Clinical Neuroscience

[Vasoreactivity changes of healthy volunteers investigated by transcranial doppler]

VALIKOVICS Atilla1, OLÁH László1, FÜLESDI Béla1, MUNKÁCSY Csaba1, CSIBA László1

JANUARY 20, 1996

Clinical Neuroscience - 1996;49(01-02)

[Transcranial Doppler (TCD) was used to measure the effect of 1 g acetazolamide (Diamox, Lederle) on blood flow velocity in the middle cerebral artery of 50 healthy volunteers (aged 20-70 years). Parameters of blood flow, blood pressure, heart rate and blood gas values were determined before and after intravenous administration of Diamox. The reserve capacity was expressed as a percentage change of baseline values. The acetazolamide did not result in significant blood pressure and blood gas changes. The mean velocity of blood flow before Diamox administration was 59.8+14.4 cm/s. The velocity of flow significantly increased after acetazolamide, peaking after 10 minutes. The extent of reserve capacity was the greatest in the age group of 31-40 years and the smallest in the 61-70 years group. The reaction was longer lasting in age groups over 50 years. Significantly higher flow parameters and greater reserve capacity was found in women than in men at each measuring time point. The reserve capacity depended on age and gender.]

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  1. Debreceni Orvostudományi Egyetem, Ideg- és Elmegyógyászati Klinika

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Clinical Neuroscience

[Differential diagnosis of Parkinson's syndrome]

FERENC Fornádi

[The fundamental improvement of therapy in Parkinson's disease during the last 25 years also led to specific requirements in differential diagnosis of Parkinson-like diseases. It has become rapidly apparent that the idiopathic Parkinson's syndrome can be treated by a substitutional levodopa therapy very well in the beginning. Considering this fact especially in the case of a so-called "primary levodopa failure" a profound differential diagnosis is necessary. On the other hand an initially diagnosed Parkinson's disease can change its character and develops a widening if symptoms secondary to a reduced levodopa responsiveness. This process can be explained bz a spread of affected cerebral systems known as multy system atrophy (MSA). In former times the differentiation of Parkinson-like diseases could only be done by clinical examination and with regard to a missing levodopa responsiveness. In the last decade diagnostic availabilities became more and more. In addition to MRI and SPECT the 18-FDG- and 18-F-levodopa-PET-scan is very helpful in the cases mentioned above. The following presentation of differential diagnosis in Parkinson-like diseases outlines especially the possibilities of PET-screening.]

Clinical Neuroscience

[Sumatriptan autoinjection in the acute treatment of migraine attack]

ERTSEY Csaba, JELENCSIK Ilona, ÁFRA Judit, BOZSIK György

[The authors report the results of the first Hungarian trial of 5-HT1 receptor agonist sumatriptan autoinjector in the acute treatment of migraine. During the treatment of 400 attacks in 67 patients a significant headache relief was reported in 41% after 30 minutes p. i. and 80.5% after 120 minutes p. i., respectively. In the same time frame complete dissolution of the headache was reported in 39.5% and 72%. The majority of the accompanying symptoms disappeared before the headache relief. Migraine recurrence was frequently noted (45.1% of all attacks). Slight side-effects were experienced in 36% of the attacks treated; in one case skin rash and in another one a temporary chest pain was reported. Using the autoinjector device did not pose serious problems to the patients.]

Clinical Neuroscience

[Distant neuromuscular effect of locally injected botulinum toxin]

DIÓSZEGHY Péter, GLAUB Teodóra, MECHLER Ferenc

[Distant neuromuscular effect of locally infiltrated botulinum toxin was studied. The extensor digitorum communis muscle far from the place of injection was sampled with single-fiber EMG in patients treated for spasmodic torticollis. In 2 and 8–16 weeks after the infiltration the mean jitter values increased significantly compared to that of the results before the treatment. Extremely increased jitter values and blocks were found, too. The fiber density was also higher after the botulinum toxin infiltration. The electrophysiological changes may be a consequence of presynaptic blockade, the botulinum toxin induced terminal sprouting of motor axons and formation of new neuromuscular junctions. Parallel with the electrophysiological abnormalities no remote clinical effects were found. The single-fiber EMG proved to be a sensitive method to control the remote neuromuscular effect of botulinum toxin.]

Clinical Neuroscience

[Schizophrenia-like psychotic episode in Multiple sclerosis]

SIMÓ Magdolna, RÓZSA Csilla, BODROGI László, TAKÁTS Annamária

[A case is presented of a twenty-year-old female with multiple sclerosis. In 1990 the patient had three exacerbations with cerebellar, optic and pyramidal symptoms. After a four-year period of remission she was hospitalized with acute schizophrenia-like psychosis. Acute psychosis is an uncommon manifestation of multiple sclerosis which may cause difficulties in differential diagnosis.]

Clinical Neuroscience

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The applications of transcranial Doppler in ischemic stroke

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Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Hungarian Radiology

[Transcranial Doppler monitoring of distal embolism during of carotid stenting]

SZIKRA Péter, VÖRÖS Erika, SZTRIHA László, SZÓLICS Alex

[INTRODUCTION - Reducing the risk of embolisation during endovascular treatment of internal carotid artery stenosis is very important. The rate of embolisation is affected by the different steps of stenting manipulation. Using transcranial Doppler equipment we studied the embolic signals during the different phases of carotid dilatation and stenting. MATERIAL AND METHOD - 50 patients (33 male, 17 female; mean age 64 years) were intraproceduraly monitorized with transcranial Doppler. Predilatation was necessary in nine cases, postdilatation was performed in 39 cases. The number of emboli were measured in seven different steps of endovascular treatment of carotid stenosis. Different type of commercial available endovascular devices were used. RESULTS - Intraprocedural embolisation was observed in every case. In different phases of carotid stenting the rate of embolisation showed marked differences in each phase of carotid stenting. Crossing the stenosis with stent delivery system were accompanied by a low rate of embolism (5.3) compared to the level during stent opening (9.16) and balloon dilatation (9.96). The highest level of embolisation was observed during predilatation (15.9) without the protection of the stent. CONCLUSIONS - We detected embolisation in all of the cases, however the number of embolic signals varied in different phases of carotid artery stenting. Embolisation can be reduced if the most dangerous steps (i.e. pre- and postdilatation) are avoided. Using TCD monitorisation the physician can be informed by the degree of embolisation that may alarm the interventionalist to perform the procedure more carefully, furthermore it can be employed during the training of carotid stenting.]

Hypertension and nephrology

[Gender differences in sport-adaptation of intramural coronary resistance arteries]

TÖRÖK Marianna

[Biomechanical and functional remodeling of coronary resistance arteries in physiological left ventricular hypertrophy has not been analyzed yet, and the possible sex differences are unknown. We aimed to study the biomechanics and function of these arteries during an exercise intervention. Wistar rats were divided into four groups: male and female sedentary controls (MSe and FSe) and male and female animals undergoing a 12-week intensive swim training programme (MEx and FEx). After the training sessions, LV morphology and function were checked by echocardiography, the coronary artery biomechanics and function were examined by pressure arteriography. Elastica remodeling was studied in resorcin-stained histological sections. The female animals had enhanced heart weight/body weight ratio compared to male rats. A similar outer radius and reduced inner radius resulted in an elevated wall-to-lumen ratio in the MEx and FEx animals compared to the sedentary controls. The wall elastic moduli increased in the MEx and FEx rats. The spontaneous tone and TxA2 agonist-induced tone was raised only in ExF animals, whereas the endotheliumdependent relaxation became more effective in ExM rats. Arteries of ExF rats had stronger contraction, whereas arteries of ExM animals had improved dilation. Range of coronary vascular reactivity increased in both exercised male and female rats, but its mechanism was different depending on sex. According to our results the coronary arterioles adapted to an elevated load during long-term exercise and this adaptation depended on sex. The observed sex differences in the biomechanics and function of the coronary resistance arteries of rats may contribute to better understanding of the physiological and pathological function of these arteries in active and retired athletes.]

Clinical Neuroscience

[Effect of mental arithmetic and verbal fluency on the flow velocity in the middle cerebral arteries]

AMREIN Ilona, PÁLVÖLGYI László, DEBRECZENI Róbert, KAMONDI Anita, SZIRMAI Imre

[Introduction - Using transcranial Doppler sonography (TCD), changes in blood flow velocity (BFV) can be measured in the Medial Cerebral Artery (MCA) during cognitive effort. Our goal was to define the time-course and laterality of BFV in healthy vo-lunters during arithmetic and verbal fluency tasks according to handedness. Methods - Twelve subjects (8 right-handed, 4 left-handed) were assessed. The TCD registered BFV in both MCA simultaneously. Heart rate was also recorded using TCD. Finally we included a 16-channel EEG. BFV laterality index (LI) was calculated. Participants were asked to count silently and generate words beginning with a specified letter. To estimate hemispheric differences in BFV, two-tailed Wilcoxon tests were utilized along with correlational analyses. Results - During cognitive effort the BFV changed in a triphasic manner in all participants. A 6-8% elevation of BFV was observed in MCAs without latency at the time of the evoking signal. Laterality of BFV developed after 5-13 seconds during cognitive effort in right-, and several seconds later in left-handed subjects. During tasks the BFV increased in the dominant hemis-phere up to 2.6-4.7% compared to the subdominant one. We also calculated the LI. During the verbal task the LI agreed with the handedness in 9 out of 12 subjects. During the mental arithmetic task, agreement was found in 6 out of 12 subjects. According to LI results we found a discrepancy between verbal and arithmetic tests in 3 out of 12 subjects. Conclusion - Cognitive effort elicites significant bilateral BFV increases in the MCAs, which suggests fast neurogenic regulation. The course of BFV during mental arithmetic proved to be different from course BFV assessed during the word fluency task. Based on the laterality of the BFV, the word-generation task was more sensitive in determining the dominant hemisphere when compared to the mental arithmetic task. The use of LI may help to estimate hemispheric functions even in pathologic circumstances.]

Lege Artis Medicinae

[GENDER ASSOCIATED DIFFERENCES IN THE PROGRESSION OF RENAL DISEASES]

MÜLLER Veronika, SZABÓ Attila

[Increasing evidence suggests an important role of gender in the incidence, progression and different therapeutic possibilities of several diseases. Recent data demonstrated gender associated differences in the development and progression of chronic renal diseases. Present work reviews sexual dimorphism in different chronic renal diseases, summarizes underlying pathophysiological processes and therapeutic possibilities focusing on the role of gender. New evidences may present the base of gender based therapies in the future.]