Том 9, брой 2 - 2013/ Vol. 9, No. 2 - 2013

M. Alpaidze, N. Kurashvili
DEKA Medical Centre University Clinic – Tbilisi, Georgia

Objective: RCVS is a cerebrovascular disorder associated with multifocal arterial constriction. The primary clinical manifestation is recurrent sudden-onset and severe headache. Diagnosis requires cerebral angiography confirmation and ultrasound monitoring. Our aim is to determine the difference of ultrasound data and clinical manifestation between RCVS and different forms of headache.

Material and Methods: 84 patients (age range 20-60 y., 55-female, 29-male) underwent sonography examination using TCD and TCCD methods. Group I-18 patients had RCVS typical acute-onset severe headaches, namely thunderclap headaches reaching peak intensity within 1 min. Group II-19 patients- migraine in anamnesis, with 1-2 attacks monthly (ultrasound examinations were performed in attack free period), Group III- 37 patients with severe headache for 1-3 hours, the period 1-3 months. This group was divided into subgroups: III-a) 17 patients -after attack felt confusion, anxiety and problems with concentration. III-b)-20 patients- during attack felt dizziness, nausea, vomiting, blurred vision, after attack-depression and cognitive dysfunctions. Group IV-10 controls.

M. De Lima Oliveira, H. Picarelli, A. Blassioli Barbosa, S. Brasil Lima, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: Radical resection of brain metastases can be associated with better outcome. The gold standard intraoperatory method to detect residual tumors is magnetic resonance (RM). However this method requires long image acquisitions time, intravenous contrast (gadolinium) to disclose residual lesions and is restrict to some neurosurgical centers. Among the image methods, intra operatory ultrasound (IOUS) has been a reliable tool for assessing residual lesions after macroscopic tumor excision.

Material and Methods: Thirty six patients with presumed diagnosis of brain metastases (BM) were underwent a surgery with IOUS to pint point tumors, delineate their margins and intra operatory control resection. A total 46 lesions were removed by microscopic surgeries. IOUS was performed in all operations. A prospective study compared the last 2D IOUS control after tumor resection with pos operatory magnetic resonance (MRI) and enhanced contrast tomography (CT) in terms of quality in residual lesion detection. Control MRI and enhanced CT were performed in 75% of patients. Control CT and MRI were considered when it was performed until five months after surgery.

E. Azevedo 1, S. Penas 2, C. Ferreira 1, L. Martins 2, A. Campilho 3, J. Polónia 4
1 Department of Neurology,
2 Department of Ophthalmology, São João Hospital Center and Faculty of Medicine of University of Porto,
3 Institute of Biomedical Engineering, University of Porto,
4 Arterial Hypertension Clinic of Hospital Pedro Hispano and Faculty of Medicine of University of Porto – Porto, Portugal

Objective: Diabetes mellitus (DM) leads to accelerated progression of arteriosclerosis in comparison to non-diabetic patients (non-DM). Retinopathy is a major microvascular complication of DM remaining a leading cause of blindness. Aortic stiffness and an increase in carotid artery intima-media thickness (IMT) are macrovascular complications that are associated with increased cardiovascular morbidity-mortality. It has been suggested that in DM blood pressure levels are more determinant than glycemic control of macrovascular lesions whereas retinopathy is more dependent on glycemic control.

A. Chiti 1, N. Giannini 1, G. Carignani 2, P. Cristofani 2, G. Gialdini 1, E. Terni 1, A. Chilosi 2, G. Orlandi 1
1 Neurological Clinic, University of Pisa,
2 Department of Developmental Neuroscience, University of Pisa – Pisa, Italy

Objective: To study hemispheric lateralization of language in a group of children with deep hearing loss and cochlear implant (CI) and in a control group (CG) by functional transcranial Doppler (fTCD).

Material and Methods: CI (N=14; 9 female, mean age 6 years, range 4-13) were divided by age of implant in ‘early’ (ECI, 6 subjects, implant <30 months) and ‘late’ (LCI, 8 subjects, implant > 30 months). CG included normal-hearing subjects matched for sex, age and hand preference. Traces obtained from fTCD (whose task consisted in description of a cartoon, with 30 trials, each lasting 38 sec) were processed by Average software that provided a lateralization index (LI) which, if positive, indicated a left hemisphere language lateralization.

S. Tromp 1, M. Braat 2, J. Van Der Heijden 3, M. Van Egdom 1, P. Dekker 1, M. Haringsma 1, J. Vos 2
1 St Antonius Hospital, Department of Clinical Neurophysiology,
2 St Antonius Hospital, Department of Radiology,
3 St Antonius Hospital, Department of Cardiology – Nieuwegein, Netherlands

Objective: This study was conducted to determine if the use of an emboli protection device prevented distal embolisation in carotid stenting procedures.

Material and Methods: We retrospectively analyzed data of 837 carotid stent procedures between December 1997 and January 2012. Cerebral embolisation was monitored using transcranial Doppler of the ipsilateral middle cerebral artery. Isolated microembolic signals and microembolic showers (cardiac cycles with too many embolisms to count separately) were counted.

N. Antonova 1, X. Dong 2, P. Tosheva 1, E. Kaliviotis 3, I. Velcheva 4
1 Department of Biomechanics, Institute of Mechanics, Bulgarian Academy of Sciences – Sofia, Bulgaria,
2 School of Civil Engineering, Tianjin University – Tianjin, China,
3 Division of Engineering, King's College – London, UK,
4 Department of Neurology, University Hospital of Neurology and Psychiatry “St. Naum”, Medical University – Sofia, Bulgaria

Objective: The aim of the study is to perform 3D numerical analysis of blood flow in the carotid artery bifurcation with and without stenoses.

Material and Methods: The analysis is based on the numerical simulation of Navier-Stokes equations. Four cases of carotid bifurcation are considered: common carotid artery (CCA) bifurcation without stenoses, with one, two and three stenoses are presented too. The analysis is performed considering one pulse wave period and it is based on the finite volume discretization of the Navier-Stokes equations.

I. Velcheva 1, N. Antonova 2, E. Titianova 3,4, P. Damianov 1
1 University Hospital of Neurology and Psychiatry, Medical University – Sofia,
2 Institute of Mechanics, Bulgarian Academy of Sciences – Sofia,
3 Military Medical Academy – Sofia,
4 Medical Faculty of Sofia University St. Kl. Ohridski – Sofia, Bulgaria

Objective: To assess the complex influence of blood viscosity and blood pressure on the neurosonographic parameters in the common carotid artery (CCA) in patients with chronic unilateral cerebral infarctions (CUCI).

Material and Methods: Thirty two patients with CUCI, 58 patients with risk factors (RF) for cerebrovascular disease (CVD) and 25 controls were included in the study. The blood flow velocities (BFV), the internal diameters (D) and the vessel wall intima-media thickness (IMT) in the CCA were recorded by color duplex sonography. Systolic (SBP) and diastolic (DBP) blood pressure were measured and mean blood pressure (MBP) was calculated by the formula of Wiggers. Additional division of the patients in subgroups with MBP < 100 and ≥ 100 was performed. The blood flow velocities (BFV), the internal diameters (D) and the vessel wall intima-media thickness (IMT) in the CCA were recorded. Whole blood viscosity (WBV) at the shear rate of 94,5 s-1 was measured on the day of the Doppler ultrasound examination and the wall shear stress (WSS), the circumferential wall tension (T) and the tensile stress (τ) were calculated.

H. Xing, T. Wang, W. Sun, R. Liu, Q. Peng, K. Xu, Y. Huang
Peking University First Hospital – Beijing, China

Objective: Measurement of carotid plaque volume and its progression are important tools for research and patient management. In this study, we investigate the observer reproducibility in the measurement of plaque volume as determined with VOCALTMII technique by 3-dimensional (3D) ultrasound (US). We also investigate the effect of plaque size and position on measurement reproducibility.

Material and Methods: Sixty five 3D US patient images of plaques (range, 53.5 to1008.5 mm3) were measured by VOCALTMII technique. The intraclass correlation coefficient (ICC) was applied to determine observer variabilities.

T. Tegos, A. Petrakis, A. Valavanis, A. Safouris, A. Papadimitriou, A. Orologas
A Neurology Department, AHEPA Hospital, Aristotelian University of Thessaloniki – Thessaloniki, Greece

Objective: Previous studies concluded that symptomatic carotid plaques are echolucent on ultrasound, whereas asymptomatic ones are echogenic. The aim of this study was to determine whether juxtaluminal plaque echogenicity (juxtaluminal 25% plaque area) constitutes a better discriminator of the symptomatic and asymptomatic status, as compared to global plaque echogenicity, in various degrees of stenosis.

Material and Methods: Analysis involved imaging by duplex of 100 carotid plaques of more than 50% stenosis (86 patients, 50 symptomatic and 50 asymptomatic plaques), capturing, digitisation and normalisation in a computer in a standard way. The global plaque Grey Scale Median (GSMglobal) was evaluated to distinguish dark (low GSM) from bright (high GSM) plaques. Subsequently, juxtaluminal 25% plaque area GSM (GSMjl25%) was evaluated semi-quantitatively in the same computer software. Stenosis was evaluated on duplex.

H. Nagai, F. Nakagawa, H. Eda, S. Higiwara, M. Daisu, T. Uemura, T. Miyazaki, Y. Akiyama
Department of Neurosurgery, Shimane University Faculty of Medicine – Izumo, Japan

Objective: In-stent restenosis (ISR) is a major problem that can occur during long-term follow-up after carotid artery stenting (CAS). Patients who undergo CAS are usually followed using three-dimensional enhanced computed tomography angiography (3D-CTA) for two years after the procedure, and with carotid duplex sonography (CDU) thereafter. However, it is not clear which factors serve as predictors of late-onset ISR or how to use data from CDU to make subsequent management decisions. Therefore, we compared the differences between patients without ISR (no-ISR group) and patients with high-grade ISR (defined as more than 40% stenosis according to the NASCET method).

M. Staneva, Ts. Tsvetanov, V. Chervenkoff, D. Markov, P. Antova
Department of Vascular Surgery and Angiology, Tokuda Hospital – Sofia, Bulgaria

Objective: To examine native carotid artery without stenosis and carotid artery after endarterectomy (CEA) without restenosis by Color-coded Duplex Ultrasound (CDU) in men, to compare the ultrasound findings and derive ultrasound criteria for postoperative follow-up.

Materials and Methods: We have followed-up two groups of patients: first group - 40 men, mean aged 66,8 years who had CEA mean 2,1 years. Second – group of controls – 40 men, mean aged 68,3 years without cerebrovascular desease. We have evaluated the diameter of the arteries (mm) (common carotid artery (CCA), bifurcation of the CCA (CCAbif), distal internal carotid artery (ICAdist); beginning, center and end of the patch), the peak systolic (PSV) and the end diastolic (EDV) velocities (cm/s) at the same points by using CDU.

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