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

M. De Lima Oliveira, K. Andrade Norremose, A. Negrao Esteves, B. Magalhaes Barbosa Leite, M. Ferreira Machado, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: Bow Hunter´s syndrome (BHS) reflects a perturbation of blood flow provoked by changes in the position of head. Symptoms include syncope, dizziness, vertigo, visual blurriness, drop attacks, tinnitus, hypoacusis, and sensory or motor deficits. Here we describe the application of Transcranial Doppler (TCD) in diagnosis of BHS.

O. Kim 1, S. An 1, S. Oh 1, J. Kim 1, W. Kim 2
1 CHA Bundang Medical Center, CHA University – Seongnam,
2 Kangdong Sacred Heart Hospital, Hallym University College of Medicine – Seoul, South Korea

Objective: Lacunar infarction was considered due to occlusion of small penetrating artery and disease of small cerebral arteriole. Transcranial Doppler (TCD) pulsatile index (PI) has been interpreted as a marker for distal vascular resistance and reflects microangiopahty in cerebral arteries. Therefore, we hypothesized that increased PI might be associated with more large infarct size due to progressed underlying microangiopathy in patients with acute lacunar stroke.

Material and Methods: We included 69 patients with acute lacunar stroke who completed TCD. We used mean PI value of both MCA for analysis. Infarct size was a maximal diameter of acute lesion based on diffusion weighted MRI.

M. De Lima Oliveira, M. Mendes Paschoal Junior, K. Almeida Lins, R. Carvalho De Nogueira, M. Krajnyk De Azevedo, E. Santos Junior, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Introduction: The cerebral vasospasm is considered one of the most common and serious complications of Subarachnoid hemorrhage (SAH) can be a cause of neurological ischemic transient or permanent, and contributes to increased rates of morbidity and mortality of patients. Previous studies suggested that intracranial aneurysms can act as sources of distal embolization. Spontaneous thrombus can be observed within the aneurysmal sac, presumably because of turbulence and slow flow. The aim of this study was to describe the detection of some MES during routine vasospasm monitoring by transcranial Doppler (TCD).

E. Titianova 1,2, I. Velcheva 3, S. Karakaneva 1
1 Clinic of Functional Diagnostics of Nervous System, Military Medical Academy – Sofia,
2 Medical Faculty of Sofia University St. Kl. Ohridski – Sofia,
3 State University Hospital of Neurology and Psychiatry, Medical University – Sofia, Bulgaria

Objective: To study the orthostatic adjustment of cerebral hemodynamics in orthostatic intolerance (OI), based on classification of Thulesius (1976).

Material and Methods: Hemodymanic changes associated with orthostatic challenge were studied in 20 volunteers and 30 patients with OI using a specially designed protocol (E. Titianova and J. Nader, 1999) – a passive 70-degree tilt of the upper part of the body followed by a passive 90-degree whole body tilting and an active stand-up (each one lasting 10 minutes and followed by return to the lying position) were applied. Mean blood pressure (MBP), heart rate and mean blood flow velocity (BFV) of both middle cerebral arteries (MCA) were determined after 10 minutes of rest and after 1, 5 and 10 minutes of each orthostatic position.

I. Velcheva 1, P. Damianov 1, K. Stambolieva 2
1 University Hospital of Neurology and Psychiatry, Medical University – Sofia,
2 Institute of Neurobiology, Bulgarian Academy of Sciences – Sofia, Bulgaria

Objective: To study the changes of the cerebral vascular reactivity after different stimuli in patients with diabetes mellitus type 2.

Material and Methods: Twenty patients with diabetes mellitus type 2 (age range 45-67years) and 10 presumed healthy age and sex matched controls were included in the study. Simultaneous transcranial Doppler, blood pressure and heart rate monitoring was performed at rest and after cold stress, deep breathing and head-up tilt. The systolic (SBP), diastolic (DBP) and mean blood pressure (MBP) were measured and the blood flow velocity (BFV) parameters of the middle cerebral artery (MCA) were recorded. Comparison of the effects of the different stimuli on the blood pressure and BFV was performed.

M. De Lima Oliveira, M. Fernando Paschoal Junior, K Almeida Lins, R. Carvalho De Nogueira, M. Jacobsen Teixeira, E. Bonr-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: The clinical course of patients with fulminant hepatic failure (FHF) is often worsened by loss autoregulation of cerebral blood flow (CBF), which leads to cerebral edema and intracranial hypertension. The development these complications is an important event in patients with FHF that needs intensive care and urgent liver transplantation. To evaluate the hemodynamic and cerebrovascular autoregulation capacity of patients with fulminant hepatic failure before and after liver transplantation and those not undergoing transplantation.

T. Plotnikova, G. Nartsissova
Research Institute of Circulation Pathology – Novosibirsk, Russia

Objective: The estimate cerebral blood flow with trascranial doppler in right brachial artery perfusion during hypotermic circulation arrest during the correction of aortic arch aneurysms and dissections.

Material and Methods: Ten patients (mean age of 52±8,3 years) were monitored. We monitored maximum blood flow velocities of bilateral middle cerebral arteries using the transcranial doppler (Multi-Dop T, Oxford Medical) at four periods: after induction of anestesia, during cardiopulmonary bypass, during antegrade cerebral perfusion and after termination of cardiopulmonary bypass. Also we used trascranial doppler monitoring with embol detection.

M. De Lima Oliveira, M. Fernandes De Oliveira, K. Andrade Norremose, S. Brasil Lima, F. Campos Gomes Pinto, H. Matsushita, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: Treatment of hydrocephalus is still a challenge to medicine. Currently, the retrograde ventriculo-sinus shunt (RVSS) is proposed in order to solve the question of ventricular catheterization complications related to siphoning. Transcranial Doppler can evaluate intracranial hypertension relief after this surgical procedure measuring brain blood flow velocities, pulsatility and resistivity index.

J. Lee 1, H.K. Song 2, S.H. Hwang 3
1 Department of Neurology, National Health Insurance Service Ilsan Hospital – Koyang-shi,
2 Department of Neurology, Hallym University KDSH Hospital – Seoul,
3 Department of Neurology, Hallym University Hospital – Seoul, South Korea

Objective: Carotid arterial stenosis becomes more common and important risk factor for stroke patients in Asian area. We reviewed stroke database to investigate changes of carotid duplex sonographic findings which reflects hemodynamic changes before and after carotid stenting.

Material and Methods: Stroke patients of which carotid stenting have been done when admitted at the National Health Insurance Service Ilsan Hospital from January 2007 to December 2012 with available carotid ultrasound study that was done before and after carotid stenting formed the analysis cohorts. Retrospective review was performed.

A. Chiti 1, N. Giannini 1, F. De Caro 2, G. Gialdini 1, E. Terni 1, E. Giorli 1, M. Puglioli 3, M. Cosottini 3, A. S. Petronio 2, G. Orlandi 1
1 Neurological Clinic,
2 Cardiothoracic Department, University of Pisa – Pisa,
3 Unit of Neuroradiology, Azienda Ospedaliero-Universitaria Pisana – Pisa, Italy

Objective: The risk of transient ischemic attack and stroke following transfemoral aortic valve implantation (TAVI) is 2-10% and is even higher considering silent ischemic brain injury. Periprocedural microembolic signals (MES) and hemodynamic changes (HC) may be considered physiopathological markers of such events. We show neurosonological and neuroradiological data about a patient submitted to TAVI.

Material and Methods: A 78-year-old man underwent TAVI. During the procedure, continuous monitoring of right middle cerebral artery was performed by transcranial Doppler (TCD), in order to reveal MES and HC (left acoustical temporal bone window was inadequate). Moreover, patient underwent brain magnetic resonance with diffusion-weighted sequences (MR-DWI) before and after TAVI.

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 Department of Clinical Neurophysiology,
2 Department of Radiology,
3 Department of Cardiology, St. Antonius Hospital – Nieuwegein, Netherlands

Objective: We studied effects of stent design on embolisation detected by transcranial Doppler during carotid artery stenting.

Material and Methods: We studied 711 carotid stent procedures performed between December 1997 and January 2012. Three stent-types were studied: open-cell (Acculink: free cell area 11.48 mm2, n=271), semi-closed cell (Precise: 5.89 mm2, n=144) and closed-cell (Carotid Wall: 1.08 mm2, n=296). Cerebral embolisation was measured by transcranial Doppler of the ipsilateral middle cerebral artery. Isolated microembolisms and microembolic showers (cardiac cycles with too many emboli to count separately) were counted.

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