大脑中动脉闭塞患者侧支循环与脑灌注研究

目的探讨大脑中动脉(MCA)闭塞患者脑侧支循环建立情况及其对脑灌注的影响。方法 46例单侧MCA闭塞患者,均行320排CT血管成像(CTA)联合CT灌注成像(CTP)检查,根据侧支循环分布状况分为侧支循环丰富组和侧支循环减少组,获取双侧MCA供血区的各项脑灌注参数值,即局部脑血流量(cerebral blood volume,CBV)、局部脑血容量(cerebral blood flood,CBF)、达峰时间(time to peak,TTP)及平均通过时间(mean transit time,MTT),用Rcbv、Rcbf、Rttp、Rmtt表示患侧与健侧各灌注参数的比值。对比分析健患两侧的脑灌注差异及两组患者脑灌注的不同。结果相比健侧,患侧MCA供血区TTP明显延长(P0.05),CBV、CBF略升高(P0.05),MTT略延长(P0.05)。侧支丰富组Rcbv、Rcbf均高于侧支减少组(P0.05),Rmtt低于侧支减少组(P0.05),Rttp高于侧支减少组(P0.05)。结论丰富的脑侧支循环可以有效地改善闭塞MCA远端缺血区脑组织的血流灌注。     

Drug effects on regional cerebral blood flow in focal cerebrovascular disease

Hemispheric and regional cerebral blood flow (rCBF) were measured using the scintillation camera connected to a 1600-word memory and digital magnetic tape in a total of 211 patients, of whom 175 suffered from cerebrovascular disease and 36 from other neurological deficits. The effects of different drugs (2 sympathomimetics with α-and 2 with β-receptor stimulation, a central nervous system stimulant, a xanthine, 2 papaverine-like drugs, a vasodilator of cerebral vessels, 1 haemodiluting and 1 dehydrating agent) on hemispheric and regional blood flow were investigated and the results were compared to the blood flow changes between 2 measurements in untreated control patients. For the evaluation of effects on rCBF a regression analysis was applied. Homogeneous and heterogeneous responses of the regional cerebral circulation were observed: β-receptor stimulants and an α- and β-receptor stimulant in combination with xanthine caused a statistically-significant diffuse depression of rCBF, while the cerebral vasodilator hexobendine and haemodiluting and dehydrating agents caused a diffuse increase of rCBF in many cases. A significant heterogeneous response in the form of an intracerebral steal syndrome was observed only with the cerebral vasodilator, while the heterogeneous response in the form of an inverse cerebral steal syndrome was seen after the application of xanthines, papaverine-like drugs and haemodiluting and dehydrating agents. The data obtained in experimental studies of drug effects on cerebral blood flow provide the basis for controlled clinical studies, by which the therapeutic value of drugs for the treatment of cerebrovascular disease has to be proven.     

Clinical implications of collateral middle cerebral artery flow in acute ischaemic stroke with internal carotid artery occlusion

Background and purpose: The presence of collateral middle cerebral artery (MCA) flow via the primary collateral pathway is thought to protect against the progression of cerebral ischaemia. However, there have been few reports on early clinical outcomes according to the presence of collateral MCA flow in acute ischaemic stroke (AIS) with internal carotid artery (ICA) occlusion. Therefore, we sought to investigate the early clinical outcomes and lesion patterns according to the presence of collateral MCA flows in AIS with ICA occlusion. Methods: This is a retrospective study of patients with AIS with ICA occlusion consecutively admitted to our stroke center between October 2008 and March 2010. Patients were included if they were admitted within 12 h of symptom onset with AIS and symptomatic ICA occlusion. Collateral MCA flow was defined as the presence of MCA signals from proximal M1 to distal MCA branches ipsilateral to the ICA occlusion by magnetic resonance angiography. Early neurological deterioration (END) was defined as a 4‐point increase in the National Institutes of Health Stroke Scale (NIHSS) score and persistent neurological deterioration for at least 24 h or newly developed neurological symptoms within 7 days. Results: Sixty‐five patients (42 men, 23 women) were finally included. Initial NIHSS scores were significantly lower, and favorable outcomes at 3 months were better in patients with collateral MCA flow than in those without (P < 0.001). Initial lesion patterns were different according to the collateral MCA flow. However, patients with mild AIS might more frequently deteriorate than those with moderate to severe AIS. Conclusions: In our study, collateral MCA flow reduced initial stroke severity and was associated with favorable outcomes at 3 months but did not seem to protect against END in mild AIS patients with ICA occlusion. Therefore, the results of this study suggest that mild AIS patients with ICA occlusion should be carefully managed because their conditions may deteriorate.     

Multiaxial classification in psychiatry

It looks like carrying coals to Newcastle to speak as a European on multiaxial classification of mental disorders here in the United States because you have just adopted DSM-III, the only official psychiatric classification that has advanced in the direction of multiaxial classification. Furthermore you have had animated discussions on this issue with highly competent contributions by authors such as—to mention only a few—Juan Mezzich, Robert Spitzer, John Strauss.^8,9,12,13Therefore, I intend to stress some historical points of view on conceptual implications in my comment on multiaxial classification in psychiatry. This comment refers partly to a background paper that I prepared together with John Strauss for the new program of WHO on further development of diagnosis and classification of mental disorders.¹⁴     

Expressed emotion and airway conductance in children with bronchial asthma

Fourteen asthmatic children (ages 9–11) and their controls were exposed to a stress inducing competitive achievement situation. Facial expression of emotions were systematically analyzed from video-recordings, and peak expiratory flow rate (PEFR) reduction was measured from pre-stress to post-stress. The asthmatic children showed a significantly lower frequency and duration of overall emotional expression than their controls. Specifically, the frequency and duration of expressed anger/rage, enjoyment/joy, and surprise/startle were lower in the asthmatic children. Moreover, duration of overall expressed emotion showed a significant negative correlation with PEFR reduction in the asthmatic group, indicating a relevant relationship between facial expression of emotions and breathing function.     

Towards precise brain stimulation: Is electric field simulation related to neuromodulation?

BackgroundRecent research on neural and behavioral consequences of transcranial direct current stimulation (tDCS) has highlighted the impact of individual factors, such as brain anatomy which determines current field distribution and may thus significantly impact stimulation effects. Computational modeling approaches may significantly advance our understanding of such factors, but the association of simulation-based tDCS-induced fields and neurophysiological outcomes has not been investigated.ObjectivesTo provide empirical evidence for the relationship between tDCS-induced neurophysiological outcomes and individually induced electric fields.MethodsWe applied tDCS during eyes-closed resting-state functional resonance imaging (rsfMRI) and assessed pre-post magnetic resonance spectroscopy (MRS) in 24 participants. We aimed to quantify effects of 15-min tDCS using the “classical” left SM1-right supraorbital area montage on sensorimotor network (SMN) strength and gamma-aminobutyric acid (GABA) and glutamate concentrations, implementing a cross-over counterbalanced design with three stimulation conditions. Additional structural anatomical MRI sequences and recordings of individual electrode configurations allowed individual electric field simulations based on realistic head models of all participants for both conditions.ResultsOn a neurophysiological level, we observed the expected reduction of GABA concentrations and increase in SMN strength, both during anodal and cathodal compared to sham tDCS, replicating previous results. The magnitudes of neurophysiological modulations induced by tDCS were significantly associated with simulation-based electric field strengths within the targeted left precentral gyrus.ConclusionOur findings corroborate previous reports on tDCS-induced neurophysiological modulations and further advance the understanding of underlying mechanisms by providing first empirical evidence for the association of the injected electric field and neuromodulatory effects.     

Changes of epidural pressures after experimental occlusion of one middle cerebral artery in cats.

Epidural pressures (EDP) were measured in 29 cats. Twenty cats had the left middle cerebral artery (MCA) occluded; pentobarbital was used for anesthesia for 10 of these, and halothane was used for the other 10. Two cats had sham operations: the MCA was manipulated but not occluded. Seven cats were used for testing the reliability of the EDP devices. EDP was measured successfully and was directly related to the swelling of the brain and to the size of the cerebral infarct resulting from MCA occlusion. Side-to-side pressure gradients were demonstrated in 7 cats with marked increases of EDP after occlusion; in these cats, EDP may have reflected the pressure of compressed cerebral tissue rather than the pressure of cerebrospinal fluid. Cats anesthetized with pentobarbital had greater increases of EDP and died before the end of the period of observation more frequently than cats anesthetized with halothane, probably because of respiratory depression and slower recovery with pentobarbital. Measurements of EDP may be useful for studies of the treatment of cerebral edema in experimental models of acute cerebral ischemia.     

Treating migraine by training in temporal artery vasoconstriction and/or cognitive behavioral coping: A one-year follow-up

A one-year follow-up on 16 chronic migraine patients treated with vasoconstriction biofeedback of the temporal arteries (VT) or cognitive behavioral stress coping training (CT), or one of two serial variations of them, is reported: there were four experimental groups EG-1a: VT, 10 sessions; EG-1b: VT, 5 sessions and CT, 5 sessions; EG-11a: CT, 10 sessions; EG-11b: CT, 5 sessions and VT, 5 sessions. Another group of 4 migraine patients was assigned to a waiting control. All treatment groups decreased the frequency, duration and intensity of headaches, as well as amount of medication from baseline to the one-year follow-up. However, there were no differences between the groups (the controls were not followed-up). During treatment, but not at follow-up 1 (two months after therapy), voluntary vasoconstriction was higher in EG-1a than in EG-11a, although all EGs vasoconstricted. Voluntary vasoconstriction was not tested at one-year follow-up. The cognitive training groups improved more in self-ratings of irritability, depression and positive self-evaluation than the biofeedback or control groups on follow-up 1, but this difference was not maintained at one year. All treatment groups showed deterioration in measure of excitement and depression, returning to pre-treatment levels. Improvements in irritability and positive self-evaluation were however sustained at one year follow-up.     

Correlation between the clinical picture,the EEG and cerebral blood flow after partial occlusion of the middle cerebral artery in man

Summary Quantitative measurements of global and regional cerebral blood flow were performed in 18 patients 1 to 3 days after the onset of symptoms of acute cerebral ischemia due to partial occlusion of the middle cerebral artery and were repeated 21 days thereafter. The first rCBF measurement revealed either an extensive ischemic focus or an ischemic focus with simultaneous reduction of the global blood flow within the corresponding hemisphere in all patients. The later measurements indicated no change in blood flow in the ischemic focus in any case, but there was a slight increase of global cerebral blood flow in 1/3 of the cases.The measurements of cerebral blood flow were correlated with the neurological, psychopathological and EEG findings and in spite of an unaltered cerebral blood circulation, all patients showed a distinct clinical improvement. Various hypotheses for the return of neurological functions in patients with persistent cerebral ischemia are discussed.Paper read at the Kongress der Deutschen Gesellschaft für Neurologie, Hamburg 1975     

大脑中动脉狭窄的侧支循环及其影响因素

目的探讨大脑中动脉(MCA)狭窄程度与侧支循环代偿建立的频率及类型关系;分析影响大脑中动脉侧支循环代偿建立的因素。方法回顾性分析78例MCA狭窄患者的临床资料,比较狭窄程度与侧支循环建立的关系,并比较有侧支循环组和无侧支循环组卒中的危险因素(高血压、高血脂、糖尿病)之间的差异。结果MCA不同的狭窄程度与有无侧支循环存在非常显著性差异(P=0.002);不同的狭窄程度其侧支循环代偿类型存在显著性差异(P=0.024)。糖尿病在有无侧支循环两组之间有差别(P=0.009);对侧支循环是否建立有影响的自变量有狭窄度(OR=4.147,P=0.003)和血脂(OR=7.526,P=0.015)。结论大脑中动脉狭窄程度越重,侧支开放出现的频率和级别越高;糖尿病不利于MCA狭窄后二级侧支循环的建立;MCA狭窄程度越重及高血脂可促进二级侧支循环的建立。高血压与侧支循环建立无明显相关。     

Assessment of the technical usability and efficacy of a new portable dry-electrode EEG recorder: First results of the HOMEONE study

ObjectivesThe HOME project is intended to provide evidence of diagnostic and therapeutic yield of a patient-controlled EEG home-monitoring for neurological outpatients.MethodsThis study evaluated the technical and practical usability and efficacy of a new portable dry-electrode EEG recorder in comparison to conventional EEG devices based on technical assessments and inter-rater comparisons of EEG record examinations of office-based practitioners and two experienced neurologists.ResultsThe technical assessment was based on channel-wise comparisons of band power values derived from power spectra as observed in two recording modalities. Slight yet significant differences were observed only in the Delta-frequency band (1.5–4 Hz). The fraction of automatically detected artifact segments was larger in the new portable recordings than in conventional recordings (20% vs. 11%, median). Overall, 93% of raters’ stated diagnostic findings gathered from conventional devices were concordant with stated diagnostic findings gathered from the new portable device.ConclusionThe new EEG device was shown to have technical comparability to and a high concordance rate of diagnostic findings with conventional EEG devices.SignificanceThe new portable dry-electrode EEG device is suitable to meet the HOME projects’ goal of establishing a patient-controlled EEG home-monitoring in the routine care of neurological outpatients.Trial registrationDRKS DRKS00012685. Registered 09 August 2017, retrospectively registered.     

Case series: Slowing alpha rhythm in late-stage ALS patients

The alpha peak frequency (APF) of the human electroencephalogram (EEG) is a reliable neurophysiological marker for cognitive abilities. In these case series, we document a shift of the APF towards the lower end of the EEG spectrum in two completely locked-in ALS patients. In not completely locked-in ALS patients, the alpha rhythm lies within the common frequency range. We discuss potential implications of this shift for the largely unknown cognitive state of completely locked-in ALS patients.