Prediction of cerebral infarct sizes by cerebral blood flow SPECT performed in the early acute stage

1999 ◽  
Vol 13 (4) ◽  
pp. 205-210 ◽  
Author(s):  
Yukio Watanabe ◽  
Hitoshi Takagi ◽  
Shin-ichiro Aoki ◽  
Hiromi Sassa
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Acute Stage ◽  
Cerebral Infarct

Early Effects of Acid-Base Management during Hypothermia on Cerebral Infarct Volume, Edema, and Cerebral Blood Flow in Acute Focal Cerebral Ischemia in Rats

2002 ◽  
Vol 97 (4) ◽  
pp. 868-874 ◽  
Author(s):  
Rainer Kollmar ◽  
Thomas Frietsch ◽  
Dimitrios Georgiadis ◽  
Wolf-Rüdiger Schäbitz ◽  
Klaus F. Waschke ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Edema ◽  
Focal Cerebral Ischemia ◽  
Infarct Volume ◽  
Cerebral Infarct ◽  
Moderate Hypothermia ◽  
Acid Base ◽  
Base Management ◽  
Ph Stat

Background Although the frequency for the use of moderate hypothermia in acute ischemic stroke is increasing, the optimal acid-base management during hypothermia remains unclear. This study investigates the effect of pH- and alpha-stat acid-base management on cerebral blood flow (CBF), infarct volume, and cerebral edema in a model of transient focal cerebral ischemia in rats. Methods Twenty Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion (MCAO) for 2 h during normothermic conditions followed by 5 h of reperfusion during hypothermia (33 degrees C). Animals were artificially ventilated with either alpha- (n = 10) or pH-stat management (n = 10). CBF was analyzed 7 h after induction of MCAO by iodo[(14)C]antipyrine autoradiography. Cerebral infarct volume and cerebral edema were measured by high-contrast silver infarct staining (SIS). Results Compared with the alpha-stat regimen, pH-stat management reduced cerebral infarct volume (98.3 +/- 33.2 mm(3) vs. 53.6 +/- 21.6 mm(3); P > or = 0.05 mean +/- SD) and cerebral edema (10.6 +/- 4.0% vs. 3.1 +/- 2.4%; P > or = 0.05). Global CBF during pH-stat management exceeded that of alpha-stat animals (69.5 +/- 12.3 ml x 100 g(-1) x min(-1) vs. 54.7 +/- 13.3 ml x 100 g(-1) x min; P > or = 0.05). The regional CBF of the ischemic hemisphere was 62.1 +/- 11.2 ml x 100 g(-1) x min(-1) in the pH-stat group versus 48.2 +/- 7.2 ml x 100 g(-1) x min(-1) in the alpha-stat group ( P> or = 0.05). Conclusions In the very early reperfusion period (5 h), pH-stat management significantly decreases cerebral infarct volume and edema as compared with alpha-stat during moderate hypothermia, probably by increasing CBF.

Significance of Quantitative Cerebral Blood Flow Measurement in the Acute Stage after Revascularization Surgery for Adult Moyamoya Disease: Implication for the Pathological Threshold of Local Cerebral Hyperperfusion

2019 ◽  
Vol 48 (3-6) ◽  
pp. 217-225 ◽  
Author(s):  
Masayuki Kameyama ◽  
Miki Fujimura ◽  
Ryosuke Tashiro ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracerebral Hemorrhage ◽  
Perioperative Management ◽  
Pressure Control ◽  
Acute Stage ◽  
Cerebral Hyperperfusion ◽  
Auc Value ◽  
Revascularization Surgery

Objective: Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is a standard surgical procedure for adult patients with moyamoya disease (MMD) and plays a role in preventing ischemic and/or hemorrhagic stroke. Cerebral hyperperfusion (CHP) syndrome is a potential complication of this procedure that can result in deleterious outcomes, such as delayed intracerebral hemorrhage, but the exact threshold of the pathological increase in postoperative cerebral blood flow (CBF) is unclear. Thus, we analyzed local CBF in the acute stage after revascularization surgery for adult MMD to predict CHP syndrome under modern perioperative management. Materials and Methods: Fifty-nine consecutive adult MMD patients, aged 17–66 years old (mean 43.1), underwent STA-MCA anastomosis with indirect pial synangiosis for 65 affected hemispheres. All patients were perioperatively managed by strict blood pressure control (systolic pressure of 110–130 mm Hg) to prevent CHP syndrome. Local CBF at the site of anastomosis was quantitatively measured using the autoradiographic method by N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography 1 and 7 days after surgery, in addition to the preoperative CBF value at the corresponding area. We defined CHP phenomenon as a local CBF increase over 150% compared to the preoperative value. Then, we investigated the correlation between local hemodynamic change and the development of CHP syndrome. Results: After 65 surgeries, 5 patients developed CHP syndrome, including 2 patients with delayed intracerebral hemorrhage (3.0%), 1 with symptomatic subarachnoid hemorrhage (1.5%), and 2 with focal neurological deterioration without hemorrhage. The CBF increase ratio was significantly higher in patients with CHP syndrome (270.7%) than in patients without CHP syndrome (135.2%, p = 0.003). Based on receiver operating characteristic analysis, the cutoff value for the pathological postoperative CBF increase ratio was 184.5% for CHP syndrome (sensitivity = 83.3%, specificity =  94.2%, area under the curve [AUC] value  =  0.825) and 241.3% for hemorrhagic CHP syndrome (sensitivity =  75.0%, specificity =  97.2%, AUC value  =  0.742). Conclusion: Quantitative measurement of the local CBF value in the early postoperative period provides essential information to predict CHP syndrome after STA-MCA anastomosis in patients with adult MMD. The pathological threshold of hemorrhagic CHP syndrome was as high as 241.3% by the local CBF increase ratio, but 2 patients (3.0%) developed delayed intracerebral hemorrhage in this series that were managed following the intensive perioperative management protocol. Thus, we recommend routine CBF measurement in the acute stage after direct revascularization surgery for adult MMD and satisfactory blood pressure control to avoid the deleterious effects of CHP.

scholarly journals The effect of dopamine on cerebral blood flow in acute stage of cerebral thrombosis in man

Nosotchu ◽  
1986 ◽  
Vol 8 (2) ◽  
pp. 115-119
Author(s):  
Hidekazu Nogaki ◽  
Hideki Matsuoka ◽  
Makoto Sasaki ◽  
Kazuhiko Ishida ◽  
Tomonori Nagao
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Acute Stage ◽  
Cerebral Thrombosis

Regional cerebral blood flow in the acute stage of experimentally induced subarachnoid hemorrhage

1983 ◽  
Vol 58 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Felix Umansky ◽  
Thalia Kaspi ◽  
Mordechai N. Shalit
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Regional Cerebral Blood Flow ◽  
Internal Capsule ◽  
Acute Stage ◽  
Regional Cerebral Blood ◽  
Content Type ◽  
Steep Decline ◽  
Triphasic Pattern

✓ Subarachnoid hemorrhage (SAH) was induced in 13 adult mongrel cats by a slow injection of fresh autogenous blood into the cisterna magna. Serial determinations of regional cerebral blood flow (rCBF) in the cortex and deep-seated areas (internal capsule, thalamus, and caudate nucleus) were made during the following 2 hours, while intracranial pressure (ICP) was maintained at normal values. A decrease in rCBF was observed in all the areas examined. This reduction followed a characteristic triphasic pattern with an initial steep decline immediately after the SAH. The clinical implications of these findings are discussed.

Cerebral blood flow and ICP patterns in patients with communicating hydrocephalus after aneurysm rupture

1984 ◽  
Vol 61 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Minoru Hayashi ◽  
Hidenori Kobayashi ◽  
Hirokazu Kawano ◽  
Shinjiro Yamamoto ◽  
Toshio Maeda
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Pressure Range ◽  
System Size ◽  
Aneurysm Rupture ◽  
Acute Stage ◽  
Communicating Hydrocephalus ◽  
Irreversible Damage ◽  
Content Type ◽  
Resting Pressure

✓ Cerebral blood flow (CBF) was measured, the intracranial pressure (ICP) was continuously recorded, and the ventricular system size was evaluated on serial computerized tomography scans in 43 patients. These patients all had communicating hydrocephalus after subarachnoid hemorrhage (SAH) from rupture of an intracranial aneurysm. The studies were carried out both in the acute stage (within 7 days after SAH) and in the communicating hydrocephalus stage. In patients in the acute stage who had no ventricular dilatation, but who later developed communicating hydrocephalus, the mean CBF was reduced; lower CBF was associated with poorer clinical grades and a higher resting pressure range. Communicating hydrocephalus produced a significant decrease in CBF. The ICP tracing showed continuing plateau waves in conjunction with B-waves in patients in whom recordings were begun within 63 days after SAH. In general, patients with more dilated ventricular systems, with less frequent ICP irregularities, and with lower resting pressure ranges had a more marked decrease in CBF. A significant decrease in CBF was also found in patients with diffuse vasospasm in comparison to those without vasospasm. Patients with communicating hydrocephalus in whom ICP recordings were started more than 6 months after SAH showed no ICP irregularities. In these patients, a mean CBF of less than 25 ml/100 gm/min and a markedly low resting pressure range were observed. Shunting procedures were never effective in any of these patients. The results suggest that, in patients with communicating hydrocephalus, a mean CBF below this level may cause irreversible damage to the brain tissue in the terminal stage, and may inhibit the cerebral vasomotor reaction that participates in the development of ICP irregularities.

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