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1.
Pol Merkur Lekarski ; 48(287): 312-317, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33130789

RESUMO

There are currently insufficient study and analysis of changes in cerebral hemodynamics of boxers who have suffered repeated traumatic brain injury (TBI). To identify such changes, the most informative is the study of blood flow in the vessels of the neck and head using ultrasound duplex scanning (USDS) of the main vessels of the neck and transcranial duplex scanning (TCDS). AIM: The aim of study was to investigate the features of cerebral hemodynamics in boxers with repeated TBI. MATERIALS AND METHODS: A study of blood flow in the vessels of the neck and head was performed for 156 amateur boxers aged 16 to 42 years who had a history of repeated TBI. In the control group, 30 practically healthy people of a similar age were examined. Patients were analyzed by gender and the number of fights held. Obtained results were analyzed statistically. RESULTS: Boxers who have had a history of repeated TBI have hemodynamic disorders. They are characterized by an increase in the velocity of blood flow in extracranial vessels of the carotid basin and a decrease in the vessels of the vertebrobasilar basin with a change in the indicators of vascular resistance. For vessels of the intracranial section of the carotid basin, a decrease in blood flow velocity without changes in the indicators of vascular resistance was typical. Disorders of venous cerebral circulation was noted in most boxers, which was manifested by an increase in speed indicators in the internal jugular vein and veins of Rosenthal. CONCLUSIONS: The study of features of the cerebral hemodynamic in boxers with repeated TBI allows them to predict their competitive activity, correctly select the appropriate therapy and recommendations of the sports regime to prevent possible long-term consequences of injury.


Assuntos
Lesões Encefálicas Traumáticas , Adolescente , Adulto , Velocidade do Fluxo Sanguíneo , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Circulação Cerebrovascular , Hemodinâmica , Humanos , Ultrassonografia , Adulto Jovem
2.
Artigo em Russo | MEDLINE | ID: mdl-33161661

RESUMO

The study was organized to evaluate influence of risk factors on hospital mortality in patients with acute stroke because incidence of stroke in patients of able-bodied age is increasing. All cases of in-patient care of patients of able-bodied age with acute stroke (n=4118) in the Tyumen Oblast clinical hospital № 2 during 2010-2018 were analyzed. The study was based on sampling data from hospital medical records. During the analyzed period, decreasing of in-patient lethality up to 34.9% in patients of able-bodied age was observed. During the period of "therapeutic window" 60% of patients of able-bodied age admitted died. The multivariate analysis was applied to assess influence of different factors on in-patient mortality. The presence of coronary heart disease increases risk of mortality up to 47.5%, Exp(Beta)=1.475, employment - up to 66.8%, Exp(Beta)=1.668 as compared to baseline risk. The presence of arterial hypertension and remoteness of symptom onset in ln (hours) (hospital admission) decreases mortality risk up to approximately 39.7%, Exp (Beta)=0.603 and up to 24.0%, Exp (Beta)=0.760, respectively (specificity - 75.86%, sensitivity - 72.18%; overall diagnostic accuracy - 75.23%). In patients of working age the presence of coronary heart disease and elder age are risk factors of stroke. The presence of coronary heart disease and employment are risk factors of in-patient mortality. Whereas presence of hypertension and employment decreases risk of lethal outcome.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Idoso , Circulação Cerebrovascular , Mortalidade Hospitalar , Humanos , Hipertensão/epidemiologia , Fatores de Risco
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 24-29, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016673

RESUMO

OBJECTIVE: To identify the likelihood of developing systemic inflammation (SI) as a general pathological process in severe haemorrhagic intracerebral stroke with and without the phenomenon of ineffective cerebral blood flow. MATERIAL AND METHOD: Three groups were examined: 1) 89 blood donors (controls), 2) 15 patients with severe haemorrhagic stroke without the phenomenon of ineffective brain blood flow; 3) 26 patients with severe haemorrhagic stroke with ineffective cerebral blood flow. Ineffective cerebral blood circulation was recorded on the basis of transcranial Doppler ultrasound data; 87% of patients had clinical signs of brain death. All patients in the groups with haemorrhagic stroke had signs of multiple organ dysfunction according to the Sepsis-related Organ Failure scale, all of them received intensive care. An integrated scale based on the determination of plasma concentrations of cytokines (IL-6, IL-8, IL-10, TNF-α), procalcitonin, cortisol, D-dimers, myoglobin, troponin I was used to verify systemic inflammation. RESULTS AND CONCLUSION: Systemic inflammation or borderline state (pre-SI) was identified in all patients of the second group both on 1-3 days from the onset of haemorrhagic stroke, and on 5-8 days. On the contrary, in the third group, there were no signs of SI on 1-3 days. On 5-8 days, signs of SI and pre-SI were recorded only in 18.2% of patients. Apparently, the reason for these differences is the blockade of the passage of tissue decay products and other pro-inflammatory factors into the bloodstream from the damaged brain in the third group.


Assuntos
Circulação Cerebrovascular , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Encéfalo/diagnóstico por imagem , Humanos , Inflamação
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5810-5813, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019295

RESUMO

Asymptomatic carotid stenosis patients manifest compromised cognitive performance compared to controls. Cerebral perfusion deficit could be an important contributor to cognitive impairment. The relationship between carotid stenosis and cerebral perfusion deficit is not established. If established, this could lead to a more informed selection of ACS patients likely to benefit from carotid revascularization. Perfusion-weighted MR imaging (PWI) is a clinically viable non-invasive technique to quantify cerebral perfusion. However, its impact is limited due to lack of efficient clinical tools to analyze PWI data in different brain regions for characterizing interhemispheric perfusion asymmetry. Development of automated approaches to characterize clinically relevant perfusion deficits is therefore required. Moreover, there is no established evidence of association between perfusion deficit and stenosis severity. In this paper, we propose an approach to quantify interhemispheric perfusion differences in different brain regions using clinical data. Our proposed metrics, based on the PWI mean transit time, for characterizing difference between ipsilateral and contralateral hemispheres demonstrate a very strong relationship with Doppler ultrasound based peak systolic velocity measured at stenosis. Our approach also highlights dependence of perfusion asymmetry on effective collateralization through the cerebral vasculature. In future studies, we plan to extend this method to a larger cohort and refine the methods for validating novel biomarker for risk-stratification of carotid stenosis.


Assuntos
Estenose das Carótidas , Estenose das Carótidas/diagnóstico por imagem , Circulação Cerebrovascular , Humanos , Angiografia por Ressonância Magnética , Perfusão , Ultrassonografia
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1489-1492, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018273

RESUMO

Cerebrovascular Reactivity (CVR), the responsiveness of blood vessels to a vasodilatory stimulus, is an important indicator of cerebrovascular health. Assessing CVR with fMRI, we can measure the change in the Blood Oxygen Level Dependent (BOLD) response induced by a change in CO2 pressure (%BOLD/mmHg). However, there exists a temporal offset between the recorded CO2 pressure and the local BOLD response, due to both measurement and physiological delays. If this offset is not corrected for, voxel-wise CVR values will not be accurate. In this paper, we propose a framework for mapping hemodynamic lag in breath-hold fMRI data. As breath-hold tasks drive task-correlated head motion artifacts in BOLD fMRI data, our framework for lag estimation fits a model that includes polynomial terms and head motion parameters, as well as a shifted variant of the CO2 regressor (±9 s in 0.3 s increments), and the hemodynamic lag at each voxel is the shift producing the maximum total model R2 within physiological constraints. This approach is evaluated in 8 subjects with multi-echo fMRI data, resulting in robust maps of hemodynamic delay that show consistent regional variation across subjects, and improved contrast-to-noise compared to methods where motion regression is ignored or performed earlier in preprocessing.Clinical Relevance- We map hemodynamic lag using breathhold fMRI, providing insight into vascular transit times and improving the regional accuracy of cerebrovascular reactivity measurements.


Assuntos
Circulação Cerebrovascular , Imagem por Ressonância Magnética , Encéfalo/diagnóstico por imagem , Hemodinâmica , Oxigênio
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2913-2916, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018616

RESUMO

Multisensory stimulation plays an important role in the recovery of ischemic stroke. However, little is known about the interactions between neuronal activities with multi-afferent stimulations and their effects on hemodynamic responses. Optogenetics has been a useful tool in neuroscience research to unravel the mechanisms of neurovascular coupling at cell-specific level. In this study, we applied laser speckle contrast imaging (LSCI) to map the cortical hemodynamic response with high spatiotemporal resolution. The results showed that optogenetic inhibition of pyramidal neurons in sensorimotor cortex induced both local and distant increases of cerebral blood flow (CBF) with dual peaks, and the full width at half maximum (FWHM) was significantly larger than that of the CBF response to optogenetic excitation. Furthermore, optogenetic excitation of pyramidal neurons could significantly increase the local CBF response to sensory stimulation, whereas optogenetic inhibition of pyramidal neurons decreased the local CBF response at the early stage after sensory stimulation and increased the distant CBF response during the recovery period. Our work provided useful insights into the mechanisms of brain stimulation, which might help in clinical neurological applications.


Assuntos
Acoplamento Neurovascular , Circulação Cerebrovascular , Hemodinâmica , Imagem Óptica , Optogenética
8.
J Stroke Cerebrovasc Dis ; 29(10): 105143, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912498

RESUMO

OBJECTIVE: The surgical procedure most appropriate for treating symptomatic Riles type 1A common carotid artery occlusion (CCAO) is unclear. This study compares the effects of ring-stripping retrograde endarterectomy (RSRE) and carotid artery crossover bypass (CACB) on cerebral perfusion improvement in patients with symptomatic Riles type 1A CCAO. METHODS: We conducted a retrospective analysis of symptomatic Riles type 1A CCAO patients treated at our centre. Postoperative improvements in the ipsilateral internal carotid artery (ICA) flow rate, ipsilateral cerebral blood perfusion (CBP) and the stroke recurrence rate were compared between patients who underwent RSRE and those who underwent CACB. RESULTS: A total of 20 CCAO patients were surgically treated at our centre from 2011 to 2018. Nine of these patients underwent RSRE, and eleven underwent CACB. No significant differences were identified between the groups in the ipsilateral blood flow rate of the ICA immediately after surgery and the ipsilateral-to-contralateral mean transit time ratios 1 day after surgery. However, the flow rate in the ICA was significantly higher in the RSRE group than in the CACB group 1 year after surgery (135.44 ± 19.22 ml/min vs. 116.36 ± 17.70 ml/min, p = 0.033). For CBP, the ipsilateral-to-contralateral mean transit time ratios were significantly lower in RSRE patients than in CACB patients 1 year after surgery (1.005 ± 0.052 vs. 1.064 ± 0.066, p = 0.044). In addition, the postoperative modified Rankin scale (mRS) score at the latest follow-up point (p = 0.884) and the stroke recurrence rate during the follow-up (88.9% vs. 90.9%, p > 0.999) were not significantly different between the two groups. CONCLUSIONS: Although the postoperative mRS score and the stroke recurrence rate were not significantly different between RSRE and CACB patients, compared to CACB, RSRE was better for improving the ipsilateral ICA flow rate and cerebral perfusion in symptomatic Riles type 1A CCAO patients.


Assuntos
Implante de Prótese Vascular , Artéria Carótida Primitiva/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Idoso , Velocidade do Fluxo Sanguíneo , Implante de Prótese Vascular/efeitos adversos , Artéria Carótida Primitiva/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Pesquisa Comparativa da Efetividade , Endarterectomia das Carótidas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
9.
J Stroke Cerebrovasc Dis ; 29(10): 105157, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912502

RESUMO

Cerebral arteriovenous malformations (AVMs) are generally attributed to congenital lesions that arise from aberrant vasculogenesis between the fourth and eighth weeks of embryonic life. However, this dogma has been challenged by several recent observations, one of which is de novo formation of AVMs. Forty cases of de novo AVMs were published between 2000 and 2019, all of which involved a history of intracranial insult, such as vascular abnormalities or nonvascular conditions, prior to AVM diagnosis. We hereby present two unique operative cases of ruptured de novo AVMs in older adult patients. Case 1 is novel in the sense that the patient did not experience any kind of environmental trigger ("second hit") such as a previous intracranial insult, while Case 2 serves as the second report of a de novo AVM patient with a medical history of Bell's palsy. Although the exact mechanisms of AVM formation remain to be elucidated, it is likely to be a multifactorial process related to environmental and hemodynamic factors.


Assuntos
Paralisia de Bell/complicações , Angiopatias Diabéticas/complicações , Hipertensão/complicações , Malformações Arteriovenosas Intracranianas/etiologia , Idoso , Paralisia de Bell/diagnóstico , Circulação Cerebrovascular , Angiopatias Diabéticas/diagnóstico , Hemodinâmica , Humanos , Hipertensão/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/fisiopatologia , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 29(10): 105168, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912520

RESUMO

BACKGROUND AND PURPOSE: Isolated Sulcal Effacement (ISE) is focal cortical swelling without obscuration of cortical gray-white junction. The available information on its role in acute stroke patients treated with intravenous (IV) tissue plasminogen activator (tPA) is limited. METHODS: ISE along with ASPECT and rLMC collateral score were determined in pre-treatment CT/CT angiography of 195 consecutive acute stroke patients treated with IV tPA "only". In addition, ISE-ASPECT score was created. Role of ISE on responsiveness to IV tPA, thrombolysis-associated hemorrhage and functional outcome were studied in 102 patients with CT-angiography-confirmed anterior system proximal vessel occlusion. RESULTS: ISE was observed in 12 patients (6.2% of all and 11.4% of those with occlusion of the carotid terminus, M1, or proximal M2) corresponding to excellent specificity (100%) but fair sensitivity (12%) for diagnosis of anterior cerebral circulation proximal artery occlusion. ISE ASPECT score was significantly correlated with rLMC score (p=0.023). Presence of ISE was linked to younger age, female gender, lower NIHSS, along with higher ASPECT and rLMC scores. Albeit not persisted after adjustment for collateral status and NIHSS, dramatic response to IV tPA along with excellent (23% vs. 8%, p<0.05), good (21% vs. 6%, p<0.05) and acceptable (19% vs. 4%, p<0.05) functional outcome were significantly higher in patients with ISE. CONCLUSIONS: As a plain CT marker of sufficient collateral status and increased cerebral blood volume, ISE indicates a better response to IV tPA. However, it should be noted that this relatively rare CT finding is highly specific for cerebral large vessel occlusions amenable neurothrombectomy.


Assuntos
Edema Encefálico/etiologia , Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/fisiopatologia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Circulação Cerebrovascular/efeitos dos fármacos , Circulação Colateral/efeitos dos fármacos , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
J Stroke Cerebrovasc Dis ; 29(10): 105134, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912530

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) caused by large vessel occlusion of the anterior circulation within 6 hours of symptoms onset and can be performed with an extended window up to 24 hours in selected patients. Nevertheless, the outcomes of MT with extended window are unknown in developing countries. OBJECTIVE: Explore the safety and efficacy of MT for AIS performed beyond 6 hours from symptoms onset in Brazil. METHODS: We reviewed data from AIS patients treated with MT beyond 6 hours of stroke onset, from 2015 to 2018 in a Brazilian public hospital. Patients had an occlusion of the intracranial internal carotid artery and/or proximal segment of the middle cerebral artery. CT Perfusion mismatch was evaluated using the RAPID® software. We evaluated the modified Rankin scale (mRS) and mortality at 90 days, and rate of symptomatic intracranial hemorrhage (sICH). RESULTS: Fifty-four patients were included, with a mean age of 65.6 ± 16.1 years, 55.6% were male, and the median NIHSS score at presentation was 17. Successful recanalization (TICI 2b to 3) was obtained in 92.6% of patients and sICH rate was 11.1%. Overall, 34% of the patients had a good outcome (mRS ≤2) at 90 days and the mortality rate was 20.3%. CONCLUSION: Our study, the first series of MT for AIS treated with extended window reported in Latin America, shows that MT can be performed with safety and lead to adequate functional outcomes in this context. Further studies should explore the barriers to broad implementation of MT for AIS in Latin America.


Assuntos
Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/terapia , Circulação Cerebrovascular , Infarto da Artéria Cerebral Média/terapia , Artéria Cerebral Média/fisiopatologia , Trombectomia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Brasil , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/fisiopatologia , Avaliação da Deficiência , Feminino , Hospitais Públicos , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Imagem de Perfusão , Recuperação de Função Fisiológica , Estudos Retrospectivos , Centros de Atenção Terciária , Trombectomia/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 29(10): 105124, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912535

RESUMO

OBJECTIVE: This study investigates the effect of aneurysm circulation on mortality and patient outcomes after aneurysmal subarachnoid hemorrhage (SAH) within the United States. METHODS: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS), a part of the Healthcare Cost and Utilization Project (HCUP), with ICD-10 codes for non-traumatic SAH between 2015-2016. Aneurysms were stratified as either anterior or posterior circulation. Multivariate logistic regression was used to find the impact of selected variables on the odds of mortality. RESULTS: The NIS reported 1,892 cases of non-traumatic SAH within the study period that were predominantly anterior circulation (82.6%), female (68.6%), white (57.7%), with mean age of 59.07 years, and in-hospital mortality of 21.4%. Anterior circulation aneurysms were associated with lower severity of initial illness (p = 0.014) but higher likelihood of vasospasm (p = 0.0006) than those of the posterior circulation. In a multivariate logistic regression analysis, mortality was associated with posterior circulation aneurysms (OR: 1.42; CI 95% 1.005-20.10, p = 0.047), increasing age (OR: 1.035; 95% CI 1.022-1.049; p < 0.0001), and shorter hospital stays (OR: 0.7838; 95% CI 0.758-0.811; p < 0.0001). Smoking history (OR: 0.825; 95% CI 0.573-1.187, p > 0.05) and vasospasm (OR: 1.005; 95% CI 0.648-1.558; p > 0.05) were not significantly associated with higher odds of mortality. CONCLUSIONS: Mortality following aneurysmal SAH is associated with posterior circulation aneurysms, and increasing age, but not smoking history or vasospasm. These findings may be useful for prognostication and counseling patients and families.


Assuntos
Aneurisma Roto/mortalidade , Circulação Cerebrovascular , Mortalidade Hospitalar , Aneurisma Intracraniano/mortalidade , Hemorragia Subaracnóidea/mortalidade , Adulto , Fatores Etários , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/fisiopatologia , Bases de Dados Factuais , Feminino , Humanos , Pacientes Internados , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Estados Unidos/epidemiologia
13.
J Stroke Cerebrovasc Dis ; 29(10): 105064, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912539

RESUMO

BACKGROUND: It was previously demonstrated that decreased cortical venous drainage is a predictive factor of poor clinical outcome in patients with an acute ischemic stroke. The aim of this investigation is to test the hypothesis that the decline in blood flow in medullary veins (MV) on CT angiogram (CTA) of patients with acute ischemic stroke (AIS) can also be predictive of clinical outcome. METHODS: We retrospectively reviewed a database of patients with AIS who were evaluated by multiphase CTA and enrolled individuals with AIS and evidence of occlusion of the intracranial internal carotid artery, the M1 or M2 segment of the middle cerebral artery, or combination of two occlusions. To characterize asymmetry of MV we used similar principle that was previously established for MV on SWI MR-images; asymmetry was defined was presence of 5 or more contrast opacified MV in one hemisphere as compared to the contralateral side. Clinical outcomes were evaluated by mRS in 90 days. The Fisher Exact test was used to examine the significance of the MV asymmetry. Odds ratio and interrater variability were calculated. RESULTS: 66 patients with AIS were included. The presence of asymmetry in MV was associated with the higher frequency of poor clinical outcomes (84.6% vs 50.9%); the OR was 5.3. Interrater agreement in assessment on MV was moderate in our study (κ=0.55). CONCLUSION: This study shows that (a) medullary veins can be reliably assessed on multiphase CTA, (b) in patients with AIS, asymmetric appearance of MV is associated with poor clinical outcome.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral/métodos , Veias Cerebrais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Bulbo/irrigação sanguínea , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Idoso , Isquemia Encefálica/fisiopatologia , Veias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia
14.
J Stroke Cerebrovasc Dis ; 29(10): 105122, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912548

RESUMO

BACKGROUND: Endovascular treatment (EVT) is merely recommended as class of recommendation IIb for patients with ASPECTS <6 according to the American Heart Association guideline 2019. In addition, the best determined imaging technique for EVT in patient with ASPECTS<6 remains unknown. The objective of this study was to define the safety and efficacy of EVT for patients with ASPECTS<6 and investigate the superiority between MRI and CT for patient selection. METHODS: A systematic search of PubMed, EMBASE, The Cochrane Library and other additional sources was performed for studies published with no publication period. Our study was conducted corresponding to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMA) guidelines. The analysis was performed using the Comprehensive Meta-Analysis (CMA) 2.0. RESULTS: Five studies reporting data from 844 participants were included in our analysis according to the inclusion criteria. Consequently, EVT was associated with statistically significant higher functional independence compared with MT (OR 5.401, 95% CI 3.227-9.041). Whereas EVT was found to be related to lower mortality compared with MT based on eligible data (OR 0.461, 95% CI 0.329-0.647). No significant difference was identified in sICH between EVT and MT (OR 1.075, 95% CI 0.452-2.558). CONCLUSION: According to the results of our study, we suggested that EVT is a preferred therapy in ACS patients with ASPECTS<6 in consideration of efficacy and safety. Furthermore, MRI did not show superiority over CT as no statistical difference was detected in all subgroups.


Assuntos
Isquemia Encefálica/terapia , Circulação Cerebrovascular , Procedimentos Endovasculares , Hemorragias Intracranianas/terapia , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
15.
J Stroke Cerebrovasc Dis ; 29(10): 105172, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912550

RESUMO

INTRODUCTION: Uncertainty regarding reperfusion of mildly-symptomatic (minor) large vessel occlusion (LVO)-strokes exists. Recently, benefits from reperfusion were suggested. However, there is still no strong data to support this. Furthermore, a proportion of those patients don't improve even after non-hemorrhagic reperfusion. Our study evaluated whether or not non-perfusion factors account for such persistent deconditioning. METHODS: Patients with identified minor LVO-strokes (NIHSS ≤ 8) from our stroke alert registry between January-2016 and May-2018 were included. Variables/ predictors of outcome were tested using univariate/multivariate logistic and linear regression analyses. Three month-modified ranking scale (mRS) was used to differentiate between favorable (mRS = 0-2) and unfavorable outcomes (mRS = 3-6). RESULTS: Eighty-one patients were included. Significant differences between the two outcome groups regarding admission-NIHSS and discharge-NIHSS existed (OR = 0.47, 0.49 / p = 0.0005, <0.0001 respectively).The two groups had matching perfusion measures. In the poor outcome group, discharge-NIHSS was unchanged from the admission-NIHSS while in the good outcome group, discharge-NIHSS significantly improved. CONCLUSION: Admission and discharge NIHSS are independent predictors of outcome in patients with minor-LVO strokes. Unchanged discharge-NIHSS predicts worse outcomes while improved discharge-NIHSS predicts good outcomes. Unchanged NIHSS in the poor outcome group was independent of the perfusion parameters. In literature, complement activation and pro-inflammatory responses to ischemia might account for the progression of stroke symptoms in major-strokes. Our study concludes similar phenomena might be present in minor-strokes. Therefore, discharge-NIHSS may be useful as a clinical marker for future therapies.


Assuntos
Circulação Cerebrovascular , Avaliação da Deficiência , Acidente Vascular Cerebral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Sistema de Registros , Reperfusão/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 29(10): 105051, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912558

RESUMO

RATIONALE: Intracranial atherosclerotic disease (ICAD) is the most common cause of ischemic stroke with the highest rate of recurrence, despite aggressive medical management. Diverse mechanisms may be responsible for ICAD-related cerebral ischemia, with potential therapeutic implications. Here we present the rationale, design and methods of the Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) study. The aim of MyRIAD is to determine the mechanisms of stroke in ICAD through physiologic imaging biomarkers that evaluate impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, artery to artery embolism, and their interaction. METHODS AND DESIGN: This is a prospective observational study of patients with recently symptomatic (<21 days) ICAD with 50-99% stenosis treated medically and monitored for up to 1 year. An estimated 110 participants are recruited at 10 sites to identify the association between the presence of each mechanism of ischemia and recurrent stroke. The primary outcome is ischemic stroke in the territory of the symptomatic artery. Secondary outcomes include new cerebral infarction on MRI at 6-8 weeks and recurrent TIA in the territory of the symptomatic artery. DISCUSSION: MyRIAD is positioned to define the role of specific mechanisms of recurrent ischemia in patients with symptomatic ICAD. This knowledge will allow the development and implementation of effective and specific treatments for this condition.


Assuntos
Infarto Encefálico/etiologia , Circulação Cerebrovascular , Arteriosclerose Intracraniana/diagnóstico por imagem , Ataque Isquêmico Transitório/etiologia , Angiografia por Ressonância Magnética , Projetos de Pesquisa , Ultrassonografia Doppler Transcraniana , Adulto , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/fisiopatologia , Infarto Encefálico/terapia , Feminino , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/fisiopatologia , Arteriosclerose Intracraniana/terapia , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/fisiopatologia , Ataque Isquêmico Transitório/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Recidiva , Fatores de Risco , Fatores de Tempo
17.
J Stroke Cerebrovasc Dis ; 29(10): 105116, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912568

RESUMO

BACKGROUND: A neck size >4.0 mm is a risk factor for recanalization after coil embolization. The high inflow magnitude of pretreatment wide-neck aneurysms may be correlated to recanalization. We aimed to elucidate the effect of the neck size on the inflow magnitude evaluated on four-dimensional (4D) flow magnetic resonance imaging (MRI) in pretreatment unruptured internal carotid artery (ICA) aneurysms. METHODS: Thirty-three untreated ICA aneurysms were subjected to 4D flow MRI to evaluate the inflow magnitude parameters including the maximum spatially-averaged inflow velocity (MSAIV), maximum inflow velocity, maximum inflow rate (MIR), and their ratios to each corresponding flow parameter in the parent artery. RESULTS: The neck size was linearly correlated to all inflow parameters investigated in this study. A strong correlation was observed between the neck size and the following: MSAIV (r = .755, p < .0001), MIR (r = .715, p < .0001), MSAIV ratio (r = .724, p < .0001), and MIR ratio (r = .741, p < .0001). The predicted value of MIR ratio of an aneurysm with the neck size of 4.0 mm was 23.0% and 20.6%, based on the linear regression equation of all aneurysms and on that of aneurysms with the neck size >4.0 mm, respectively. CONCLUSIONS: The neck size was linearly correlated with the inflow magnitude of unruptured ICA aneurysms. Inflow magnitude evaluation using 4D flow MRI may help to hemodynamically identify aneurysms with a high risk of recanalization after endovascular coil embolization.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Circulação Cerebrovascular , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Imagem de Perfusão/métodos , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Feminino , Humanos , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
18.
J Stroke Cerebrovasc Dis ; 29(10): 105075, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912572

RESUMO

We report an extremely rare case of a 27-year-old woman presenting with ischemic stroke as an initial manifestation of moyamoya disease in the first trimester of pregnancy. We conducted an artificial abortion when her neurological symptoms rapidly became refractory to optimal antithrombotic treatments. The progression of neurologic deficits stopped immediately after abortion, resulting in recovery to independence, with slight motor aphasia and right hemiparesis due to improved cerebral flow. We highlight rapid artificial abortion combined with antithrombotic treatment for patients of moyamoya disease with pregnancy-associated ischemic stroke as an appropriate treatment to correct hemodynamic instability and suppress the progression of neurological symptoms.


Assuntos
Aborto Terapêutico , Isquemia Encefálica/terapia , Fibrinolíticos/uso terapêutico , Doença de Moyamoya/terapia , Complicações Cardiovasculares na Gravidez/terapia , Acidente Vascular Cerebral/terapia , Adulto , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Circulação Cerebrovascular , Feminino , Hemodinâmica , Humanos , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
19.
Artigo em Russo | MEDLINE | ID: mdl-32929929

RESUMO

OBJECTIVE: To compare the effects of cortexin, cerebrolysin and actovegin on memory impairment, cerebral circulation and morphological changes in the hippocampus of rats with chronic brain ischemia. MATERIAL AND METHODS: The study was conducted using male rats with chronic brain ischemia caused by stenosis of the common carotid arteries by 50%. Animals received cortexin (0,3; 1 or 3 mg/kg), cerebrolysin (0,8; 2,5 or 7,5 ml/kg) and actovegin (5 ml/kg) in two 10-day courses with 10 days of treatment break. The severity of cognitive impairment was evaluated using the Morris water maze, passive and active avoidance tests. Cerebral circulation using laser flowmetry and brain hippocampus structures were studied in the end of treatment. RESULTS: Cognitive impairment in animals with chronic brain ischemia was accompanied by the development of pathological changes in the CA1 and CA4 regions of the hippocampus. Administration of cortexin (1 and 3 mg/kg) and cerebrolysin (2.5 and 7.5 ml/kg) to rats with chronic brain ischemia had almost no effect on cerebral blood flow, but contributed to the improvement in memory formation and retrieval processes in the Morris water maze. The treatment effect was comparable for both drugs and persisted after 10 days of treatment break. Morphological assessment showed a decrease in the severity of pathological changes in the hippocampal regions. CONCLUSION: The course-administration of cortexin and cerebrolysin lead to a decrease in the severity of memory impairment and pathomorphological changes in the hippocampus in rats with chronic brain ischemia.


Assuntos
Isquemia Encefálica , Aminoácidos , Animais , Circulação Cerebrovascular , Heme/análogos & derivados , Hipocampo , Peptídeos e Proteínas de Sinalização Intercelular , Masculino , Ratos , Ratos Wistar
20.
PLoS One ; 15(9): e0238224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881886

RESUMO

OBJECTIVE: We previously showed that MELAS patients have decreased cerebrovascular reactivity (CVR) (p≤ 0.002) and increased cerebral blood flow (CBF) (p<0.0026); changes correlated with disease severity and % mutant mtDNA (inversely for CVR; directly for CBF). We ran a prospective pilot in 3 MELAS sibs (m.3243A>G tRNALeu(UUR)) with variable % mutant blood mtDNA to assess effects of L-Arginine (L-Arg) (single dose and 6-wk steady-state trial) on regional CBF, arterial CVR and neurovascular coupling. METHODS: Patients were studied with 3T MRI using arterial spin labeling (ASL) to measure CBF and changes in % Blood Oxygen Level Dependent (BOLD) signal to changes in arterial partial pressure of CO2 to measure CVR. Task fMRI consisted of an alternating black and white checkerboard to evaluate visual cortex response in MELAS and controls. RESULTS: Following L-Arg, there was restoration of serum Arg (76-230 µM) in MELAS sibs and a trend towards increasing CVR in frontal and corresponding decrease in occipital cortex; CVR was unchanged globally. There was a 29-37% reduction in baseline CBF in one patient following 6 wks of L-Arg. Pre-treatment fMRI activation in response to visual cortex stimulus was markedly decreased in the same patient compared to controls in primary visual striate cortex V1 and extrastriate regions V2 to V5 with a marked increase toward control values following a single dose and 6 wks of L-Arg. CONCLUSION: Proposed "healing" effect may be due to more efficient utilization of energy substrates with increased cellular energy balances and ensuing reduction in signalling pathways that augment flow in the untreated state. CLASSIFICATION OF EVIDENCE: This prospective pilot study provides Class III evidence that oral L-Arginine (100 mg/kg single dose or 100 mg/kg three times daily po X 6 weeks) normalizes resting blood flow from elevated pre-treatment levels in patients with MELAS syndrome, selectively increases their CVR from reduced pre-treatment levels in regions most impaired at the expense of less abnormal regions, and normalizes reduced BOLD fMRI activation in response to visual cortex stimulus. CLINICAL TRIALS.GOV (NIH): NCT01603446.


Assuntos
Arginina/uso terapêutico , Circulação Cerebrovascular/fisiologia , Síndrome MELAS/tratamento farmacológico , Acoplamento Neurovascular/fisiologia , Administração Oral , Adolescente , Arginina/sangue , Arginina/farmacologia , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Dióxido de Carbono/sangue , Circulação Cerebrovascular/efeitos dos fármacos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Acoplamento Neurovascular/efeitos dos fármacos , Ornitina/sangue , Oxigênio/sangue , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Córtex Visual/efeitos dos fármacos , Adulto Jovem
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