Assessment of cerebrovascular insufficiency with MR-ASL perfusion in patients with moyamoya angiopathy

Purpose. To develop a methodology for assessing the degree of cerebrovascular insufficiency in patients with moyamoya angiopathy (AMM) based on measurement of cerebral blood flow (CBF) and determination the presence of arterial transit artifact (ATA) using MR method of arterial spin labeling (ASL).Materials and methods. The study included 47 patients with AMM who underwent 148 MR studies in PCASL mode (296 hemispheres), of which 47 (94 hemispheres) were done before surgical treatment. On received perfusion maps 7 areas of interest (ROI) were manually set in the gray and white matter of the brain using “Fusion” technique outside the ATA zones. The CBF values at the central point of the ATA were estimated. In the preoperative stage, 47 patients underwent direct angiography to assess the stage of the disease according to Suzuki, the presence and severity of leptomeningeal and transdural collaterals and MR angiography to assess the stage of the disease according to Houkin and the level of ICA stenosis. Statistical processing included univariate analysis of variance (ANOVA) and chi-square test (IBM SPSS Statistics 23).Results. ATA was detected in 77% of studies (69% of hemispheres). The average minimum CBF in ATA was 120.2 ± 21.1 ml/min/ 100 g at the lower bound of the confidence interval of 117.43 ml/min / 100 g. The average maximum CBF in ATA was 234.9. Depending on the CBF values in the MCA territory and the presence of ATA, 4 degrees of perfusion deficiency were identified: degree 0 (CBF = 64.5 ± 16.2 ml/min / 100 g, without ATA) corresponded to the stage of “compensation” of cerebral blood flow, degree 1 (CBF = 61.5 ± 16.6 ml/min/ 100 g, with ATA) – “subcompensation”, degree 2 (CBF = 26.5 ± 7.2 ml/min/100 g, with ATA) – “initial decompensation”, degree 3 (CBF = 16.0 ± 4.7 ml/min / 100 g, without ATA) – “decompensation”. The highlighted degrees statistically significantly differed among themselves in all ROIs (p < 0.0001). More severe perfusion deficiency corresponded to the more developed stages of AMM according to Suzuki and Houkin, proximal stenosis of the ICA (p < 0.0001), and more severe neurological deficit (p < 0.02). The occurrence of ATA reliably reflected the presence of leptomeningeal collaterals (p < 0.001).Conclusions. The proposed method for assessing patterns of ASL perfusion has a good agreement with the stage of the disease, the presence of sources of collateral circulation, the severity of neurological deficit and can be used to assess cerebrovascular insufficiency in patients with AMM.

Role of autoimmune disorders in the pathogenesis of cerebrovascular insufficiency in children with bronchial asthma

It has been shown that the main spectrum of immunopathological reactions in bronchial asthma in children has a clear antigenic dependence not only on the inflammatory-activated intermediate stroma of the bronchopulmonary system, but also on the effects of autoantibodies on cerebral vessels and cell tissue. insufficiency of this contingent of children, which is currently insufficiently studied. The aim is to study autoimmune disorders in the pathogenesis of cerebrovascular insufficiency in children with bronchial asthma. 121 patients with asthma aged 5 to 15 years in the period of exacerbation were examined. To study the role of the autoimmune component in the development of cerebrovascular insufficiency and its connection with the autoimmune process in the bronchopulmonary system in asthma in children, we used the method of quantitative determination of autoantibodies to lipopolysaccharide antigens of cerebral vessels and topographic structures of the brain and brain, trachea, bronchi and lung tissue. The results showed that the levels of autoantibodies to lipopolysaccharide antigens vessels and cell tissue structures of the brain and bronchopulmonary system in children with asthma significantly increased from mild to severe. The rank correlation showed that there is a direct reliable connection between the autoimmune process in the bronchopulmonary system and the level of autoantibodies to the lipopolysaccharide antigens of cerebral vessels and cell tissue structures of the brain. Thus, it is shown that the level of autoantibodies to lipopolysaccharide antigens arteries, venous vessels and cell tissue structures of the brain, allows to detect lesions of blood vessels and tissue areas of the brain in cerebrovascular insufficiency in children with asthma.

Autoimune component in the development of celebrovascular insufficiency in children with bronchial asthma

Bronchial asthma (BA) remains one of the most serious diseases of our time. A number of studies have shown that this disease in a number of cases, especially with the threat of termination of pregnancy, acute and chronic diseases of mothers, accompanied by fetal hypoxia, originates in the ante- and postnatal period. In general, taking into account the peculiarities of the cellular tissue organization of the brain and cerebrovascular blood supply, prolonged hypoxic lesions increase the activity of the hypothalamic-diencephalic structures and the cerebral cortex. The existing respiratory disorders lead to hemodynamic and metabolic disorders of cerebral structures, emotional sphere and autonomic regulation. However, this issue in childhood requires further study. The aim is to study autoimmune processes in the pathogenesis of cerebrovascular insufficiency in children with BA. Materials and methods. We examined 121 patients with asthma aged 5 to 15 years in the period of exacerbation. To study the role of the autoimmune component in the development of cerebrovascular insufficiency and its relationship with the autoimmune process in the bronchopulmonary system in AD in children, we used a method for the quantitative determination of autoantibodies to lipopolysaccharide antigens (LA) of cerebral vessels and topographic structures of the brain, as well as to homologous LA bronchi and lung tissue. The results of the studies have shown that the first signs of cerebral hemodynamic disturbance are recorded already in patients with mild disease and are aggravated depending on the severity of BA. Conclusions. The most characteristic changes are an increase in the tone of small and medium vessels and impaired cerebral venous circulation. It was also found that the levels of autoantibodies to lipopolysaccharide antigens of cerebral vessels and cellular tissue structures of the brain correlate with an increase in the level of autoantibodies to lipopolysaccharide antigens of the trachea, bronchi and lung tissue and reflect the severity of AD in children.

Neuroimaging patterns of chronic cerebrovascular insufficiency with evaluation of cerebral perfusion depending on the level of cognitive disorders

Aim. To evaluate the neuroimaging patterns of chronic cerebrovascular insufficiency with cerebral perfusion assessment depending on the level of cognitive impairment.Materials and methods. The 58 patients aged 50–79 years were examined: 45 patients with a diagnosis of сhronic cerebrovascular insufficiency and 13 conditionally healthy volunteers. Patients with Chronic cerebrovascular insufficiency were ranked into three subgroups depending on the severity of cognitive impartment (CI). T1-, T2, T2*- VI, DWI, FLAIR and non-contrast MR perfusion (ASL) were included in the MR-protocol (Toshiba Vantage Titan, 1.5 T). The analysis of MRM patterns of Chronic cerebrovascular insufficiency was carried out according to STRIVE criteria. The total cerebral blood flow and regional in the frontal and parietal lobes were evaluated by the ASLperfusion.Results. A relationship was found between the degree of leukoaraiosis, the type of expansion of the perivascular spaces of Virchow-Robin and the level of CI. According to ASL, total cerebral blood flow is higher in groups without CI and in patients with severe CI. There is a diffuse decrease of cerebral perfusion in patients with mild CI. This phenomenon is explained by initial impairment of the blood-brain barrier permeability, damage to the microvasculature. Relative hyperperfusion in the cortex of the frontal and parietal lobes of patients with dementia indicates the ineffectiveness of increased cortical blood flow and the resulting shunt blood flow due to the high resistance of the altered small cerebral vessels under high pulsating properties of the main arteries.Conclusion. ASL perfusion is a complementary link to the STRIVE criteria in the diagnosis of chronic cerebrovascular insufficiency. The absence of changes in cerebral perfusion in patients with subjective manifestations of chronic cerebrovascular insufficiency makes it advisable to search for new methods for the diagnosis of preclinical stages of vascular cognitive impairment.

Cognitive and emotional impairment in patients with chronic cerebrovascular insufficiency

Cerebrovascular disease is one of the most important problems of clinical neurology, which is a significant cause of cognitive impairment and depression. Chronic forms of cerebrovascular insufficiency are most often associated with cerebral microangiopathy or a disease of small vessels, which is characterized by the presence of lacunae, microinfarction and microbleeding, leukoaraiosis and dilated perivascular spaces. One of the main and most common clinical symptoms is vascular cognitive impairment. They are characterized by extremely variable cognitive deficits, highly dependent on the location and severity of vascular damage. However, clinical manifestations associated with impaired frontal circulation are usually observed. Recent international criteria for vascular cognitive impairment presented by the VASCOG (International Society for Vascular Behavioral and Cognitive Disorders) working group emphasize the particular importance of impaired information processing speed, attention, and/or frontal regulatory functions, often in combination with personality or emotional disorders. The frequency of vascular depression in chronic cerebrovascular insufficiency reaches 70%. The addition of affective disorders significantly aggravates the existing cognitive deficit, increases the risk of dementia. This is due to the fact that depression itself leads to the development of cognitive impairment, causes multiple functional disorders of cerebral microcirculation and a number of other mechanisms. The presence of cerebral microangiopathy underlying this pathology makes the use of drugs with vascular effects in the treatment of these patients. The use of preparations with multimodal action, in particular the combined drug and, is most preferable.

Dyscirculatory encephalopathy in clinical practice

Dyscirculatory encephalopathy (DE) or chronic cerebrovascular insufficiency (CPVC) is a condition in which the delivery of nutrients and oxygen to the brain cells is impaired, and damage and impairment of the functions occur in these cells. It is worth noting that elderly people suffer from this disease more often, but there has been a disappointing tendency of early onset of the disease. Clinical picture of this syndrome is as follows: impaired memory, speech, hearing; function of maintaining balance and even gait suffer, in rare cases there are urinary disorders — all this inevitably leads to a decrease in the quality of human life.