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Using the derived auditory brain stem response to estimate traveling wave velocity.

An estimate of the traveling wave velocity (TWV) was evaluated in 18 young adults to determine the technique's applicability as a possible tool in evaluating Meniere's disease. This TWV estimation uses a derived auditory brain stem response procedure requiring high-intensity masking. The results indicate that on average, TWVs were similar to those obtained via psychophysical measures or electrocochleography. However, instances of undermasking, due to subjects' intolerance, resulted in a number of subjects exhibiting faster than expected TWVs.

Acoustic Stimulation↗

Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern.

BACKGROUND: Left ventricular diastolic dysfunction is common in patients with systolic heart failure and the restrictive type of filling pattern appears to be associated with increased cardiac mortality. Both artrial and brain (or ventricular) natriuretic peptides are also proven markers of the severity of heart failure. The aim of this study was to determine in a large cohort of patients with systolic heart failure whether diastolic abnormalities, and in particular the restrictive filling pattern of transmitral flow velocity, correlate with plasma atrial and brain natriuretic peptide levels. METHODS: Sixty-eight consecutive patients with symptomatic systolic heart failure (ejection fraction < 0.5) underwent two-dimensional Doppler echocardiography of left ventricular systolic and diastolic function, together with measurement of atrial and brain natriuretic peptides. RESULTS: The restrictive filling pattern was present in 62%, the abnormal relaxation pattern in 31% and only 7% were normal. Atrial and brain natriuretic peptide (ANP/BNP) levels were significantly higher in the restrictive compared to the abnormal relaxation group (ANP: 202.2 +/- 31.7 vs 102.5 +/- 22.1 pg.ml-1, P = 0.012; BNP: 277.8 +/- 27.7 vs 162.4 +/- 21.9 pg.ml-1, P = 0.002). In addition, a restrictive filling pattern was associated with lower ejection fractions (P = 0.026), higher pulmonary artery systolic pressure (P < 0.001), larger left atrial size (P = 0.044), and were more likely to be in New York Heart Association class III or IV than those with an abnormal relaxation pattern (P = 0.007). Both atrial and brain natriuretic peptides correlated inversely with ejection fraction (P < 0.001), fractional shortening (P < 0.001), and positively with pulmonary artery pressure (P = 0.004 and 0.001 respectively). There were no significant correlations between single diastolic parameters and atrial or brain natriuretic peptide levels for the total patient group except between mitral peak A wave velocity and brain natriuretic peptides (r = -0.3, P = 0.01). For those with abnormal relaxation pattern mitral, valve E-wave deceleration time correlated significantly with both atrial and brain natriuretic peptide levels (P < 0.01). CONCLUSIONS: This study confirms that the restrictive filling pattern of transmitral flow velocity is a marker of more severe heart failure, as indicated by its association with higher atrial and brain natriuretic peptide levels, lower ejection fraction and higher pulmonary artery pressure. Thus, this easily obtained Doppler-derived marker of diastolic dysfunction is useful for identifying those patients with more severe heart failure.

Aged↗

Quantification of D- and I-wave effects evoked by transcranial magnetic brain stimulation on the tibialis anterior motoneuron pool in man.

Transcranial stimulation in man evokes multiple descending volleys in the spinal cord giving rise to multiple subpeaks in a peri-stimulus-time histogram (PSTH) obtained from a cross-correlation of motor unit discharges with transcranial stimuli. The first volley is termed the D wave, as it is assumed to be evoked by direct excitation of pyramidal tract neurons, whereas the subsequent I waves appear to be generated by indirect excitation of the pyramidal tract neurons via cortical interneurons. It was the aim of this study to obtain an estimate of the effect induced by multiple volleys evoked by transcranial magnetic stimulation on the entire motoneuron pool of the tibialis anterior in awake subjects. A considerable part of a particular motoneuron pool was investigated by sampling responses of a large number (at least 19) from each muscle investigated. In total, three tibialis anterior muscles from three normal volunteers were studied. From each of the 63 units included in this study, a PSTH to 100 transcranial magnetic stimuli and a PSTH to 100 electrical stimuli given to the peroneal nerve were compiled. From the motor unit response to the peripheral nerve stimulation, the latency of the single-unit H reflex peak was obtained. This yielded, the timing of the subpeaks in response to the magnetic stimulation relative to the timing of the H reflex of the same unit, thus eliminating the influence of the peripheral conduction time from the motoneuron to the recording electrode. It was found that 50 (79%) of the motor units exhibited at least two subpeaks in response to the cortical stimulus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Effects of continuous-wave, pulsed, and sinusoidal-amplitude-modulated microwaves on brain energy metabolism.

A comparison of the effects of continuous-wave, sinusoidal-amplitude-modulated, and pulsed square-wave-modulated 591-MHz microwave exposures on brain energy metabolism was made in male Sprague-Dawley rats (175-225 g). Brain NADH fluorescence, adenosine triphosphate (ATP) concentration, and creatine phosphate (CP) concentration were determined as a function of modulation frequency. Brain temperatures of animals were maintained between -0.1 and -0.4 degrees C from the preexposure temperature when subjected to as much as 20 mW/cm2 (average power) CW, pulsed, or sinusoidal-amplitude modulated 591-MHz radiation for 5 min. Sinusoidal-amplitude-modulated exposures at 16-24 Hz showed a trend toward preferential modulation frequency response in inducing an increase in brain NADH fluorescence. The pulse-modulated and sinusoidal-amplitude-modulated (16 Hz) microwaves were not significantly different from CW exposures in inducing increased brain NADH fluorescence and decreased ATP and CP concentrations. When the pulse-modulation frequency was decreased from 500 to 250 pulses per second the average incident power density threshold for inducing an increase in brain NADH fluorescence increased by a factor of 4--ie, from about 0.45 to about 1.85 mW/cm2. Since brain temperature did not increase, the microwave-induced increase in brain NADH and decrease in ATP and CP concentrations was not due to hyperthermia. This suggests a direct interaction mechanism and is consistent with the hypothesis of microwave inhibition of mitochondrial electron transport chain function of ATP production.

Adenosine Triphosphate↗

Monoamine changes in the brain of cats during slow-wave sleep.

We have found that the metabolism of 5-hydroxytryptamine increases in the hippocampus and that the metabolism of dopamine decreases in the striatum and thalamus during slow-wave sleep, and we suggest that these changes are related to this stage of sleep. We have also found that the concentration of dopamine increases in the hippocampus during slow-wave sleep, and suggest that this may be related to the subsequent appearance of paradoxical sleep. These data raise new questions on the hippocampal role in the sleep-wakefulness cycle.

Animals↗

Brain blood volume and blood flow in patients with plateau waves.

Plateau waves, characterized by acute transient rises of the intracranial pressure (ICP), are accompanied by a marked decrease of the cerebral perfusion pressure. Patients with plateau waves, however, often show no clinical symptoms of ischemia of the brain stem, such as vasopressor response or impairment of consciousness during the waves. The authors studied brain blood volume and blood flow with dynamic computerized tomography using rapid-sequence scanning in patients with plateau waves identified during continuous ICP recording. Following an intravenous bolus injection of contrast medium, density-versus-time curves were obtained for the regions of interest; that is, the frontal lobe, the temporal lobe, the caudate nucleus, the putamen, and the pons. The dynamic studies were undertaken when the ICP was high during a plateau-wave phase and when it was low during an interval phase between two plateau waves. The results indicate that, in the cerebral hemisphere (frontal lobe, temporal lobe, caudate nucleus, and putamen), plateau waves were accompanied by an increase in blood volume and, at the same time, a decrease in blood flow. In the pons, however, both the blood volume and blood flow showed little change during plateau waves as compared with the intervals between two plateau waves. These observations may explain why there is no rise in the systemic blood pressure and why patients are often alert during plateau waves.

Adult↗

Spreading depolarization waves triggered by vagal stimulation in the embryonic chick brain: optical evidence for intercellular communication in the developing central nervous system.

Throughout experiments on multiple-site voltage-sensitive dye recordings of neural activity in embryonic chick brain preparations, we have found a novel type of depolarization waves which spread widely from the brainstem to the whole brain region at a rapid rate (mm/s). This depolarization wave was triggered by glutamate-mediated postsynaptic potentials and was especially correlated to N-methyl-D-aspartate receptor function. Evidence that the spreading depolarization wave is eliminated by octanol or 18beta-glycyrrhetinic acid suggests that the depolarization wave depends on functions of gap junctions. The profile obtained with Ca(2+)-imaging experiments also suggests that the propagation of the depolarization wave is accompanied by a calcium wave. These results provide new evidence for intercellular functional communication between neural cells in the vertebrate central nervous system during embryonic development.

Animals↗

Place specific influences on the wave I to V interpeak latency of the auditory brain-stem response.

There is controversy over whether the wave I to V interpeak latency (I-V IPL) of the auditory brain-stem response can be manipulated by cochlear processing. In this study, a forward masking paradigm was used to test the predictions of two contrasting models of I-V IPL generation. The paradigm was designed to determine if the I-V IPL can be affected by masking selected portions of the cochlear response region. The results from ten normal hearing subjects suggest that: (1) waves I and V can be masked semi-independent of each other, and (2) the I-V IPL can be shortened or prolonged by masking the basal or apical portion of the cochlear response region respectively. These findings support the hypothesis that, at least in normal hearing subjects, wave V is biased to reflect more apical cochlear events than wave I. Additionally, they offer tentative support for anecdotal reports of shortened I-V IPLs in the presence of high-frequency hearing loss.

Adult↗

Peripheral high-energy missile hits cause pressure changes and damage to the nervous system: experimental studies on pigs.

The aim of the present study was to investigate pressure changes and possible damage to the central and peripheral nervous system induced by a high-energy missile striking a peripheral extremity. Anesthetized pigs were shot with a high-velocity missile (1,500 ms-1) in their left thigh. Transducers placed in the abdomen and brain recorded short-lasting bursts (1.0 to 1.5 ms) of oscillating pressure waves of high frequency. The amplitude of the pressure waves within the brain was about 125 KPa, and in the abdomen about 270 KPa, with a mean value of transferred energy from the missile of about 700 joules. Concomitantly, there were one or two apneic periods with a duration of a few seconds during the first minute after the shot. No significant changes in the heart rate, blood pressure, or other circulatory parameters were detected. Minor blood-brain and blood-nerve barrier damage occurred. It is concluded that the pressure waves caused by hits of peripheral parts of the body by high-energy missiles may be of such a large magnitude that distant damage to nervous tissue may result.

Abdomen↗

[A study of evoked potentials in the brains of very low birth weight infants].

INTRODUCTION: This work studies the behaviour of the N200 and P300 waves of the brain evoked potentials (BEP) in a group of very low birth weight infants and results are compared with a second group of children whose weight was normal at birth. AIMS: The objective of this study was to determine whether the N200 and, more especially, the P300 waves in children under the age of 3 could be used to assess the development and prognosis of their disorders. PATIENTS AND METHODS: BEP were performed in very low birth weight infants (taken as the test group) and in others whose weight at birth was normal (control group); the difference in ages when the potentials were recorded was not statistically significant. RESULTS: The EEG index was evaluated for both the test and the control group, and a difference was found with a significance of p < 0.001. Latency, in milliseconds, of the N200 wave and the P300 wave was recorded at the same sites for the test and control groups and showed differences with a significance of p < 0.001. CONCLUSIONS: The findings from the EEG and the latencies of the N200 and P300 waves in the BEP of very low birth weight infants are pathological and are linked to immaturity of the brain, which is characteristic of this population. This tool could help to detect developmental disorders and to facilitate a better approach to attending these children.

Brain↗

Astrocyte Ca2+ waves trigger responses in microglial cells in brain slices.

Pathologic impacts in the brain lead to a widespread activation of microglial cells far beyond the site of injury. Here, we demonstrate that glial Ca2+ waves can trigger responses in microglial cells. We elicited Ca2+ waves in corpus callosum glial cells by electrical stimulation or local adenosine triphosphate (ATP) ejection in acute brain slices. Macroglial cells, but not microglia, were bulk-loaded with Ca2+-sensitive dyes. Using a transgenic animal in which astrocytes were labeled by the enhanced green fluorescence protein (EGFP) allowed us to identify the reacting cell populations: the wave activated a Ca2+ response in both astrocytes and non-astrocytic glial cells and spread over hundreds of micrometers even into the adjacent cortical and ventricular cell layers. Regenerative ATP release and subsequent activation of metabotropic purinergic receptors caused the propagation of the glial Ca2+ wave: the wave was blocked by the purinergic receptor antagonist Reactive Blue 2 and was not affected by the gap junction blocker octanol, but enhanced in Ca2+ free saline. To test whether microglial cells respond to the wave, microglial cells were labeled with a dye-coupled lectin and membrane currents were recorded with the patch-clamp technique. When the wave passed by, a current with the characteristics of a purinergic response was activated. Thus, Ca2+ waves in situ are not restricted to astrocytic cells, but broadly activate different glial cell types.

Adenosine Triphosphate↗

The use of hyperventilation in the treatment of plateau waves in two patients with severe traumatic brain injury: contrasting effects on cerebral oxygenation.

We present the case reports of two patients with severe traumatic brain injury who, in the absence of external stimuli, developed episodes of acute elevation of intracranial pressure (plateau waves) associated with jugular bulb oxyhemoglobin (SjO2) desaturation, severe reduction of cerebral tissue PO2 (PbrO2), and deterioration of neurological status. In all of these episodes hyperventilation was successful in extinguishing plateau waves, but in one patient it was associated with an improvement of both the global (increased SjO2) and local (increased PbrO2) cerebral perfusion, while in the other patient it was associated with a reduction of both SjO2 and PbrO2. In both patients the effects of hyperventilation (and other pharmacological treatments) were short-lived; plateau waves reappeared and the patients had to be submitted to decompressive craniotomy (first patient) and cerebrospinal fluid (CSF) drainage (second patient). We conclude that hyperventilation can be useful as a temporary measure to treat plateau waves, but cerebral oxygenation should always be monitored to avoid iatrogenic cerebral ischemia.

Accidents, Traffic↗

Is non-invasive monitoring of intracranial pressure waveform analysis possible? Preliminary results of a comparative study of non-invasive vs. invasive intracranial slow-wave waveform analysis monitoring in patients with traumatic brain injury.

BACKGROUND: An increasing body of evidence supports the concept that intracranial pressure (ICP) slow B waves represent the auto-regulatory response of spontaneous fluctuations of cerebral perfusion pressure. A relationship between cerebral auto-regulation and clinical outcome in patients with traumatic brain injury has also been established. The objective of our prospective clinical study was to compare the B slow ICP waves obtained invasively by standard ICP monitoring to those obtained noninvasively using a new ultrasound technology. MATERIAL/METHODS: In the participating institutions, over a period of six months, thirteen consecutive patients (8 males and 5 females) with severe closed head injuries (GCS < 8) were included in our IRB-approved study. Intracranial pressure and B slow waves, as well as arterial blood pressure and waveforms, were evaluated by standard invasive techniques. Additionally, a new non-invasive ultrasound device, Vittamed (Telematics Scientific Laboratory, Kaunas, Lithuania), was employed for monitoring intracranial blood volume slow waves. Using these modalities, it was possible to compare the changes that occurred with invasive monitoring (Correlation factor RI) and the changes that occurred using non-invasive technology (Correlation factor RN). RESULTS: Bland Altman plot analysis showed positive correlation between the invasively and non-invasively obtained slow intracranial B waves (2sigma = 8.9%, p < 0.0001) and cerebral auto-regulation indexes (RI and RN) (SD = 5%, p < 0.0001). Positive RI and RN values were correlated with poor clinical outcome. CONCLUSIONS: Ultrasonographic technology (Vittamed) may have significant application in non-invasive continuous cerebrovascular auto-regulation monitoring in patients with severe head injuries.

Adolescent↗

Reappearance of brain-stem auditory evoked potentials after surgical treatment of a brain-stem hemorrhage: contributions to the question of wave generation.

We report on a patient suffering a spontaneous hemorrhage primarily located in the right brain-stem; surgical correction of this led to a substantial improvement in clinical deficits. Brain-stem auditory evoked potentials (BAEPs) were recorded on postoperative days 18, 30, 55 and 205. Waves II through V were initially undetectable on stimulation of the damaged side, whereas the absence of peak V was the only abnormality seen on left-side stimulation. With the regression of the right lower mid-pontine deficits, the right waves gradually reappeared and normalized progressively. On the last recording, only a left wave V abnormality persisted. At that time, the patient had a moderate left hemisyndrome due to a circumscribed right upper pontine-midbrain lesion. Therefore, it can be suggested that the first 4 waves of BAEPs mainly originate in the ipsilateral pons, and the Vth in the contralateral higher regions.

Acoustic Stimulation↗

Enhanced ultrasound transmission through the human skull using shear mode conversion.

A new transskull propagation technique, which deliberately induces a shear mode in the skull bone, is investigated. Incident waves beyond Snell's critical angle experience a mode conversion from an incident longitudinal wave into a shear wave in the bone layers and then back to a longitudinal wave in the brain. The skull's shear speed provides a better impedance match, less refraction, and less phase alteration than its longitudinal counterpart. Therefore, the idea of utilizing a shear wave for focusing ultrasound in the brain is examined. Demonstrations of the phenomena, and numerical predictions are first studied with plastic phantoms and then using an ex vivo human skull. It is shown that at a frequency of 0.74 MHz the transskull shear method produces an amplitude on the order of--and sometimes higher than--longitudinal propagation. Furthermore, since the shear wave experiences a reduced overall phase shift, this indicates that it is plausible for an existing noninvasive transskull focusing method [Clement, Phys. Med. Biol. 47(8), 1219-1236 (2002)] to be simplified and extended to a larger region in the brain.

Absorption↗

Post partum creatine phosphokinase and its muscle-brain isoenzyme elevation and transient Q-wave in a patient with idiopathic hypertrophic subaortic stenosis.

A primigravida with idiopathic hypertrophic subaortic stenosis, New York Heart Association Classification III, developed acute chest pain with significant ST segment depression together with a new Q-wave in chest lead V6 on the electrocardiograph following delivery under lumbar epidural analgesia. An intrapartum myocardial infarct was suspected because serial creatine phosphokinase and its muscle-brain isoenzyme levels were elevated in the postpartum period. However, the ST segment and the Q-wave changes returned to baseline within 4 h, thus eliminating the possibility of acute myocardial infarction. The uterus and placenta release creatine phosphokinase and its muscle-brain isoenzyme substantially during normal vaginal delivery, thus mimicking acute myocardial infarction. Consequently, the elevations of creatine phosphokinase and its muscle-brain fraction alone are not diagnostic of myocardial infarction in the postpartum period. The diagnosis of myocardial infarction must be based on the clinical picture, serial electrocardiogram recording and determination of lactate dehydrogenase and aspartate amino transferase.

Journal Article↗