[Carotid endarterectomy. A critical analysis of current studies].
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Carotid Arteries↗
Biomedical subjects
M Hennerici
Publications and source records attributed to M Hennerici.
On the influence of spatial resolution and of the size and form of regions of interest on the measurement of regional cerebral metabolic rates by positron emission tomography.
Factors that affect the accuracy of the positron emission tomographic (PET) quantification of cerebral metabolic rates include the spatial resolution of the employed imaging device and the method used for extraction of regional metabolic values from the PET data set. The present article reviews (i) how and to what extent these two factors are presumed to influence the measurement of absolute values of cerebral metabolic rates and their ratios, and (ii) whether and how these factors may affect comparisons of regional metabolic rates between groups of subjects.
Brain↗
Regional cerebral glucose consumption measured by positron emission tomography in patients with Wilson's disease.
Using positron emission tomography (PET), the regional cerebral metabolic rate of glucose consumption (rCMRGlc) was measured in 14 patients with Wilson's disease (WD) and 23 normal subjects. In WD patients, cerebellar, striatal and--to a lesser extent--cortical and thalamic rCMRGlc were significantly decreased compared with controls. Striatal rCMRGlc was significantly reduced in those 4 patients who had recently started decoppering therapy as compared with striatal rCMRGlc measured in those 10 patients with longer duration of medication. Caudate rCMRGlc correlated significantly with various signs of extrapyramidal dysfunction. Cerebellar, thalamic and cortical rCMRGlc correlated significantly with the severity of pyramidal signs. These data indicate that the PET measurement of rCMRGlc may be a useful tool to evaluate cerebral involvement in WD and to monitor the response to treatment.
Adult↗
Magnetic resonance imaging follow-up in Creutzfeldt-Jakob disease.
The history of a 67-year-old woman with histologically proven Creutzfeldt-Jakob disease (CJD) is presented. Before typical clinical and neurophysiological signs of CJD developed, magnetic resonance imaging (MRI) showed slightly enhanced signal intensity of the caudate nuclei and putamina in T2-weighted and proton density images, corresponding to spongiform degeneration in neuropathological examination. Five weeks later characteristical progressive cortical atrophy was demonstrated by follow-up MRI.
Aged↗
Comparison of flow disturbances in small carotid atheroma using a multi-gate pulsed Doppler system and Doppler color flow imaging.
The capacity of a multi-gate pulsed Doppler (MPD) system and Doppler color flow imaging (DCFI) for the evaluation of flow patterns was studied in 14 patients with 17 nonstenotic carotid plaques (luminal narrowing less than 40%). Plaque morphology was assessed by means of a high-resolution B-mode system with subsequent three-dimensional reconstruction of the lesion surface. MPD velocity profiles obtained proximally, centrally and distally to the plaque (51 analyses) were normal in 31 sites corresponding to 28 undisturbed and 3 turbulent flow patterns assessed by Doppler color flow imaging (90% specificity). Of the 10 irregular MPD flow profiles, DCFI detected turbulence in 7 (70% sensitivity). 10 asymmetric MPD waveforms without irregularities were normal in 7 and turbulent in 3 DCFI studies. These results suggest, that MPD is superior to DCFI for the detection of nonturbulent flow asymmetry nearby small carotid plaques. However, DCFI displays turbulence with a high specificity and reasonable sensitivity and visualizes the morphologic-hemodynamic interaction in carotid atherosclerosis simultaneously.
Aged↗
Stroke and dolichoectatic intracranial arteries.
During a 6-year-period, in 45 patients the diagnosis of dolichoectatic intracranial arteries was established. Dolichoectasia of the vertebrobasilar system was the most frequent finding (n = 39). Twenty-two patients presented with brain stem ischaemia, and 10 patients had ischaemic hemispheric events. Six patients had symptoms due to compression of cranial nerves. Hydrocephalus was observed once. Peak and mean flow velocities in 39 patients with dolichoectatic basilar arteries as revealed by transcranial Doppler ultrasound were significantly reduced (p less than 0.00001) when compared with an age-adjusted control group of 20 patients without evidence of vertebrobasilar dolichoectasia on angiogram. Non-invasive MR-angiography offered an excellent imaging of the vascular abnormality. The combined use of CT, TCD, MRI and MR-angiography allows reliable non-invasive diagnosis of dolichoectatic intracranial arteries. This condition seems to play an underestimated role in stroke patients, in particular with respect to the vertebrobasilar circulation.
Brain Ischemia↗
Hypoglycemia presenting as basilar artery thrombosis.
BACKGROUND AND PURPOSE: Following our treatment of a patient with hypoglycemia-induced brain stem symptoms, we examined the possible mechanisms for hypoglycemia presenting as basilar artery disease. CASE DESCRIPTION: We describe a patient who had progressive brain stem symptoms due to a diet-induced hypoglycemia initially diagnosed as basilar artery thrombosis. Symptoms ceased immediately after intravenous glucose. CONCLUSIONS: Before invasive diagnostic and thrombolytic strategies are considered, hypoglycemia as a rare but important cause of acute brain stem dysfunction must be considered in patients suspected to suffer from basilar artery thrombosis.
Adult↗
Spontaneous vertebral artery dissection initially mimicking myocardial infarction.
BACKGROUND AND PURPOSE: Vertebral and carotid artery dissections may present with very different signs and symptoms, making early recognition difficult. However, diagnosis should be established as soon as possible to prevent unnecessary diagnostic investigations and to institute adequate treatment. CASE DESCRIPTION: A 46-year-old man presented with severe intermittent pain of his left upper arm and general discomfort. During extensive cardiological evaluation for suspected myocardial infarction, a severe brain stem syndrome occurred. Ultrasound Doppler studies detected vertebral artery dissection, which was confirmed by angiography. CONCLUSIONS: The unusual initial presentation of vertebral artery dissection delayed an early diagnosis and adequate treatment. Because noninvasive methods are available today, their applications are recommended in similarly uncharacteristic circumstances.
Aortic Dissection↗
Symptomatic and asymptomatic high-grade carotid stenoses in Doppler color-flow imaging.
We examined 63 patients with 31 symptomatic and 44 asymptomatic carotid stenoses with Doppler color-flow imaging (DCFI); conventional Doppler duplex had shown a hemodynamic obstruction (greater than or equal to 80% stenosis) in all patients. Analysis of plaque surface morphology demonstrated more ulcerated plaques in symptomatic (43%) than asymptomatic (23%) stenoses. Although the frequency of homogeneous and heterogeneous plaques was not different, calcific lesions were more frequent in asymptomatic (46% versus 29%), and echolucent plaques, probably indicating mural thrombi, were more frequent in symptomatic (29% versus 11%) stenosis. Color-coded hemodynamic patterns, such as jet flow, poststenotic turbulence, or reversed flow, were not different in symptomatic and asymptomatic stenoses. Comparison of DCFI with 30 angiograms showed agreement in plaque surface analysis in 70%. DCFI measurements of area reduction in cross sections correlated with angiography in 85%, while DCFI tended to underestimate the degree of stenosis from diameter reduction in longitudinal cuts. The advanced DCFI technique identified distinct morphologic features but no hemodynamic patterns, separating symptomatic from asymptomatic high-grade carotid stenoses.
Carotid Arteries↗
[Asymptomatic carotid processes--which forms should be surgically treated?].
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Carotid Stenosis↗
[New aspects of therapy and prevention of cerebral infarcts].
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Anticoagulants↗
Imaging in cerebrovascular disease.
High-resolution structural imaging of ischemic lesions now enables the assignment of complex ischemic clinical symptoms to cortical and subcortical lesions. Functional imaging shows some new features of cerebral ischemia which can be directly investigated in the individual patient. Vascular imaging is rapidly improving with the introduction of magnetic resonance angiography (MRA). Today its diagnostic value is unsettled but promising, in particular if used in combination with other techniques like ultrasonography and positron emission tomography (PET).
Brain Ischemia↗
[Traumatic carotid dissection after chiropractic therapy].
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Aortic Dissection↗
Spontaneous oscillations in cerebral blood flow velocity in normal humans and in patients with carotid artery disease.
Spontaneous oscillations in cerebral blood flow velocity (CBFV) in normals and in patients with stenoses or occlusions of the internal cerebral artery were measured using transcranial Doppler sonography. In normal subjects, large oscillations of up to +/- 30% from the mean CBFV were found with low frequencies between 0.4 and 9 cycles/min. No correlations between CBFV oscillations and systemic circulatory parameters were detected. In patients with carotid artery obstructions the CBFV oscillations were significantly reduced in the middle cerebral artery ipsilaterally to a hemodynamically significant lesion, but not contralaterally. Our results support the hypothesis that spontaneous oscillations (B-waves) of small pial vessels are responsible for the CBFV fluctuations.
Adult↗
Orthostatic changes of cerebral blood flow velocity in patients with autonomic dysfunction.
Simultaneous registrations of intracranial blood flow velocity parameters achieved by transcranial Doppler sonography and basic cardiovascular parameters were carried out during orthostatic changes in normal controls, diabetic patients and patients with pandysautonomia. Normal subjects had a rapid increase in heart rate at a constant blood pressure and a slight decrease in cerebral blood flow velocities associated with a mild increase of the pulsatility index (PI) after being tilted from a horizontal to a vertical position. Diabetics showed a fixed heart rate reflecting the disturbed autonomic innervation but only minor changes of cerebral blood flow velocity, which is similar to normal cerebrovascular autonomic regulation. Patients with pandysautonomia had a fixed heart rate associated with a decrease of systemic blood pressure but a failure of compensatory cerebral autoregulation to maintain normal flow velocity values after standing up. The results suggest that in diabetics cerebrovascular autonomic regulation is intact in contrast to cardiac autonomic function, while in patients with pandysautonomia both functions are disturbed. Criteria for the interpretation of autonomic regulatory mechanisms involved in cerebrovascular flow measurements are discussed.
Adult↗
Spectral composition of Doppler signals.
The spectral content of the Doppler signal (as revealed by spectral analysis) provides useful diagnostic information about local hemodynamic conditions. Changes in these conditions are used to diagnose atherosclerotic lesions in arteries accessible to ultrasound. Extremely high frequencies, as found in and distal to a tight stenosis, indicate the presence of a jet, while Doppler signals with a wide bandwidth are related to regions with wide velocity ranges and/or disturbed flow patterns. However, the random interactions of the scatterers, the dimensions of the sample volume, the velocity of the scatterers and the method of signal processing used affect the displayed spectral composition of the Doppler signal. This article reviews the basic mechanisms and cautions the investigator against a quick and superficial interpretation of the results obtained without a proper appreciation of the random fluctuations due to the methods used to record and process the signals.
Humans↗
Doppler colour flow imaging after carotid endarterectomy.
Sixty-six patients (72 carotid arteries) were examined after carotid endarterectomy (CEA) using Doppler colour flow imaging (DCFI). Examinations were performed 4-18 days (mean: 7 days) after surgery (32 patients, 34 arteries) or between 2 and 100 months (mean: 39 months) after CEA (34 patients, 38 arteries). Minor vessel wall abnormalities were found in 36% in the internal carotid artery (ICA) and in 55% in the common carotid artery (CCA) or bifurcation. One patient had a minor residual ICA stenosis after surgery; two low-grade stenoses and three ICA-occlusions were diagnosed at follow-up. Altered flow patterns occurred most in CCA (90%) and were predominantly located adjacent to the vessel wall and in dilated vascular segments of the CCA. Disturbed haemodynamics in the ICA were less marked (57%) and frequently found in the central vessel lumen or diffusely distributed. We conclude that surgically induced changes of the vessel geometry and residual or recurrent vascular wall abnormalities are often associated with distinct haemodynamic disturbances, which can reliably be detected by DCFI.
Blood Flow Velocity↗
Regression of carotid plaques during low density lipoprotein cholesterol elimination.
We performed serial prospective ultrasound examinations of four flat and 17 soft carotid plaques during an average of 17 months in seven patients with heterozygous hypercholesterolemia during heparin-induced extracorporeal low density lipoprotein elimination on precipitation from plasma. By means of a specially designed quantitative three-dimensional ultrasound analysis, significant plaque volume reduction could be evaluated in all subjects, along with a marked reduction of total and low density lipoprotein cholesterol and fibrinogen serum levels.
Adult↗