scholarly journals Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study

2021 ◽  
Vol 11 (7) ◽  
pp. 874
Author(s):  
Sérgio Brasil ◽  
Fabio Silvio Taccone ◽  
Sâmia Yasin Wahys ◽  
Bruno Martins Tomazini ◽  
Filippo Annoni ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cerebral Arteries ◽  
Receiver Operating Curve ◽  
Severe Illness ◽  
Mean Flow ◽  
Non Invasive ◽  
Intracranial Compliance ◽  
Middle Cerebral Arteries ◽  
Primary Composite Outcome ◽  
Cerebrovascular Hemodynamics

Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00–1.28] vs. 1.00 [0.88–1.16]; p = 0.03) and eICP (14 [11–25] vs. 11 [7–15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8–12] vs. 6 [5–7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75–0.97); a score > 8.5 had 63 (46–77)% sensitivity and 87 (62–97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5–31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.

scholarly journals Cerebral Hemodynamics and Intracranial Compliance Impairment In Critically Ill COVID-19 Patients: A Pilot Study

2020 ◽  
Author(s):  
Sérgio Brasil ◽  
Fabio Silvio TACCONE ◽  
Sâmia Yasin WAHYS ◽  
Bruno Tomazini ◽  
Filippo ANNONI ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cerebral Arteries ◽  
Receiver Operating Curve ◽  
Severe Illness ◽  
Mean Flow ◽  
Non Invasive ◽  
Intracranial Compliance ◽  
Middle Cerebral Arteries ◽  
Primary Composite Outcome ◽  
Cerebrovascular Hemodynamics

Abstract Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC), due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcome. Methods: 50 consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and a non-invasive monitoring of ICC. Subjects were included on ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI) and estimated cerebral perfusion pressure (eCPP), while ICC using the P2/P1 ratio of estimated ICP curve (B4C device). The primary composite outcome was unsuccessful weaning from respiratory support or death at day 7.Results: On the first assessment (n= 50), only P2/P1 (1.20 [1.00-1.28] vs. 1.00 [0.88-1.16]; p=0.03) and eICP (14 [11-25] vs. 11 [7-15] mmHg; p=0.01) were significantly higher among patients with UO than others. Patients with UO had a significantly higher CVH/ICC score (9 [8-12] vs. 6 [5-7]; p<0.001) than those with favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75-0.97); a score > 8.5 had 63 (46-77)% sensitivity and 87 (62-97)% specificity to predict UO. For those patients undergoing a second assessment (n=29) after a median of 11 (5-31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n=30) and survivors were observed.Conclusions: ICCI and CVH disturbances are often present in COVID-19 severe illness and could accurately predict early poor outcome.

scholarly journals Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill Covid-19 Patients: A Pilot Study

2020 ◽  
Author(s):  
Sérgio Brasil ◽  
Fabio Taccone ◽  
Sâmia Wayhs ◽  
Bruno Tomazini ◽  
Filippo Annoni ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cerebral Arteries ◽  
Receiver Operating Curve ◽  
Severe Illness ◽  
Mean Flow ◽  
Non Invasive ◽  
Intracranial Compliance ◽  
Middle Cerebral Arteries ◽  
Primary Composite Outcome ◽  
Cerebrovascular Hemodynamics

Abstract Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcome.Methods: 50 consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and a non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI) and estimated cerebral perfusion pressure (eCPP) while ICC was assessed by using the P2/P1 ratio of estimated ICP curve (B4C device). The primary composite outcome was unsuccessful weaning from respiratory support or death on day 7.Results: At the first assessment (n= 50) only P2/P1 (1.20 [1.00-1.28] vs. 1.00 [0.88-1.16]; p=0.03) and eICP (14 [11-25] vs. 11 [7-15] mmHg; p=0.01) were significantly higher among patients with unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8-12] vs. 6 [5-7]; p<0.001) than those with favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75-0.97); a score > 8.5 had 63 (46-77)% sensitivity and 87 (62-97)% specificity to predict UO. For those patients undergoing a second assessment (n=29) after a median of 11 (5-31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n=30) and survivors were observed.Conclusions: ICCI and CVH disturbances are often present in COVID-19 severe illness and could accurately predict early poor outcome.

scholarly journals Cerebral haemodynamics in early puerperium: A prospective study

Ultrasound ◽  
2017 ◽  
Vol 25 (2) ◽  
pp. 107-114 ◽  
Author(s):  
GP Anzola ◽  
R Brighenti ◽  
M Cobelli ◽  
A Giossi ◽  
S Mazzucco ◽  
...  
Keyword(s):  
Prospective Study ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Cerebral Arteries ◽  
Velocity Ratio ◽  
Mean Flow ◽  
Middle Cerebral Arteries ◽  
A Prospective Study ◽  
Mean Flow Velocity

Aim Prospective study on 900 consecutive puerperae to assess normal values and range of the blood flow velocity in the middle cerebral artery in both hemispheres. Material and method M1 and M2 segments of both middle cerebral arteries were assessed in all subjects within 96 hours of delivery. Mean flow velocity was recorded after adjusting for insonation angle. Lindegaard index (LI = middle cerebral artery–Internal Carotid Artery mean flow velocity ratio) was calculated whenever the mean flow velocity exceeded 100 cm/second. Asymmetry indexes were calculated inter hemispherically for M1 and M2 segments separately. Results Mean flow velocities were 74 ± 17 and 72 ± 17 in right and 73 ± 17 and 72 ± 17 cm/second in the left M1 and M2, respectively. A total of 136 subjects (12.1%) exceeded the threshold of 100 cm/second, but LI was consistently <3 in all of them. Mean flow velocity was inversely and independently correlated to haemoglobin levels and to parity. Mean asymmetry indexes were 0.25 ± 23 in M1 and 0.45 ± 25 in M2. Conclusion Mean flow velocity in the middle cerebral artery of healthy subjects in early puerperium is higher than in age-matched non-puerperal women and may exceed the threshold of 100 cm/second with no evidence of intracranial spasm, because of blood loss during delivery. Mean flow velocity is independently correlated with parity. Right-to-left mean flow velocity asymmetry may reach 50% as a consequence of a transient imbalance in vascular tone regulation.

scholarly journals Brain Circulation during Panic Attack: A Transcranial Doppler Study with Clomipramine Challenge

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Francesco Rotella ◽  
Marinella Marinoni ◽  
Francesca Lejeune ◽  
Fabiana Alari ◽  
Daniela Depinesi ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Transcranial Doppler ◽  
Panic Attack ◽  
Cerebral Arteries ◽  
Mean Flow ◽  
Middle Cerebral Arteries ◽  
History Of ◽  
Drug Naïve ◽  
Left Middle ◽  
Flow Velocities

Introduction. Cerebral blood flow has been well studied in patients with panic disorder, but only few studies analyzed the mechanisms underlying the onset of a panic attack. The aim of the present study was to monitor the cerebral hemodynamics modifications during a panic attack.Materials and Methods. 10 panic disorder patients with recent onset, fully drug naïve, were compared to 13 patients with panic disorder with a previous history of treatment and to 14 controls. A continuous bilateral monitoring of mean flow velocities in right and left middle cerebral arteries was performed by transcranial Doppler. Clomipramine was chosen as challenge.Results. Eight out of 10 patients drug naïve and 6 control subjects out of 13 had a full blown panic attack during the test, whereas none of the patients with a history of treatment panicked. The occurrence of a panic attack was accompanied by a rapid decrease of flow velocities in both right and left middle cerebral arteries.Discussion. The bilateral acute decrease of mean flow velocity during a panic attack suggests the vasoconstriction of the microcirculation of deep brain structures perfused by middle cerebral arteries and involved in the so-called “fear circuitry,” thus suggesting that cerebral homeostatic dysfunctions seem to have a key role in the onset of a panic attack.

scholarly journals Doppler velocimetry of umbilical, and middle cerebral arteries in the prediction of fetal outcome

2017 ◽  
Vol 5 (11) ◽  
pp. 4789
Author(s):  
Sumangali P. K. ◽  
Omana E. K. ◽  
Shabnam S. Nambiar
Keyword(s):  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Cerebral Arteries ◽  
Fetal Outcome ◽  
Close Monitoring ◽  
Doppler Velocimetry ◽  
Intrauterine Growth ◽  
Medical College ◽  
Non Invasive ◽  
Middle Cerebral Arteries

Background: Doppler ultrasound offers a unique non-invasive technology for investigating fetal, feto placental and utero placental circulation Intrauterine growth restriction is associated with increased perinatal morbidity and mortality.Methods: A hospital based descriptive study of Doppler velocimetry of umbilical Artery and Middle cerebral Artery was carried out in the Department of Obstetrics and Gynecology Pariyaram Medical College over a period of 1 year – April 2016 to March 2017. A total of 180 patients with clinically IUGR were selected for the study. Close monitoring done with daily NST and repeated Doppler study.Results: The S/D ratio in Umbilical artery and RI ratio of MCA is valuable for monitoring growth retarded and small for gestational age fetuses and to take decision for early termination of pregnancy. In our study, perinatal outcome is very good, only 3 NND happened. i.e., due to extreme prematurity.Conclusions: Colour Doppler helps in detection of compromised fetuses in high risk pregnancies like PIH, IUGR and other risk factors likely to cause placental insufficiency. 

scholarly journals Effect of Smoking on Cerebrovascular Reactivity

1996 ◽  
Vol 16 (4) ◽  
pp. 746-749 ◽  
Author(s):  
Mauro Silvestrini ◽  
Elio Troisi ◽  
Maria Matteis ◽  
Letizia Maria Cupini ◽  
Giorgio Bernardi
Keyword(s):  
Flow Velocity ◽  
Cerebral Arteries ◽  
Transcranial Doppler Ultrasound ◽  
Cerebrovascular Reactivity ◽  
Breath Holding ◽  
Mean Flow ◽  
Increased Risk ◽  
Middle Cerebral Arteries ◽  
Cerebrovascular Regulation ◽  
Breath Holding Index

Current smoking is a risk factor for stroke. The aim of this study was to evaluate the effect of smoking one cigarette on cerebral hemodynamics. Using transcranial Doppler ultrasound, we studied the changes of flow velocity after hypercapnia in the middle cerebral arteries (MCAs) of 24 healthy young smokers and 24 healthy controls matched for age and sex. We obtained hypercapnia with breath-holding and evaluated cerebrovascular reactivity with the breath-holding index. In smokers, the evaluation was performed during basal condition, immediately after smoking one cigarette, and at 10-, 20-, and 30-min intervals thereafter. In controls, the evaluation was performed at corresponding time intervals. Breath-holding index (BHI) values at rest were similar for both controls and smokers. In the former, breath-holding index values remained constant for each of the different evaluations. On the contrary, in smokers, breath-holding index values were significantly lower immediately ( p < 0.0001), at 10 min ( p < 0.001), and at 20 min ( p < 0.0001) after smoking with respect to baseline values. Smoking also caused more short-lasting changes, in this case increases in mean flow velocity (MFV), heart rate (HR), and mean blood pressure (MBP). These results suggest that a failure of cerebrovascular regulation occurs after smoking. This phenomenon might contribute to the increased risk of cerebrovascular disease in current smokers.

scholarly journals Reversible Cerebral Vasoconstriction Syndrome Associated with Levonorgestrel-Releasing Intrauterine System

2021 ◽  
Vol 11 (5) ◽  
pp. 601
Author(s):  
Sangwon Choi ◽  
Ju-Young Lee ◽  
Jong Seok Bae ◽  
Hong-Ki Song ◽  
Ju-Hun Lee ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Density Lipoprotein ◽  
Low Density ◽  
Mean Flow ◽  
Cerebral Vasoconstriction ◽  
Middle Cerebral Arteries ◽  
The Mean

Reversible cerebral vasoconstriction syndromes (RCVS) is a rare disease that is characterized by reversible multifocal stenosis of the cerebral arteries with various clinical manifestations. Though the pathomechanism of RCVS was unclear, we reported RCVS related to the levonorgestrel-releasing intrauterine system (IUS). A previous healthy 36-year-old woman had thunderclap headache after implanting the levonorgestrel-releasing IUS a year ago. In the serial angiography, we initially found left vertebra artery (VA), and then additionally new stenosis of both anterior cerebral arteries and middle cerebral arteries (MCA). Bilateral MCA stenosis improved but developed stenosis of right VA after a week. The mean flow velocities of both MCA increased in the first transcranial doppler (TCD), but normalized in the follow up TCD. Levonorgestrel might act as the vasoconstrictitve factor that increased the level of endothelin-1, diminished the release of NO and raised oxidative low-density lipoprotein (LDL). Although the exact pathological mechanisms for RCVS were not yet elucidated, this case might help clinicians understand the mechanisms of RCVS.

DIFFICULTIES IN DIAGNOSING MOYA-MOYA DISEASE (CLINICAL CASE)

2020 ◽  
pp. 48-53
Author(s):  
Novikova I.N. ◽  
Popova T.F. ◽  
Gribacheva I.A. ◽  
Petrova E.V. ◽  
Marushchak A.A. ◽  
...  
Keyword(s):  
Cerebral Angiography ◽  
Neurological Disorders ◽  
Clinical Case ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Moya Moya Disease ◽  
Middle Cerebral Arteries ◽  
Internal Carotid Arteries ◽  
Made In

Moya-Moya disease is a rare progressive chronic cer-ebrovascular disease characterized by a narrowing of the lumen of the intracranial segments of the internal carotid arteries, as well as the initial segments of the anterior and middle cerebral arteries with the devel-opment of a network of small vascular anastomoses. Violations of blood supply due to occlusion lead to the development of ischemic strokes in the correspond-ing pools, and ruptures of vascular anastomoses - to the development of hemorrhagic strokes, causing a variety of neurological disorders. The article presents a clinical case of Moya-Moya disease in a 31-year-old patient. The disease was manifested by acute disorders of cerebral circulation in ischemic and hemorrhagic types. The diagnosis was made in accordance with the diagnostic criteria of the disease based on the data of endovascular cerebral angiography.

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