ALTERATIONS OF COGNITIVE PERFORMANCE AND BRAIN PERFUSION AS ASSESSED BY CONTRAST ENHANCED MRI IN REVASCULARIZATION OF CAROTID ARTERY STENOSIS. PDF Download
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Author: Marlene Heinze
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Languages : en
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Background and Aims:There is evidence suggesting a detrimental effect of asymptomatic carotid artery stenosis on cognitive function even in the absence of ischemic cerebral lesions. Hypoperfusion has been suggested as pathophysiological mechanism causing cognitive impairment. We aimed to assess cognitive performance and cerebral perfusion changes in patients with carotid artery stenosis without ischemic lesions by contrast enhanced (CE) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent CE perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (CE-CBF), mean transit time (CE-MTT), cerebral blood volume (CE-CBV)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:Multivariate analysis revealed a significant impact of revascularization therapy on all perfusion measures analyzed. At baseline post-hoc testing showed significant hypoperfusion in MCA borderzones as assessed by CE-MTT and CE-CBV, but not in CE-CBF. All perfusion alterations normalized after revascularization. We did not observe any significant correlation of cognitive test results with perfusion parameters. There was no significant change in cognitive performance after revascularization.Conclusions:We found evidence of traceable perfusion alterations in patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Marlene Heinze
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Languages : en
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Background and Aims:There is evidence suggesting a detrimental effect of asymptomatic carotid artery stenosis on cognitive function even in the absence of ischemic cerebral lesions. Hypoperfusion has been suggested as pathophysiological mechanism causing cognitive impairment. We aimed to assess cognitive performance and cerebral perfusion changes in patients with carotid artery stenosis without ischemic lesions by contrast enhanced (CE) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent CE perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (CE-CBF), mean transit time (CE-MTT), cerebral blood volume (CE-CBV)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:Multivariate analysis revealed a significant impact of revascularization therapy on all perfusion measures analyzed. At baseline post-hoc testing showed significant hypoperfusion in MCA borderzones as assessed by CE-MTT and CE-CBV, but not in CE-CBF. All perfusion alterations normalized after revascularization. We did not observe any significant correlation of cognitive test results with perfusion parameters. There was no significant change in cognitive performance after revascularization.Conclusions:We found evidence of traceable perfusion alterations in patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Julian Schroeder
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Languages : en
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Several studies have suggested a correlation between impairment of cognitive function and asymptomatic carotid artery stenosis without ischemic cerebral brain lesions. Hypoperfusion has been discussed as a possible underlying pathophysiological cause. It remains unclear whether hypoperfusion alone without evidence of infarction is sufficient to cause cognitive decline. In this study, we evaluated cognitive performance and cerebral perfusion changes in patients with asymptomatic carotid artery stenosis by arterial spin labeling (ASL) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent ASL perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (ASL-CBF), bolus arrival time (ASL-BAT)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:A significant impact of revascularization therapy was shown through multivariate analysis on all perfusion measures analyzed. MCA borderzones were identified as territories showing significant hypoperfuion at baseline post-hoc testing in both ASL-CBF and ASL-BAT. All perfusion alterations normalized after revascularization. No significant correlation of cognitive test results with perfusion parameters was observed. Cognitive Performance showed no significant change after revascularization. Conclusion:Our study was able to show perfusion alterations in asymptomatic patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Simona Lattanzi
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Languages : en
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Background and Aims: The effects of carotid revascularization on the neurocognitive functioning still remains elusive. The aim of this study was to evaluate the changes in cognitive performance and their predictors in patients with symptomatic high-grade internal carotid artery (ICA) stenosis undergoing carotid endarterectomy (CEA). Methods: Participants were patients who underwent CEA and had history of transient ischemic attack within the past 6 months due to ipsilateral severe ICA stenosis. Coloured Progressive Matrices plus Complex Figure Copy Test, and phonemic plus categorical Verbal Fluency tests were performed to assess right and left hemisphere cognitive functions, respectively. Cerebral hemodynamics was assessed with transcranial Doppler ultrasonography by means of the cerebral vasomotor reactivity (CVR) to hypercapnia.Results: One hundred and ninety patients were enrolled. At 6 months from CEA, the scores obtained in the cognitive tests exploring the re-vascularized hemisphereu2019s functions and ipsilateral cerebral hemodynamics were significantly improved. At multivariate linear regression analysis, the change in cognitive performance was inversely associated with age [u00df=-0.17, 95% confidence interval (CI) -0.23 to -0.12; p
Author: Fanny Quandt
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Languages : en
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Carotid artery stenosis is a well-known risk factor for ischemic stroke. Moreover, even in the absence of stroke, asymptomatic carotid stenosis has been associated with cognitive impairment. It has been suggested that disturbed functional brain connectivity might underlie cognitive impairment in asymptomatic carotid stenosis in the absence of structural brain damage. If so, then carotid revascularization should have an effect on the hypothesized brain network disturbances in these patients. We studied resting-state 64-channel EEG in 12 patients with high grade (u226570%) asymptomatic carotid stenosis before and 6 - 8 weeks after revascularization (carotid endarterectomy or carotid artery stenting). Data were compared with 23 controls of comparable age. We investigated the imaginary EEG coherence in a motor network located within the affected (stenosis side) and unaffected middle cerebral artery territory. At baseline, we observed decreased connectivity of the alpha (8 u2013 13 Hz) and beta (14 u2013 25 Hz) frequency band of EEG oscillations in patients with carotid stenosis compared with healthy controls, particularly on the affected side. After revascularization, a significant increase of functional connectivity was observed. At 6 u2013 8 weeks after revascularization, patients did not significantly differ from healthy controls anymore. In summary, we identified oscillatory connectivity changes in asymptomatic patients with impaired brain perfusion resulting from carotid artery stenosis, that normalized after restoration of cerebral blood flow. Hence, electrophysiological changes might be a reversible precursor preceding macroscopic structural damage and behavioral impairment in patients with asymptomatic carotid stenosis.
Author: László Csiba
Publisher: Cambridge University Press
ISBN: 1107659159
Category : Medical
Languages : en
Pages : 333
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Book Description
Neurosonology is non-invasive, portable, and has excellent temporal resolution, making it a valuable and increasingly popular tool for the diagnosis and monitoring of neurological conditions when compared to other imaging techniques. This guide looks beyond the use of neurovascular ultrasound in stroke to encompass a wide range of other neurological diseases and emergencies. It offers a practical approach to the examination of patients, interpretation of ultrasound studies, and the application of neurosonology to the development of management and treatment strategies. Each chapter incorporates a thorough and clear procedural methodology alongside scanning tips for trainees; this step-by-step approach is further enhanced by example images and focused diagnostic questions. Authored and edited by international experts, this practical manual of neurosonology is an invaluable resource for neurologists, neurosurgeons, intensivists, radiologists, and ultrasonographers.
Author: Jean Chen
Publisher: Humana
ISBN: 9781071617625
Category : Medical
Languages : en
Pages : 218
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Book Description
This volume provides a comprehensive overview of the methodology, physiology, and contemporary and novel applications of cerebrovascular reactivity (CVR) measurements. The chapters in this book cover topics such as an introduction of the neurophysiology, neuroimaging, and clinical methods for CVR measurement; the use of CVR methods in the study of aging, cerebrovascular dysfunction, dementia, and brain tumors; and recommendations for measurement protocols and future applications in clinical translation. In Neuromethods series style, chapters include the kind of detail and key advice from the specialists needed to get successful results in your research center and clinical investigation. Thorough and comprehensive, Cerebrovascular Reactivity: Methodological Advances and Clinical Applications is a valuable tool that provides researchers in neuroscience and neurology with the latest resources on the measurement, interpretation, and application of CVR measurement.
Author: Juerg Hodler
Publisher: Springer Nature
ISBN: 303038490X
Category : Medical
Languages : en
Pages : 252
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Book Description
This open access book offers an essential overview of brain, head and neck, and spine imaging. Over the last few years, there have been considerable advances in this area, driven by both clinical and technological developments. Written by leading international experts and teachers, the chapters are disease-oriented and cover all relevant imaging modalities, with a focus on magnetic resonance imaging and computed tomography. The book also includes a synopsis of pediatric imaging. IDKD books are rewritten (not merely updated) every four years, which means they offer a comprehensive review of the state-of-the-art in imaging. The book is clearly structured and features learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers navigate the text. It will particularly appeal to general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic expertise, as well as clinicians from other specialties who are interested in imaging for their patient care.
Author: Michael Brainin
Publisher: Cambridge University Press
ISBN: 1107047498
Category : Medical
Languages : en
Pages : 425
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Book Description
Fully revised throughout, the new edition of this concise textbook is aimed at doctors preparing to specialize in stroke care.
Author: Marilyn J. Cipolla
Publisher: Biota Publishing
ISBN: 1615047239
Category : Medical
Languages : en
Pages : 82
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Book Description
This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.
Author: José Biller
Publisher: Cambridge University Press
ISBN: 1316351726
Category : Medical
Languages : en
Pages : 281
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Book Description
Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning – all desirable generic skills for health care professionals. This book is a teaching tool that bridges the gap between textbook information and everyday experience of clinicians 'in the trenches'. Leading practitioners bring a practical approach to these complex conditions, highlighting specific areas of diagnostic uncertainty in evaluation and treatment. Each case is taken from real-world clinical practice and reviews the diagnostic and treatment process in a systematic manner, identifying common challenges and potential pitfalls. This concise and useful guide in the Common Pitfalls series provides a step-by-step guide for everyday clinical practice, invaluable to anyone dealing with cerebrovascular disease on a front-line basis. The intended readership is trainees and non-specialist practitioners in neurology, stroke medicine, and neurosurgery.
