Non-invasive assessment of the cerebral vasomotor reactivity by means of transcranial doppler sonography during hyper- and hypocapnea

Ringelstein, E. B.; Grosse, W.; Matentzoglu, S.; Glöckner, W. M.

doi:10.1007/bf01713462

Cited by 24 publications

(13 citation statements)

References 2 publications

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“…The percent difference between the middle cerebral artery mean CBFV peak during the CO 2 inhalation and trough during hyperventilation phases was calculated to yield the subject’s vasomotor reactivity (Ringelstein et al, 1988; Ringelstein, Grosse, Matentzoglu, & Glöckner, 1986). Subjects were categorized as “normal” if vasomotor reactivity was in the range of 68–110% or “abnormal” if outside that range (either < 68% or > 110%) (Ringelstein et al, 1986).…”

Section: Methodsmentioning

confidence: 99%

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

et al. 2014

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Background Significant alterations in autonomic nervous system (ANS) function, vasomotor reactivity, and cerebral blood flow may develop from damage to brain ANS regulatory areas in heart failure (HF). This preferentially right-sided injury occurs largely in autonomic structures perfused by the middle cerebral artery. Indications of altered, asymmetrical perfusion raise the potential for further neural damage. Objectives To determine whether the extent of middle cerebral artery blood flow velocity and vasomotor reactivity is altered on one side of the brain over the other in HF vs. control subjects, three ANS challenges were administered—each challenge recruited ANS regulatory areas potentially injured in HF. Methods Transcranial Doppler ultrasonography was used to measure cerebral blood flow velocity and vasomotor reactivity in 40 HF (mean age = 52.7 years, SD = 7.5; 27 males; left ventricular ejection fraction 26.8, SD = 8.3) and 42 control subjects (mean age = 48.3 years; SD = 6.0; 22 males) during 5% CO2 and hyperventilation, Valsalva, and orthostatic (upper body tilt) challenges. Results Lower cerebral blood flow velocity and abnormal vasomotor reactivity (p < .01) were noted in HF middle cerebral arteries during all challenges. More right-sided flow velocity reductions appeared in HF, with laterality differences noted during CO2 and orthostatic (p < .05), but not Valsalva challenges. Discussion Diminished cerebral blood flow velocity and altered vasomotor reactivity were associated with HF, changes being preferentially on the right-side; the asymmetry was more pronounced during CO2 and orthostatic challenges. The impaired blood flow regulation may contribute to the lateralized brain pathology in ANS areas, undermining autonomic control in HF.

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Section: Methodsmentioning

confidence: 99%

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

et al. 2014

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“…3,4 Quantitative assessment of cerebrovascular reactivity (CVR) to acetazolamide can be used to assess the severity of hemodynamic impairment in patients with major cerebral artery occlusive disease. 5,6 In fact, recent prospective studies have demonstrated that reduced CVR after acetazolamide administration can predict the risk for stroke recurrence in patients with symptomatic internal carotid artery (ICA) occlusive disease.…”

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confidence: 99%

Simple Assessment of Cerebral Hemodynamics Using Single-Slab 3D Time-of-Flight MR Angiography in Patients with Cervical Internal Carotid Artery Steno-Occlusive Diseases: Comparison with Quantitative Perfusion Single-Photon Emission CT

Hirooka

Ogasawara²,

Inoue³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Visualization of the peripheral arteries on single-slab 3D time-of-flight (TOF) MR angiography (MRA) can reflect blood flow velocity. The velocity in the middle cerebral artery (MCA) may correlate with cerebrovascular reactivity (CVR) to acetazolamide, which can be used to assess hemodynamic impairment. The goal of this study was to compare the signal intensity of the MCA on MRA versus CVR quantified by perfusion single-photon emission CT (SPECT).

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“…Some further studies in the literature report cerebral autoregulatory measurements by transcranial Doppler sonography but the authors performed only a few tests: Grosse and Ringelstein investigated 21 ICA occlusions and found a markedly decreased C02-reactivity in four cases (19%). 34 The study by Bishop et al included 11 ICA occlusions, of whom two showed an exhausted autoregulatory capacity." A direct comparison ofthe results is not possible because the method of calculating the CO2 reactivity is different.…”

Section: Discussionmentioning

confidence: 99%

The Doppler CO2 test to exclude patients not in need of extracranial/intracranial bypass surgery.

Widder

1989

Journal of Neurology, Neurosurgery & Psychiatry

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Extra/intracranial (EC/IC) bypass surgery does not benefit patients with an occluded internal carotid artery (ICA) who are selected for surgery on the basis of clinical symptoms.' From the pathophysiological point of view this is not surprising: the establishment of an additional collateral pathway from the superficial temporal artery to branches of the middle cerebral artery (MCA) will help only if the circle of Willis is insufficiently developed.2 In this case, the cerebral blood flow (CBF) may be partially maintained by a compensatory autoregulatory dilatation of the intracerebral arterioles; the brain, however, is then more vulnerable to ischaemia during periods of a decrease in systemic blood pressure. Therefore the degree of dilatation of the cerebral arterioles is a more sensitive index than the degree of stenosis, whether or not an ICA stenosis or occlusion is haemodynamically critical.3Twenty years ago, Bloor et al7 proposed that patients at risk of haemodynamic ischaemia could be detected by measuring CBF during vasodilatation caused by CO2 inhalation. The increase in CBF during hypercapnia ("CO2 reactivity") gives a measure of the capability of the intracerebral arterioles to dilate further. This test has been revived during recent years, but it is expensive and few patients have been repor-

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Non-invasive assessment of the cerebral vasomotor reactivity by means of transcranial doppler sonography during hyper- and hypocapnea

Cited by 24 publications

References 2 publications

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

Simple Assessment of Cerebral Hemodynamics Using Single-Slab 3D Time-of-Flight MR Angiography in Patients with Cervical Internal Carotid Artery Steno-Occlusive Diseases: Comparison with Quantitative Perfusion Single-Photon Emission CT

The Doppler CO2 test to exclude patients not in need of extracranial/intracranial bypass surgery.

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