scholarly journals Suspected Cerebral Hyperperfusion Syndrome after Stenting for Intracranial Vertebral Artery Stenosis Associated with Reduced Cerebral Blood Flow to the Posterior Cerebral Artery Territory

2021 ◽  
Author(s):  
Masahiro Katsumata ◽  
Wataro Tsuruta ◽  
Hisayuki Hosoo ◽  
Daiichiro Ishigami
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Vertebral Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Stenosis ◽  
Cerebral Hyperperfusion Syndrome ◽  
Vertebral Artery Stenosis ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion

Global Oxygen Extraction Fraction by Blood Sampling to Anticipate Cerebral Hyperperfusion Phenomenon After Carotid Artery Stenting

Neurosurgery ◽  
2014 ◽  
Vol 75 (5) ◽  
pp. 546-551 ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Yuichi Miyazaki ◽  
Yuhei Tanno ◽  
Shigen Kasakura ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Blood Sampling ◽  
Oxygen Extraction Fraction ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Extraction Fraction

Abstract BACKGROUND: Cerebral hyperperfusion syndrome sometimes occurs after carotid revascularization in patients with severe hemodynamic failure. To prevent cerebral hyperperfusion syndrome, cerebral hyperperfusion phenomenon (CHP) must be detected early. Single-photon emission computed tomography (SPECT) is useful for detecting CHP, but it is impractical on a daily basis. A tool with high availability to find CHP is desired. OBJECTIVE: To investigate whether global oxygen extraction fraction (OEF) by a blood sampling method is useful for indicating CHP after carotid artery stenting (CAS). METHODS: When patients underwent elective CAS from September 2010 to August 2012, we performed blood sampling for OEF calculation and SPECT before and immediately after elective CAS. Data were collected prospectively. OEF was calculated from the cerebral arteriovenous oxygen difference. Cerebral blood flow was measured in the affected middle cerebral artery (MCA) territory and in the ipsilateral cerebellum by SPECT. The ratio of MCA to cerebellar activity was defined as cerebral blood flow in the affected MCA territory divided by cerebral blood flow in the ipsilateral cerebellar hemisphere. Probable CHP was defined as ≥10% increase in the ratio of MCA to cerebellar activity after CAS. The relationship between peri-CAS OEF and probable CHP was evaluated. RESULTS: Of the 96 patients enrolled, 92 patients were analyzed. Probable CHP occurred in 17 patients. Post-CAS OEF was related to probable CHP (P < .01), but pre-CAS OEF was not. The receiver-operating characteristic curve showed that the cutoff value was 45% for probable CHP (P < .001). CONCLUSION: An increase in blood sampling OEF immediately after CAS was related to probable CHP; then the oxygen demand should be reduced.

scholarly journals The diagnostic value of 3D-ASL in vertebral artery stenosis among individuals at risk of stroke

2019 ◽  
Author(s):  
DanDan Xu ◽  
XinMing Huang ◽  
GuoEn Cai ◽  
XiaoXia Yang ◽  
YingQing Wang ◽  
...  
Keyword(s):  
At Risk ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Vertebral Artery ◽  
Occipital Lobe ◽  
Brain Regions ◽  
Artery Stenosis ◽  
Vertebral Artery Stenosis ◽  
Left And Right ◽  
The Difference

Abstract Background: This study explored the predictive value of 3D-ASL for vertebral artery stenosis (VAS) in individuals at risk of stroke. Methods: A total of 43 participants at risk of stroke were enrolled in our study. All participants underwent 3D-ASL and carotid artery computed tomography angiography (CTA) or cervical vascular ultrasound. Cerebral blood flow (CBF) was measured in the left and right frontal lobes, temporal lobes, parietal lobes, occipital lobes, basal ganglia, thalamus, cerebellum, and hippocampus. Calculate the CBF BI (CBF BI means: The absolute value of the difference in cerebral blood flow in the corresponding brain regions on the left and right sides of the enrolled personnel) of the corresponding brain regions of the left and right between the VAS group and the non-VAS group respectively. To evaluate the predictive value of 3D-ASL for vascular stenosis in participants at risk of stroke, we used two-sample t-tests to determine if there were significant differences in BI. Results: Among 43 participants at risk of stroke we recruited, 20 participants with vertebral artery stenosis (the VAS group) and 23 without vertebral artery stenosis (the non-VAS group). There were significant differences in BI of the occipital lobe between the VAS group and the non-VAS group (p < 0.05). According to the occipital lobe BI value, the receiver operating characteristic curve (ROC) demonstrated best diagnostic limits of 10.46 ml/(100g×min). Conclusion: Using 3D-ASL to detect cerebral blood flow and calculate the difference of bilateral occipital cerebral blood flow which can help to diagnose vertebral artery stenosis in high risk population of stroke.

Transcranial Doppler-determined change in posterior cerebral artery blood flow velocity does not reflect vertebral artery blood flow during exercise

2017 ◽  
Vol 312 (4) ◽  
pp. H827-H831 ◽  
Author(s):  
Takuro Washio ◽  
Hiroyuki Sasaki ◽  
Shigehiko Ogoh
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Vertebral Artery ◽  
Flow Velocity ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Posterior Cerebral Artery ◽  
Dynamic Exercise ◽  
Artery Blood Flow ◽  
Artery Flow

We examined whether a change in posterior cerebral artery flow velocity (PCAv) reflected the posterior cerebral blood flow in healthy subjects during both static and dynamic exercise. PCAv and vertebral artery (VA) blood flow, as an index of posterior cerebral blood flow, were continuously measured during an exercise trial using transcranial Doppler (TCD) ultrasonography and Doppler ultrasound, respectively. Static handgrip exercise significantly increased both PCAv and VA blood flow. Increasing intensity of dynamic exercise further increased VA blood flow from moderate exercise, while PCAv decreased to almost resting level. During both static and dynamic exercise, the PCA cerebrovascular conductance (CVC) index significantly decreased from rest (static and high-intensity dynamic exercise, −11.5 ± 12.2% and −18.0 ± 16.8%, means ± SD, respectively) despite no change in the CVC of VA. These results indicate that vasoconstriction occurred at PCA but not VA during exercise-induced hypertension. This discrepancy in vascular response to exercise between PCA and VA may be due to different cerebral arterial characteristics. Therefore, to determine the effect of exercise on posterior cerebral circulation, at least, we need to carefully consider which cerebral artery to measure, regardless of exercise mode. NEW & NOTEWORTHY We examined whether transcranial Doppler-determined flow velocity in the posterior cerebral artery can be used as an index of cerebral blood flow during exercise. However, the changes in posterior cerebral artery flow velocity during exercise do not reflect vertebral artery blood flow.

Longitudinal changes in cerebral blood flow velocities in different clinical courses of migraine

Cephalalgia ◽  
2016 ◽  
Vol 37 (10) ◽  
pp. 927-937 ◽  
Author(s):  
Mi Ji Lee ◽  
Min Kyung Chu ◽  
Hanna Choi ◽  
Hyun Ah Choi ◽  
Chungbin Lee ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Clinical Course ◽  
Episodic Migraine ◽  
Longitudinal Changes ◽  
Blood Flow Velocities ◽  
Headache Clinic ◽  
Flow Velocities

Objective To assess longitudinal changes in cerebral blood flow velocities (ΔCBFVs) according to the clinical course of migraine. Methods We retrospectively included migraine patients with two or more attacks per month at baseline who were followed up within 2 years with transcranial Doppler in a tertiary headache clinic. ΔCBFVs were analyzed in relation to clinical courses, defined as remission (0–1 headache days/month), persistence (2–14/month), or progression (≥15/month) in episodic migraine (EM), and conversion to EM (<15/month) and persistence (≥15/month) in chronic migraine (CM). Results A total of 166 patients (90 EM and 76 CM) were included. In EM, the remission group ( n = 30) showed a decrease in CBFV in the middle cerebral artery (MCA) and the basilar artery (BA). The progression group ( n = 10) showed increasing CBFVs in the bilateral MCAs. Patients with the persistence course ( n = 50) showed generally unchanged CBFVs. In CM, ΔCBFVs decreased in the BA and increased in the posterior cerebral artery (PCA) after conversion to EM ( n = 61), whereas they remained unchanged in the persistence group ( n = 15). In all patients, % change in headache days was positively correlated with the %ΔCBFVs of the bilateral MCAs and the BA. Conclusions CBFV changes are associated with the different clinical courses of migraine. The association is more prominent in EM than CM.

scholarly journals Long-Lasting Symptomatic Cerebral Hyperperfusion Syndrome following Superficial Temporal Artery-Middle Cerebral Artery Bypass in a Patient with Stenosis of Middle Cerebral Artery

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Shinji Shimato ◽  
Toshihisa Nishizawa ◽  
Takashi Yamanouchi ◽  
Takashi Mamiya ◽  
Kojiro Ishikawa ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Receptor Antagonist ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Hyperperfusion Syndrome ◽  
Speech Disturbance ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Dopamine 2 Receptor

Cerebral hyperperfusion syndrome (CHPS) is a complication that can occur after cerebral revascularization surgeries such as superficial temporal artery- (STA-) middle cerebral artery (MCA) anastomosis, and it can lead to neurological deteriorations. CHPS is usually temporary and disappears within two weeks. The authors present a case in which speech disturbance due to CHPS lasted unexpectedly long and three months was taken for full recovery. A 40-year-old woman, with a history of medication of quetiapine, dopamine 2 receptor antagonist as an antipsychotics for depression, underwent STA-MCA anastomosis for symptomatic left MCA stenosis. On the second day after surgery, the patient exhibited mild speech disturbance which deteriorated into complete motor aphasia and persisted for one month. SPECT showed the increase of cerebral blood flow (CBF) in left cerebrum, verifying the diagnosis of CHPS. Although CBF increase disappeared one month after surgery, speech disturbance continued for additionally two months with a slow improvement. This case represents a rare clinical course of CHPS. The presumable mechanisms of the prolongation of CHPS are discussed, and the medication of quetiapine might be one possible cause by its effect on cerebral vessels as dopamine 2 receptor antagonist, posing the caution against antipsychotics in cerebrovascular surgeries.

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