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

S. Andonova-Atanasova 1, D. Mintchev 1, M. Novakova 2, R. Georgiev 2
1 Department of Neurology, Second Clinic of Neurology,
2 Department of Radiology, University Hospital St Marina – Varna, Bulgaria

Objective: The aim of this study is to find the initial changes of brain hemodynamic using color duplex sonography and evoked potentials - brainstem auditory and visual by patients with asymptomatic ischemic disturbances of cerebral circulation.

Material and Methods: By 40 elderly individuals (mean age – 65,7 years) with asymptomatic ischemic disturbances of cerebral circulation – diagnosed with MRI of the brain, was measured a blood flow velocity (BFV) and cerebral vasomotor reactivity (CVR) in the vertebral arteries using color coded duplex sonography. MRI was done at the beginning of the study and at 24 months to measure the severity of white matter changes. Evoked potentials – brainstem auditory and visual were also performed and evaluated in dynamics. It was analysed the latency, configuration and amplitude of the waves.

S. Andonova-Atanasova 1, D. Petkova 2, M. Novakova 3, R. Georgiev 3
1 Department of Neurology, Second Clinic of Neurology,
2 Clinic of Pneumology and Phtisiology,
3 Department of Radiology, University Hospital St Marina – Varna, Bulgaria

Objective: To evaluate the change of intima-media thickness of the carotid artery in patients suffering by obstructive sleep apnea (OSAS) and asymptomatic ischemic disturbances of cerebral circulation.

Materials and Methods: The participants of the study are divided into 2 groups: 12 patients suffering from OSAS and asymptomatic ischemic disturbances of cerebral circulation (mean age 50.7±8.4 years), and a control group of 10 participants (mean age 50.4±8.4 years), having risk factors (RF) for cerebrovascular diseases (CVD) and asymptomatic ischemic disturbances of cerebral circulation but not OSAS. The morphology of the artery wall – the thickness of the intima media complex (IMT) of the common carotid arteries (CCA), the presence of atherosclerotic plaques, their magnitude, echogenicity and stability- are determined by a color-coded duplex sonography of the main arteries of the head.

E. Titianova 1,4, I. Velcheva 5, S. Karakaneva 1, K. Hristova 5, Z. Ramsheva 2, K. Ramshev 3
1 Clinic of Functional Diagnostics of Nervous System,
2 Clinical Laboratory,
3 Department of Cardiology and Intensive Care, Military Medical Academy – Sofia,
4 Medical Faculty of Sofia University St. K. Ohridski – Sofia,
5 State University Hospital of Neurology and Psychiatry, Medical University – Sofia, Bulgaria

Objective: To study the relationship between carotid pathology, cardiac function and risk factors (RF) for cerebrovascular diseases (CVDs).

Material and Methods: Color duplex sonography of carotid arteries was performed in 924 patients: 368 with RF for CVDs, 126 with transient ischemic attacks (TIAs), 287 with chronic unilateral infarction (CUI) and 143 with multiple infarctions. The intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured by B-mode and M-mode scanning. Nonmodifiable (age and sex) and some modifiable (hypertension, diabetes mellitus, atrial fibrillation or other cardiac conditions, dyslipidemia, carotid artery stenoses and obesity) RF for CVDs were evaluated. In 67 subjects with RF, 57 patients with CVDs (31 with TIAs and 26 with CUI) and 16 healthy volunteers correlative clinical, neurosonographic and echocardiographic investigations were performed.

K. Hristova 1, L. Vladimirova 2, F. Nikolov 2, P. Nikolov 2, Tz. Katova 1
1 National Heart Hospital – Sofia,
2 Medical University – Sofia, Bulgaria

Objective: To study the relationship between carotid pathology and exercise stress-test in patients with new onset symptoms for cardiovascular diseases (CVDs).

Material and Methods: Exercise stress-test (EST) and echocardiography were performed in 503 patients (mean age 54±17 years) with symptoms for CVD in two cardiological centers. Based on EST the patients were classified in three groups - with positive, negative or questionable results. Color duplex sonography of both carotid arteries was performed in transverse and longitudinal planes and intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured. No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia, carotid stenosis, obesity, hemorheological variables – leucocytes (Leuc) hemoglobin (Hb), hematocrit (Ht), FR for CVD were evaluated. The pts with positive EST were on PTCA undergone and pts with questionable EST the decision for PTCA was taken after severity of carotid pathology and clinical exam.

M. Staneva 1, P. Antova 1, Ts. Tsvetanov 1, G. Simeonov 2, B. Minkova 1, I. Staikov 3
1 Department of Vascular Surgery and Angiology,
2 Department of Anesthesiology and Intensive Care,
3 Department of Neurology, Tokuda Hospital – Sofia, Bulgaria

Objective: The ain of this prospective study is to define the clinical significance of diagnosis partial or complete thrombosis of Internal jugular vein (IJV) after insertion of a central venous catheter (CVC) in patients in intensive care unit (ICU).

Materials and Methods: Central venous catheter in IJV is implanted to 233 patients for the period 03.2013 to 05.2013. From all the patients 135 are men, 98 are women, mean age 60,6 years. The IJV is evaluated with Color-coded Duplex Ultrasound (CDU), before insertion of the CVC and at the 7th post procedure day, for the existence of partial or complete thrombosis. Some of the patients with trombosis were symptomatic of thet, other – were asymptomatic. Degree of thrombosis was: incomplete small (less than 50% of the lumen); incomplete high (more than 50% of the lumen) and complete thrombosis. While staying in ICU were used to prophylaxis thrombosis low-molecular-weight heparin and antibiotics.

M. Danovska 1, B Stamenov 1, T. Andreev 2, P. Stoev 1, M. Valkova 1, P. Stefanovski 3
1 Neurology Clinic, 2 Neuroimaging Department,
3 Emergency Department, Umhat Georgi Stranski – Pleven, Bulgaria

Objective: To assess the prognostic value of some clinical, ultrasound and neuroradiological parameters on the 30-th day clinical outcome of patients with acute spontaneous intracerebral hemorrhage (sICH).

Material and Methods: We examined 88 patients with sICH admitted to the Neurology clinic of UMHAT “Dr Georgi Stranski”, Pleven within 48 hours after the symptoms onset. The neurological deficit was assessed by the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS) on admission. Clinical outcome on the 30-th day of sICH was evaluated by the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS). Hemorrhage volume was measured on computed tomography (CT) by a simplified formula for the volume of an ellipsoid, (AxBxC)/2. All the patients underwent ultrasound examination of the carotid arteries.The statistical analysis was performed with the Statistical Package for Social Sciences version 19.0 (SPSS) and Statgraphics plus 4.1 for Windows.

M. De Lima Oliveira, A. Ferreira De Andrade, A. Rodrigo Belon, W. Silva Paiva, M. Shimidt Soares, G. Cataxo Patriota, C. Nobrega Nascimento, J. Pinhata Otoch, B. Chian Ping Jeng, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: The image of the real-time ultrasound combined with pulsed Doppler system is a noninvasive and bedside method that allows the cerebral blood flow velocity and evaluation and flow resistance measurement in intracranial hypertension patients. The intracranial hypertension is an important clinical condition and represents high risk to patients with acute brain injury. In this study, we describe in an experimental model, application of cerebral duplex to evaluate changes in pre and post-intracranial hypertension.

G. Tekgol Uzuner, N. Uzuner
Eskisehir Osmangazi University – Eskisehir, Turkey

Objective: We assessed the motor stimulus to blood flow velocity (BFV) changes of bilateral middle cerebral arteries (MCAs) by transcranial Doppler (TCD) sonography in patients with acute ischemic cerebrovascular events and normal subjects.

Material and Methods: Fourty-three patients (20 female, 23 male; aged 55.6 years) with acute territorial stroke in the MCA territory, 38 patients (11 female, 27 male; aged 57.6 years) with acute lacunar stroke in the MCA territory, and 19 control subjects (9 female, 10 male; aged 53.5 years) were investigated. Bilateral TCD sonography from both MCAs were monitored during 10 cycles of 20 seconds when subjects are performing hand gripping with a frequency of one per second, and subsequently 20 seconds when they are rest to assess BFV changes on activated cortical motor areas. BFV increase was calculated off-line for each subjects.

M. Mijajlovic
Neurology Clinic, Clinical Center of Serbia and School of Medicine University of Belgrade – Belgrade, Serbia

The use of transcranial Doppler (TCD) is well established in the evaluation of many neurovascular conditions; however its use in cerebral vasculitis is less well documented.

Ultrasound has the highest resolution among the imaging techniques that are in use for the diagnosis of vasculitis. High-frequency probes provide an axial and a lateral resolution of 0.1 mm. Ultrasound depicts well the artery wall and provides information about blood flow characteristics.

M. De Lima Oliveira, B. Lembo Conde De Paiva, R. Faria Simm, P. Henrique Pires Aguira, E. Bor-Seng-Shu
Department of Neurology, Hospital Santa Paula – São Paulo, Brazil

Objective: Cerebral vasospasm following SAH is one of the main causes of secondary brain injury. The incidence peak is between the 7th and 14th day after bleeding. The management of cerebral vasospasm is based on the triple H therapy, although this therapy may not be enough to control the vasospasm complications. In these cases, mechanical or pharmacological angioplasty on the affected vessel may be indicated if neurological deterioration occurs. Sedated or comatose patients make clinical evaluation difficult and limited. Combining different brain monitoring techniques can provide valuable information that help physicians to identify patients before clinical deterioration.

M. De Lima Oliveira, S. Paulo Brasil Lima, M. Kranyk De Azevedo, E. Santos Junior, L. Peraza, F. Lacerda Brambilla, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: Intracranial vasospasm is an important cause of brain ischemia when associated to subarachnoid hemorrhage. Multimodal monitoring can detect brain flow decrease and patients with high risk to develop brain ischemic lesions. TCD can detect and measure vasospasm intensity in the large intracranial arteries. Usually the oximetry catheter is implanted in the area most likely to occur vasospasm, which is near of brain bleeding. It can measure brain tissue oxygen (PtiO2) in areas with oligoemia associated to vasospasm. They give support to plane treatment to improve brain blood flow in patients suffering brain vasospasm.

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