exposure was defined as any preadmission BB therapy. The primary outcome was cVSP assessed by serial transcranial Doppler with any mean flow velocity ≥ 120 cm/sec and/or need for endovascular intervention for medically refractory cVSP. Secondary outcomes were cardiac dysfunction (defined as cardiac troponin-I elevation > 0.05 μg/L, low left ventricular ejection fraction [LVEF] < 40%, or LV wall motion abnormalities [LVWMA]) and in-hospital mortality. RESULTS The cohort consisted of 210 patients treated between February 2009 and September 2010 (55% were women), with a mean age of 53.4 ± 13 years and median Hunt and Hess Grade III (interquartile range III–IV). Only 13% (27/210) of patients were exposed to preadmission BB therapy. Compared with these patients, a higher percentage of patients not exposed to preadmission BBs had transcranial Doppler-mean flow velocity ≥ 120 cm/sec (59% vs 22%; p = 0.003). In multivariate analyses, lower Hunt and Hess grade (OR 3.9; p < 0.001) and preadmission BBs (OR 4.5; p = 0.002) were negatively associated with cVSP. In multivariate analysis, LVWMA (OR 2.7; p = 0.002) and low LVEF (OR 1.1; p = 0.05) were independent predictors of in-hospital mortality. Low LVEF (OR 3.9; p = 0.05) independently predicted medically refractory cVSP. The in-hospital mortality rate was higher in patients with LVWMA (47.4% vs 14.8%; p < 0.001). CONCLUSIONS The study data suggest that preadmission therapy with BBs is associated with lower incidence of cVSP after aSAH. LV dysfunction was associated with higher medically refractory cVSP and in-hospital mortality. BB therapy may be considered after aSAH as a cardioprotective and cVSP preventive therapy.

Transcranial Doppler Evaluation of Cerebral Hemodynamics in Migraineurs During Prophylactic Treatment with Flunarizine

Cephalalgia ◽  
1999 ◽  
Vol 19 (5) ◽  
pp. 492-496 ◽  
Author(s):  
G Fiermonte ◽  
A Annulli ◽  
F Pierelli
Keyword(s):  
Flow Velocity ◽  
Transcranial Doppler ◽  
Prophylactic Treatment ◽  
Cerebral Hemodynamics ◽  
Cerebrovascular Reactivity ◽  
Reactivity Index ◽  
Breath Holding ◽  
Mean Flow ◽  
The Mean ◽  
Doppler Evaluation

Transcranial Doppler (TCD) recording was used to evaluate the mean flow velocity (MFV) and cerebrovascular reactivity to CO2 in 21 migraineurs during the interictal phase. Nine were affected by migraine with aura (MwA) and 12 by migraine without aura (MwoA). During each session the middle cerebral artery (MCA) flow velocity was examined in basal conditions, in hypocapnia after a 3-min period of hyperventilation, in basal conditions a second time, and in hypercapnia after breath-holding. The same procedure was followed in a group of 21 age-and sex-matched volunteers. Recordings were performed before (T1), during (T2), and after (T3) prophylactic treatment with flunarizine (10 mg/day for 2 months) to assess the possible effect of this drug on cerebral hemodynamics. In basal condition, increased MFV values were found in both MwA and MwoA patients. In MwA patients the reactivity index (RI) to hypocapnia was significantly increased in T1 ( p < 0.05). This abnormal cerebrovascular reactivity disappeared during flunarizine treatment (T2) and in the post-therapy period (T3).

scholarly journals Transcranial Doppler Study Among Children with Sickle Cell Anaemia Vs Normal Children

2012 ◽  
Vol 32 (2) ◽  
pp. 146-149 ◽  
Author(s):  
BB Lakhkar ◽  
BN Lakhkar ◽  
P Vaswani
Keyword(s):  
Sickle Cell Disease ◽  
Flow Velocity ◽  
Sickle Cell ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Cell Disease ◽  
Mean Flow ◽  
Mean Velocity ◽  
Mean Flow Velocity ◽  
Age And Sex

Introduction: Role of transcranial Doppler in prevention of stroke in sickle cell children has been well appreciated. Studies are being done to develop the protocol in children. Since we don’t find stroke very commonly in this part of the world, this study was done in order to see the prevalence of abnormal flow velocity in sickle children attending sickle cell clinic. The aims of this study were to measure mean flow velocity in different vessels in homozygous sickle cell patients using transcranial Doppler study, to compare the mean velocity in sickle children with age and sex matched controls and to correlate mean velocity with headache or stroke if any and also to correlate mean velocity with number of transfusions. Materials and Methods: The study was done in Paediatric wards. It was a prospective crosssectional comparative study. Twenty six children below 14yrs of age with homozygous sickle cell disease attending the Sickle cell clinic were selected as the cases. Forty cases of similar age and sex were recruited as normal control group. Transcranial Doppler was done in six different vessels in both the groups and mean flow velocity was measured. Mean flow velocity was correlated with symptoms and number of transfusions. Velocity was classified as normal (<170cm/sec), conditional (170-199cm/sec) or abnormal (>200cm/sec). Statistical analysis was done using SPSS 10 software. Results: In normal age and sex matched controls mean blood flow velocity was 50cm/sec where as in the cases of sickle cell disease was 180cm/sec. Maximum mean velocity was observed in middle and posterior cerebral artery. In two Sickle cell cases (8%) blood flow velocity was abnormal, these children had headache though received 5-10 transfusions/year. In only 4% sickle cell children flow velocity was normal and rest had conditional velocity. Among these children 39% received less than 5 and rest received 5-9 transfusions /yr and had no symptoms of stroke. Conclusions: Flow velocity measured by Transcranial Doppler is highest in middle cerebral artery and Posterior cerebral artery which appear to be the best arteries for this test in this region. Flow velocity was significantly high in children with sickle cell disease as compared to normal children. Prevalence of abnormal flow velocity in our children was 8% and children with abnormal mean flow velocity presented with headache. J. Nepal Paediatr. Soc. 32(2) 2012 146-149 doi: http://dx.doi.org/10.3126/jnps.v32i2.5681

Myogenic Cerebrovascular Autoregulation in Migraine Measured by Stress Transcranial Doppler Sonography

Cephalalgia ◽  
1998 ◽  
Vol 18 (3) ◽  
pp. 133-137 ◽  
Author(s):  
JG Heckmann ◽  
MJ Hilz ◽  
A Katalinic ◽  
H Marthol ◽  
M Mück-Weymann ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Physical Stress ◽  
Cerebrovascular Reactivity ◽  
Mean Flow ◽  
Cerebrovascular Autoregulation ◽  
Mean Flow Velocity

Background and purpose: Transcranial Doppler sonography (TCD) studies may help to elucidate the nature and role of vascular abnormalities in migraine. Our aim in this study was to evaluate cerebrovascular autoregulative response in migraine patients with and without aura to blood pressure increase using stress TCD. Patients and methods: Using transcranial Doppler ultrasound at rest and during ergometer stress (stress TCD), we studied the changes in mean flow velocities and resistance index (RI) in relation to physical stress in the middle cerebral artery. Fifteen migraine patients without aura, 15 migraine patients with aura, and 15 healthy control subjects were examined. Patients suffered from predominantly unilateral headache and were studied during an attack-free period. The Pourcelof's RI as a measure of cerebrovascular reactivity was calculated by dividing the difference between systolic and diastolic velocity by the systolic velocity. Results: None of the subgroups showed any difference during ergometer exercise with regard to blood pressure, endtidal CO2, heart rate, or mean flow velocity. In all subgroups, sufficient physical stress was achieved. With respect to RI change, migraine patients without aura and healthy controls did not differ ( p>0.05). However, the RI change of migraine patients with aura was significantly lower than the RI change of migraine patients without aura or healthy subjects ( p>0.05). The discrimination analysis showed in addition that RI change (absolute and as a percentage) and mean flow velocity change (as a percentage) could be used as diagnostic variables to detect patients with aura symptoms. Conclusion: Differences exist in cerebrovascular reactivity in migraine patients with aura that may contribute to the neurologic disturbances in these patients during attack. We propose that there is disorder of myogenic cerebrovascular autoregulation in migraine patients with aura during headache-free intervals.

Cerebral vasospasm evaluated by transcranial Doppler ultrasonography at different intracranial pressures

1991 ◽  
Vol 75 (5) ◽  
pp. 752-758 ◽  
Author(s):  
Jürgen Klingelhöfer ◽  
Dirk Sander ◽  
Manfred Holzgraefe ◽  
Christian Bischoff ◽  
Bastian Conrad
Keyword(s):  
Flow Velocity ◽  
Cerebral Vasospasm ◽  
Transcranial Doppler ◽  
Time Course ◽  
Doppler Ultrasonography ◽  
Resistance Index ◽  
Transcranial Doppler Ultrasonography ◽  
Mean Flow ◽  
The Mean ◽  
Mean Flow Velocity

✓ The present study evaluates the interdependence of clinical stage, cerebral vasospasm, intracranial pressure (ICP), and transcranial Doppler ultrasonographic parameters. The mean flow velocity of blood in the middle cerebral artery and the index of cerebral circulatory resistance as a measure of the peripheral vascular flow resistance were determined in 76 patients with spontaneous subarachnoid hemorrhage. The ICP was measured using an epidural transducer in 41 patients. There was no case in which both high ICP and a high mean flow velocity were observed simultaneously. The investigations led to the following conclusions. 1) In patients with a resistance index of less than 0.5, changes in the mean flow velocity seem to reflect sufficiently the actual severity and time course of vasospasm. 2) During the time course of vasospasm, an increase in the resistance index above values of 0.6 with a simultaneously decreased mean flow velocity indicates a rise in ICP rather than a reduction in vasospasm. 3) With a pronounced increase in ICP, evaluation of the severity and time course of vasospasm by transcranial Doppler ultrasonography based solely upon the mean flow velocity can lead to false-negative results.

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