Dynamic cerebral autoregulation is compromised in ischaemic stroke of undetermined aetiology only in the non-affected hemisphere

Tutaj, Marcin; Miller, Małgorzata; Krakowska-Stasiak, Małgorzata; Piątek, Anna; Hebda, Jadwiga; Łątka, Mirosław; Strojny, Jacek; Szczudlik, Andrzej; Słowik, Agnieszka

doi:10.1016/j.pjnns.2013.12.006

Cited by 9 publications

(25 citation statements)

References 26 publications

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“…Only two studies demonstrated a higher gain on the affected 23,40 and unaffected hemispheres 23 in AIS patients. However, on pooled analyses, gain was significantly lower (signalling better autoregulation) in AIS compared to control.…”

Section: Gainmentioning

confidence: 96%

“…25,30,33,50 Eleven studies presented the modified Rankin Scale (mRS). 13, 24, 27, 29, 32, 35-38, 43, 46 Moreover, the majority of participants were recruited within 6 to 72 hours from stroke onset, 2, 12, 13, 24-27, 29, 34-40, 42, 43, 45-47, 49, 51 including within 48 hours (n = 8), 2, 25, 34-36, 39, 47, 49 five studies assessed dCA at 72 hours, 24,29,40,45,51 twenty-four hours were studied in four studies, 37,42,43,46 three studies examined dCA between 30 to 37 hours, 12,13,38 dCA was assessed at 6 hours (n = 2), 26,27 one study assessed between onset to 16 days, 52 other three studies recruited participants after first week of stroke onset 32,33,48 and one study examined recovery at 6 months. 49 The location of the lesion was identified in the MCA (n = 13), 23, 26-28, 33-37, 40, 41, 49, 51 posterior cerebral artery (n = 3), 31,32,49 and anterior cerebral artery territories (n = 3), 2, 25, 52 though eight studies did not specify the precise localization of the lesion.…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…reporting unit of gain as cm/s/mmHg, 23,32,35,38,41,47,49,50,52 six studies as %/%, 29,31,33,39,43,46 four studies as %/mmHg, 27,45,48,50 with dB and amplitude used for one study each. 28,40 Two units were used for phase with twenty four studies presenting degrees 23, 24, 26-36, 39, 41-44, 46, 47, 49, 51, 52 and four studies using radians. 38,40,48,50 Phase by affected and unaffected hemispheres Data were pooled from nine studies by using the mean difference (MD).…”

Section: Transfer Function Analysis Parametersmentioning

confidence: 99%

“…28,40 Two units were used for phase with twenty four studies presenting degrees 23, 24, 26-36, 39, 41-44, 46, 47, 49, 51, 52 and four studies using radians. 38,40,48,50 Phase by affected and unaffected hemispheres Data were pooled from nine studies by using the mean difference (MD). Phase was significantly lower in AIS compared to controls, for both the affected ( Figure 3B).…”

Section: Transfer Function Analysis Parametersmentioning

confidence: 99%

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Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest

Intharakham

Beishon

Panerai

et al. 2019

J Cereb Blood Flow Metab

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Dynamic cerebral autoregulation (dCA) has been shown to be impaired in cerebrovascular diseases, but there is a lack of consistency across different studies and the different metrics that have been proposed for assessment. We performed a systematic review and meta-analyses involving assessment of dCA in ischemic and hemorrhagic stroke. Thirty-three articles describing assessment of dCA with transfer function analysis (TFA) were included, with meta-analyses performed for derived parameters of gain, phase and autoregulation index (ARI). A total of 1233 patients were pooled from 12 studies on acute ischemic stroke (AIS) and two studies on intracerebral hemorrhage (ICH). In comparison with controls, TFA phase of AIS was significantly reduced (nine studies), in both hemispheres ( P < 0.0001). TFA gain provided inconsistent results, with reduced values in relation to controls, for both hemispheres. The ARI (six studies) was reduced compared to controls, in both hemispheres ( P < 0.005). In ICH, gain showed higher values compared to controls for the unaffected ( P = 0.01), but not for the affected hemisphere. Meta-analyses in AIS have demonstrated that phase and the ARI index can show highly significant differences in comparison with healthy controls, while ICH have been limited by the scarcity of studies and the diversity of units adopted for gain.

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Section: Gainmentioning

confidence: 96%

Section: Participant Characteristicsmentioning

confidence: 99%

Section: Transfer Function Analysis Parametersmentioning

confidence: 99%

Section: Transfer Function Analysis Parametersmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest

Intharakham

Beishon

Panerai

et al. 2019

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

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“…Based on previous studies [21,22,23,24], we measured forehead tHb, HbO 2 , and deoxyHb within 72 h (first measurement) and 7–10 days (second measurement) after AIS onset. After placing probes on the forehead, the participant laid on his/her back.…”

Section: Methodsmentioning

confidence: 99%

Transient Laterality of Cerebral Oxygenation Changes in Response to Head-of-Bed Manipulation in Acute Ischemic Stroke

Katayama

Odagiri

Hakamata

et al. 2019

JCM

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Background: Cerebral oxygenation monitoring provides important information for optimizing individualized management in patients with acute ischemic stroke (AIS). Although changes in cerebral oxygenation are known to occur in response to head-of-bed (HOB) elevation within 72 h after onset, changes in cerebral oxygenation during stroke recovery are unclear. We compared changes in total- (tHb), oxygenated- (HbO2), and deoxygenated-hemoglobin (deoxyHb) concentrations in response to HOB manipulation between the timeframes within 72 h and 7–10 days after AIS onset. Methods: We measured forehead ΔtHb, ΔHbO2, and ΔdeoxyHb in response to HOB elevation (30°) within 72 h (first measurement) and 7–10 days (second measurement) after AIS onset using time-resolved near-infrared spectroscopy. Results: We enrolled 30 participants (mean age 72.8 ± 11.3 years; 13 women) with a first AIS. There were no significant differences in ΔtHb, ΔHbO2, or ΔdeoxyHb measurements on the infarct or contra-infarct side. At the first measurement, ΔtHb, ΔHbO2, and ΔdeoxyHb measured on the contra-infarct side did not correlate with those measured on the infarct side: ΔtHb (r = 0.114, p = 0.539); ΔHbO2 (r = 0.143, p = 0.440); ΔdeoxyHb (r = 0.227, p = 0.221). Notably, at the second measurement, correlation coefficients of ΔtHb and ΔHbO2 between the contra-infarct and infarct sides were statistically significant: ΔtHb (r = 0.491, p = 0.008); ΔHbO2 (r = 0.479, p = 0.010); ΔdeoxyHb (r = 0.358, p = 0.054). Conclusion: Although changes in cerebral oxygenation in response to HOB elevation had a laterality difference between hemispheres within 72 h of AIS onset, the difference had decreased, at least partially, 7–10 days after AIS onset.

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Do acute stroke patients develop hypocapnia? A systematic review and meta-analysis

Salinet

Minhas

Panerai

et al. 2019

Journal of the Neurological Sciences

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Purpose: Carbon dioxide (CO2) is a potent cerebral vasomotor agent. Despite reduction in CO2 levels (hypocapnia) being described in several acute diseases, there is no clear data on baseline CO2 values in acute stroke. The aim of the study was to systematically assess CO2 levels in acute stroke. Material and methods: Four online databases, Web of Science, MEDLINE, EMBASE and CENTRAL, were searched for articles that described either partial pressure of arterial CO2 (PaCO2) and end-tidal CO2 (EtCO2) in acute stroke. Results: After screening, based on predefined in-and exclusion criteria, 19 studies were retained. There were 5 studies in intracerebral haemorrhage and 14 in ischemic stroke, totalling 614 stroke participants. Acute stroke was associated with a significant decrease in CO2 levels compared to controls (-1.28 mmHg [95% CI -2.20 to -0.37]; I 2 = 78%, p=0.006). Cerebral haemodynamic studies using transcranial Doppler ultrasonography have demonstrated a significant reduction in cerebral blood flow velocities and cerebral autoregulation in acute stroke patients. Conclusion:The evidence from this review suggests that acute stroke patients are significantly more likely than controls to be hypocapnic, supporting the value of routine CO2 assessment in the acute stroke setting. Further studies are required in other to evaluate the clinical impact of these findings.

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Dynamic cerebral autoregulation is compromised in ischaemic stroke of undetermined aetiology only in the non-affected hemisphere

Abstract: During the first days of ischaemic stroke of undetermined aetiology, dynamic cerebral autoregulation is compromised in the non-affected hemisphere, but not in the hemisphere with ischaemic lesion.

Cited by 9 publications

References 26 publications

Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest

Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest

Transient Laterality of Cerebral Oxygenation Changes in Response to Head-of-Bed Manipulation in Acute Ischemic Stroke

Do acute stroke patients develop hypocapnia? A systematic review and meta-analysis

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