Regional cerebral blood flow in lacunar infarction.

Ten cases of lacunar infarction, 10 cases of nonlacunar cerebral thrombosis, and 8 healthy controls who did not have risk factors of cerebrovascular diseases were studied. Subcortical cystic infarctions with a diameter of less than 1.5 cm were classified as lacunar infarction and the other cerebral thrombosis were classified as nonlacunar cerebral thrombosis. Cerebral blood flow examination by Xenon computed tomography (CT) method was performed within 14 days after the onset of stroke. Stable Xenon was inhaled for 3 minutes and CT scan was taken once before the inhalation, 3 times during the inhalation, and 5 times in the washout phase. Regional blood flows in the infarcted area, around the infarcted area, and in the cerebral cortex and the cerebral white matter where the influence of the infarction was considered to be little were measured before and after intravenous injection of 17 mg/kg acetazolamide. In the lacunar infarction, the blood flow in the cerebral cortex where the influence of the infarction was considered to be little was decreased and the cerebrovascular dilatory reserve capacity in the cerebral cortex and the cerebral white matter was decreased. Arteriolosclerosis is considered to be the basic cause of lacunar infarction.     

High blood pressure and inflammation are associated with poor prognosis in lacunar infarctions

Lacunar infarction has long been considered to be associated with good prognosis, however a significant percentage of these patients remain functionally dependent. In this study we sought to investigate the factors associated with poor outcome in patients with lacunar infarction. SUBJECTS AND METHODS: We have performed a secondary study in 113 patients with lacunar infarctions admitted within the first 24 h of symptom onset (mean age 70 years, 57.5% men). Blood pressure, body temperature, serum glucose levels, neurotransmitters and pro-inflammatory markers were measured at admission and during the first 72 h. Stroke severity was assessed by the Canadian Stroke Scale (CSS). Neuroimaging evaluation was performed at admission and between days 4 and 7. Poor functional outcome was considered as a Barthel index <85 at 3 months. RESULTS: 36 patients (31.9%) had poor outcome. Older age (p = 0.009), history of hypertension (p = 0.005), higher body temperature (p < 0.0001), systolic blood pressure (SBP) (p = 0.010), serum glucose (p = 0.002) and interleukin-6 (IL-6) (p < 0.0001) levels, as well as lower CSS score at admission (p < 0.0001) were all predictive factors of poor outcome in bivariate analyses. SBP at admission (OR 2.07, CI 95% 1.04-3.28, p = 0.015) was the only clinical predictor on multivariate analysis. When the logistic model was further adjusted for biomarkers of inflammation and excitotoxicity, IL-6 levels (OR 1.09, CI 95% 1.01-1.26, p = 0.003), but not SBP, was independently associated with poor outcome. This association persisted even after adjusting for potential predictors recorded during the first 72 h of hospitalization. CONCLUSION: High SBP and IL-6 levels on admission may predict poor outcome in patients with lacunar infarction.     

Regional cerebral blood flow and P3 variables in patients with multiple lacunar infarcts.

We measured regional cerebral blood flow (rCBF) and event-related potentials (ERPs) in 36 patients with multiple lacunar infarcts and 14 age-matched normal subjects. rCBF was measured by the 133Xe inhalation method. ERPs were recorded during visual discrimination tasks using three kinds of stimuli. The patients showed lower mean cortical blood flow than normal subjects especially for the frontal cortex. Nontarget P3 latency in patients was longer than in normal subjects, while no significant differences could be found in target P3 latency between the two groups. Nontarget P3 latency correlated with frontal CBF. These results show that frontal lobe dysfunction may be particularly marked with multiple lacunar infarcts and suggest that reduction of frontal CBF is related to the impairment of the automatic processing associated with the nontarget P3 component.     

腔隙性梗死患者脑微出血和动态血压的相关性分析

目的探讨腔隙性梗死患者脑微出血和动态血压的相关性。方法 45例腔隙性梗死患者随机分为脑微出血组21例和对照组24例,监测2组间动态血压值。结果脑微出血组24h收缩压和夜间收缩压显著高于对照组,夜间收缩压下降率小于对照组(P<0.01),24h舒张压高于对照组(P<0.05)。结论 24h收缩压及舒张压、夜间收缩压和夜间收缩压下降率与脑微出血发生有相关性。     

TCD对小动脉病变为主的腔隙性脑梗死脑血流动力学评价

目的探讨以小动脉病变为主要发病机制的腔隙性脑梗死患者的血流动力学改变。方法利用颈部血管彩超和MRA等排除伴有显著大血管病变的患者后,利用TCD观察115例腔隙性脑梗死患者脑内主要动脉的血流动力学改变,并与年龄和动脉血压等进行相关分析。同时以同年龄阶段、头颅影像学检查正常的30例健康体检者作为对照。结果腔隙性脑梗死组大脑中、前、后动脉的平均血流速度均低于对照组、脉动指数均高于对照组[分别为(1．05±0．26)、(1．01±0．24)、(1．05±0．23)和(0．87±0．12)、(0．88±0．20)、(0．88±0．16),均P＜0．05]。其中大脑中、前、后动脉的脉动指数均与年龄呈正相关(r=0．394、0．299、0．352,均P＜0．05),大脑前动脉脉动指数与收缩压和脉压差呈正相关(r=0．338、0．353,P＜0．05),大脑中动脉脉动指数与脉压差呈正相关(r=0．220,P＜0．05)。结论以小动脉为主要发病机制的腔隙性脑梗死患者脑血流动力学表现为血流速度轻度减慢,脉动指数显著升高,其中脉动指数与年龄和动脉血压有一定的关系。     

Flow-mediated dilatation and intima-media thickness in patients with lacunar infarctions

OBJECTIVES: To evaluate systemic endothelial function and atherosclerotic changes in patients with lacunar infarctions (LI) we examined flow-mediated dilatation (FMD) and intima-media thickness (IMT) and compared them to patients with similar risk factors (SR) and healthy controls. METHODS: FMD and IMT were investigated in patients with LI (20 patients, aged 60.9 +/- 7.3 years), 21 age- and gender-matched patients with SR and 21 healthy controls. RESULTS: FMD was more impaired in patients with LI (0.4% +/- 5.0%) compared to patients with SR (3.8% +/- 4.8%) and healthy controls (7.9% +/- 6.0%) (P < or = 0.01), whereas IMT was similarly thickened in both groups of patients. CONCLUSIONS: We found that patients with LI have a diminished FMD, but a similar IMT, compared to patients with SR. Our results reveal that for a given level of atherosclerosis patients with LI have additional endothelial impairment.     

Cerebrovascular reactivity to L-arginine in patients with lacunar infarctions

BACKGROUND: It is well known that endothelial dysfunction plays an important role in the pathogenesis of many cardiovascular disorders. The aim of this study was to test the hypothesis that specific, marked endothelial dysfunction of cerebral arteries is present in patients with lacunar cerebral infarctions. METHODS: Cerebrovascular reactivity to L-arginine, which reveals the function of the cerebral endothelium, was investigated in patients with lacunar infarctions (20 patients, 11 male and 9 female, aged 60.9 +/- 7.3 years), 21 age- and gender-matched asymptomatic patients with similar cardiovascular risk factors (all patients had arterial hypertension) and 21 age- and gender-matched healthy controls. The mean arterial velocity (vm) in both middle cerebral arteries was measured by transcranial Doppler sonography during a 15-min baseline period, a 30-min intravenous infusion of L-arginine and a 15-min interval after L-arginine infusion. Arterial blood pressure, heart rate and CO2 were measured continuously. RESULTS: The measured vm increase during L-arginine infusion in the patients with lacunar infarctions (13.4 +/- 9.1%) was significantly lower compared to the healthy controls (20.5 +/- 9.9%) but similar to that obtained in the patients with cardiovascular risk factors (11.5 +/- 8.9%). CONCLUSIONS: Our results showed that cerebrovascular reactivity to L-arginine, which demonstrates cerebral endothelial function, is significantly impaired in patients with cardiovascular risk factors. Importantly, we found that patients with lacunar infarctions do not show any additional impairment of cerebral endothelial function.     

不同血压控制水平对少量高血压脑出血患者再出血及预后的影响

目的探讨不同血压控制水平对高血压脑出血（<30 mL）患者再出血风险及预后的影响。 方法选取重庆市梁平区人民医院神经外科自2015年7月至2018年7月收治的符合纳入标准的245例患者的临床资料,以单双日随机分成2组,急性期均以静脉用药为主,血压平稳后以口服降压药为主,静脉用降压药为辅。对照组120例患者血压控制在140/80~160/100 mmHg（1 mmHg=0.133 kPa）、试验组125例患者血压控制在140/80 mmHg以下,分析2组患者的临床资料,比较2组患者再出血发生率、脑灌注压、临床神经功能缺损评分（FD）、总的生活能力状态（BI）以及预后情况。 结果2组患者的一般资料比较,差异无统计学意义（P>0.05）;试验组再出血风险较对照组降低,差异有统计学意义（P<0.05）;2组患者的血压控制范围内的脑灌注压比较,差异无统计学意义（P>0.05）;2组发病后3、10、30 d、6个月的FD和BI指数比较,差异均无统计学意义（P>0.05）;发病后半年对再出血患者随访发现,试验组较对照组恢复良好。 结论血压控制在140/80 mmHg以下可降低再出血风险,改善再出血患者的预后。     

控制血压防止高血压脑出血血肿扩大的研究

目的研究控制血压对防止高血压脑出血血肿扩大的效果。方法将96例病程<3h,平均动脉压(MAP)>130mmHg(1mmHg=0.133kPa)的高血压脑出血患者随机分为治疗组(48例)和对照组(48例);治疗组采用舌下含服卡托普利12.5～25mg,每3～4h1次,使MAP≤130mmHg并维持到病后24h,对照组不用任何降压药物,观察并比较两组血肿扩大的发生率。结果治疗组患者舌下含服卡托普利后15min起效,60min时MAP均降至≤130mmHg,并维持稳定,与对照组比较差异有显著性(P<0.05～0.01)。治疗组血肿扩大的发生率8.3%,对照组22.9%,两组比较差异有显著性(P<0.01)。结论舌下含服卡托普利控制高血压脑出血患者发病后24h内的血压可防止其血肿扩大,舌下含服卡托普利安全有效。     

Regional cerebral blood flow decreases during chronic and acute hyperglycemia

The presence of hyperglycemia prior to stroke or cardiac arrest can increase neuronal damage caused by brain ischemia. Acute hyperglycemia shows this effect in animal models of stroke. However, chronic hyperglycemia and chronic hyperglycemia with additional acute elevation of blood glucose are more common premorbid states for stroke patients. The effect of chronic hyperglycemia on regional cerebral blood flow (rCBF) is unclear but blood flow changes may play a role in this ischemic cell damage. We measured rCBF in awake restrained rats that had chronic hyperglycemia induced by treatment with streptozotocin. This was compared to that measured in rats made acutely hyperglycemic by injecting glucose into the peritoneal space. rCBF was measured in 17 brain regions using [14C]iodoantipyrine. During chronic hyperglycemia, when plasma glucose was 29 microns/ml, rCBF was decreased and a regional distribution of this effect was noted; 9 hindbrain regions showed a mean flow decrease of 14% while forebrain regions demonstrated less flow reduction. Acute elevation of plasma glucose during normoglycemia or superimposed on chronic hyperglycemia produced flow reductions of 7% for each 10 microns/ml increment in plasma glucose up to 60 microns/ml. Both chronic and acute hyperglycemia are associated with decreased rCBF and the mechanism for this effect does not appear to adapt to chronic hyperglycemia.     

Regional cerebral blood flow and neurological conditions in patients with surgically treated hypertensive intracerebral hemorrhage

Regional cerebral blood flow (rCBF) was measured in 49 patients with surgically treated hypertensive intracerebral hemorrhage (putaminal hemorrhage 27: thalamic hemorrhage 22). The hematoma evacuation was performed within 14 days after the hemorrhage. For the measurement of rCBF, the intracarotid xenon-133 injection method was used. Two rCBF studies were performed on all patients, the first giving the resting state of the brain perfusion, the second after Prostaglandin E1 (PGE) administration into the internal carotid artery 10 minute after the first study. (PGE was administered 10 micrograms in 5 minutes.) In all patients blood pressure and arterial carbon dioxide tension were examined before and after each CBF study. The evaluation was made by comparing the rCBF maps obtained before and after PGE administration. (A rate of rCBF increase was calculated by dividing each rCBF value obtained after PGE administration by each rCBF value obtained before PGE administration (control value), and the ratio was multiplied by 100.) The PGE-induced reaction patterns were divided into four; the first is the diffuse increase pattern, characterized by a diffuse increase of rCBF values in the hematoma-evacuated area and the surrounding brain; the second is the diffuse decrease pattern, characterized by a global decrease of rCBF values in the hematoma-evacuated area and the surrounding brain; the third is the pattern of intracerebral steal effect, characterized by a decrease of rCBF in the hematoma-evacuated area and an increase of rCBF values in the surrounding brain; and the fourth is the pattern of inverse cerebral steal effect, characterized by an increase of rCBF in the hematoma-evacuated area and a decrease of rCBF in the surrounding brain.(ABSTRACT TRUNCATED AT 250 WORDS)     

Xueshuantong improves cerebral blood perfusion in elderly patients with lacunar infarction

A total of 64 patients with acute lacunar infarction were enrolled within 24 hours of onset. The patients received conventional therapy (antiplatelet drugs and hypolipidemic drugs) alone or conventional therapy plus 450 mg Xueshuantong once a day. The main ingredient of the Xueshuantong lyophilized powder used for injection was Panax notoginseng saponins. Assessments were made at admission and at discharge using the National Institutes of Health Stroke Scale, the Activity of Daily Living and the Mini-Mental State Examination. Additionally, the relative cerebral blood flow, relative cerebral blood volume and relative mean transit time in the region of interest were calculated within 24 hours after the onset of lacunar infarction, using dynamic susceptibility contrast magnetic resonance perfusion imaging technology. Patients underwent a follow-up MRI scan after 4 weeks of treatment. There was an improvement in the Activity of Daily Living scores and a greater reduction in the scores on the National Institutes of Health Stroke Scale in the treatment group than in the control group. However, the Mini-Mental State Examination scores showed no significant differences after 4 weeks of treatment. Compared with the control group, the relative cerebral blood flow at discharge had increased and showed a greater improvement in the treatment group. Furthermore, there was a reduction in the relative mean transit time at discharge and the value was lower in the treatment group than in the control group. The experimental findings indicate that Xueshuantong treatment improves neurological deficits in elderly patients with lacunar infarction, and the mechanism may be related to increased cerebral perfusion.     

Classic risk factors, hypercoagulability and migraine in young women with cerebral lacunar infarctions

OBJECTIVE: Lacunar cerebral infarctions (LACI) in young women is a rare condition which pathogenesis is still not fully recognized. We explored the presence of classic risk factors, hypercoagulability and migraine in young women with LACI. METHODS: Charts of 192 consecutive premenopausal women suffering cerebrovascular insult [125 (65%) haemorhagic, 58 (30%) ischaemic and 9 (5%) unclassified] during a period of 5 years were reviewed. Sixteen out of 58 (27%) patients with ischaemic stroke were identified to have LACI and included in a study. RESULTS: Ten and seven out of 16 LACI women had at least one classical risk factor (hypertension, hyperlipidaemia, smoking or oral contraceptives) or migraine, respectively. LACI patients had slight hypercoagulable state indicated by shorter thrombin and thromboplastin times, higher fibrinogen and higher t-PA antigen than 47 age matched controls (all P < 0.05). In addition in LACI patients with migraine the trend toward more pronounced hypercoagulable state in comparison to LACI patients without migraine was found. The combination of migraine, at least one classic risk factor and hypercoagulability was present in 5/16 (31.25%) of patients. CONCLUSIONS: The combination of slightly to moderately expressed classic risk factors, hypercoagulability and migraine might be a risk profile for LACI in young women. Further studies are needed to clarify risk profile, rather than isolated risk factors, for LACI in a specific group as young women are.     

Regional cerebral blood flow in normal pressure hydrocephalus.

Regional cerebral blood flow (rcbf) was studied preoperatively and at 2 and 6 months postoperatively in 22 normal pressure hydrocephalus patients using xenon-133 inhalation and single photon emission computed tomography. Sixteen of the 22 patients improved (improved group) and six did not (unimproved group). The following comparisons were made: (1) preoperative rcbf in the improved group, to 14 normal elderly volunteers and to that in 59 SDAT (senile dementia of the Alzheimer type) patients; (2) preoperative rcbf in the improved and unimproved groups to determine if rcbf could predict surgical outcome; (3) pre- to postoperative rcbf in the improved group to see if increased cbf accounted for clinical improvement. The findings were: (1) preoperative rcbf in the improved group was lower than that in normal controls but was the same as that in SDAT; however, the ratios of rcbf values in anterior and posterior brain regions were significantly different between improved group and SDAT (p = 0.02); (2) an anterior/posterior ratio of 1.05 correctly classified surgical outcome in 19/22 patients; five of six in the unimproved group were above this cut off while 14/16 in the improved group were below; (3) in the improved group rcbf increased at 2 but not at 6 months after surgery without a corresponding reduction of clinical signs, supporting the notion that increase in cbf probably does not account for clinical improvement in normal pressure hydrocephalus.     

Regional cerebral blood flow in patients with Parkinson's disease.

Regional cerebral blood flow (rCBF) was measured by the xenon 133 inhalation method in 60 patients with Parkinson's disease and compared with flow data obtained in 51 age-matched normal control subjects. Mean brain rCBF was significantly reduced in patients with parkinsonism (9.5%, P less than .001). The most marked and significant rCBF decreases were observed in the older patients (18.8%, P less than .001). There was no correlation between degree of rCBF reduction and duration of parkinsonism. Decreases in hemispheric mean rCBF values were similar in both hemispheres even in patients with unilateral signs. The present study provides additional evidence for involvement of the cerebral cortex in Parkinson's disease. The rCBF decline may be associated in part with high prevalence of mental impairment and cortical atrophy and with diminished cerebral metabolic rate due to brain dopamine deficiency in patients with parkinsonism.     

高血压性脑出血头痛与血压

目的：探讨脑出血头痛与血压的关系。方法：脑出血147例,按有无头病症状分为头痛组和无头痛组,并对有高血压病史、病后血压升高、两者皆有、两者皆无等四个类型给予对照分析。结果：高血压性脑出血发生后约1／3无头痛。脑出血后血压升高与病后头痛无关,与临床表现有关,临床表现越重,血压升高越显著。结论：脑出血后头痛与血压升高是高血压性脑出血的早期症状,但不能作为确诊依据,仅供临床参考。     

Regional cerebral blood flow in patients with schizophrenia

Summary Regional cerebral blood flow was evaluated using Tc99m-HMPAO SPECT in 10 medicated patients with schizophrenia and 9 healthy volunteers. There were no prefrontal regions in the patient group with lower regional indices than in the control group. However, in the left hippocampal region, relative blood flow was significantly increased in the patient group compared with the control group. Furthermore, there was a relative increase in blood flow in the left basal ganglia of the patient group. A negative correlation coefficient was calculated between the relative blood flow in the left middle prefrontal cortex and the severity of the blunted affect, as well as between the relative blood flow in the left basal ganglia and the severity of the anhedonia-asociality. These findings indicate that prefrontal hypoactivity is not invariably present in all schizophrenics and that left basal ganglial hyperactivity may be associated with the effects of antipsychotic treatment and clinical improvement. Moreover, the left hippocampal hyperactivity may correspond to left limbic dysfunction in schizophrenia.     

SPECT studies of regional cerebral blood flow in 8 patients with Japanese encephalitis in subacute and chronic stage

OBJECTIVE: There is a paucity of regional cerebral blood flow studies in Japanese encephalitis (JE). In this communication we report clinical, radiological and single photon emission computed tomography findings in subacute and chronic JE patients. MATERIAL AND METHODS: Eight JE patients whose ages ranged between 10 and 50 years underwent neurological evaluation. Varying degree of parkinsonian features were present in all, dystonia in 4 and abulia in 5 patients. They were subjected to cranial CT, MRI and SPECT studies. CT scan revealed low density area in 7 patients and midbrain involvement in 1. MRI was carried out in 3 patients and revealed medial temporal involvement in addition to bilateral thalamic involvement in all. RESULTS: SPECT results on visual analysis revealed thalamic hypoperfusion in all the patients, frontal hypoperfusion was present in 5 and lentiform hypoperfusion in 2 patients. Frontal or lentiform hypoperfusion was not associated with corresponding CT or MRI changes. On semiquantitative measurement, thalamic hypoperfusion was present in 7, frontal hypoperfusion in 3, occipital in 2 and lentiform in 1 patient. CONCLUSION: These results confirm high frequency of thalamic involvement in JE. The hypoperfusion in thalamus, frontal cortex and lentiform area is consistent with the crucial role of thalamus and its connections in the genesis of movement disorders in JE.