Correlation of Homocysteine with Cerebral Hemodynamic Abnormality, Endothelial Dysfunction Markers, and Cognition Impairment in Patients with Traumatic Brain Injury
Masoud HatefiSomeyeh BehzadiMasoud Moghadas DastjerdiAlireza AbootalebiAsghar RahmaniFatemeh MahdizadehMohammad Reza Hafezi AhmadiKhairollah Asadollahi
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Montreal Cognitive Assessment
Endothelial Dysfunction
Transcranial Doppler
The objective of this study was to evaluate the effect of preeclampsia and its severity on maternal mean middle cerebral artery blood flow velocity (mean MCA-CBFV) using transcranial doppler sonography (TCD), as well as the effect of magnesium on mean MCA-CBFV in preeclampsia.This study used a prospective, comparative design. TCD was used to examine maternal mean MCA-CBFV in both healthy subjects (controls) and preeclamptic subjects (cases). The two groups were similar in age, gestational age, and parity. Healthy subjects were categorized into three groups: Group I, 6–14 weeks, n = 10; Group 11, 24–40 weeks, n = 27; Group HI, postpartum n = 15, 12–36 h. Serial TCD examinations of the middle cerebral artery were completed in 21 preeclamptic subjects at four different points in time: Time I is an initial measurement before delivery; Time 2 is also before delivery but after magnesium had been administered; Time 3 is postpartum while on magnesium (12–24 h), Time 4 is postpartum off magnesium, (24–48 h).Preeclamptic subjects had significantly increased mean MCA-CBFV when compared to healthy subjects: antepartum (mean 78.2 vs. 55.1 cm/sec, P < 0.0005); postpartum (mean 101.3 vs. 69.8 cm/sec, P < 0.0001). Severe preeclamptics had significantly higher mean MCA-CBFV than mild preeclamptics at each point in time: Time 1: P < 0.016; Time 2: P < 0.040; Time 3: P < 0.002; and Time 4: P < 0.028. These data support the theory that cerebral vasospasm of the smaller diameter vessels is a major component of preeclampsia.
Transcranial Doppler
Cerebral Vasospasm
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Bilateral transcranial Doppler ultrasound measures of blood flow velocities in the middle cerebral artery of college students were taken during three 90‐second memory tasks: generating and maintaining images, remembering letters, and answering general knowledge questions. Blood flow velocities in the middle cerebral artery during each task increased significantly over their respective 30‐second baseline period. Differences in blood flow velocities due to the kind of memory task, the middle cerebral artery sampled (right or left), or subject gender were not significant.
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Anterior cerebral artery
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Endothelial Dysfunction
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Doppler ultrasound
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Abstract Background: Cognitive impairment is a progressive disorder that affects the aging population. With the increase in the mean age of our population, it is becoming a public health problem. Homocysteinemia has been implicated in cognitive impairment. While it is modulated by vitamins B12 and folate, it acts through MMPs 2 and 9. Objectives: To assesses the relationship of cognitive impairment with homocysteine, B12, folate, and MMPs 2 and 9, with the intention of detecting cases of mild cognitive impairment which are potentially reversible.Materials and Methods: Blood samples were drawn from 73 enrolled subjects, with and without cognitive impairment on basis of Montreal cognitive assessment (MoCA) score <25 or > 25, respectively. Homocysteine, B12, folate, and MMPs2 and 9 were estimated. Correlation between MoCA score and these parameters was elucidated. Results: After adjusting for age and sex, homocysteine was the only significant independent predictor of MoCA score. Cut off of homocysteine for prediction of MoCA <25 was derived at 13.5 µmol/L (PPV=59.6%; NPV=79.2%; Sensitivity=84.8%; Specificity=50%). The equation derived for calculation of MoCA score from homocysteine is: MoCA score = 32.893 + [(-0.223)(homocysteine in mmol/L)] Conclusions: Homocysteine >13.5mmol/L predicts low MoCA (<25) with 84.8% sensitivity and 50% specificity. So patients with a Hcy >13.5mmol/L should be carefully evaluated for the presence/progression of dementia and administered vitamins of the B group as a measure towards amelioration of the modifiable risk factor of cognitive decline, i.e. homocysteinemia.
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Hyperhomocysteinemia
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Objective:To investigate the changes of t he mean velocity(Vm) by transcranial doppler ultrasound(TCD) in the middle cer ebral artery(MCA) area with acute ischemic stroke patients,and to evaluate the s ignificance of TCD findings in the different course of stroke. Methods:Fourty nine stroke patients,proven by CT and/or MRI scan in the MCA area,got TCD serial examination at 1,2,3 weeks after admission.Results:①The Vm in ipsilateral MCA was significantly lo wer than that of the contralateral(P0.01) and the control group(P0.0 5); and the Vm in bilateral anterior cerebral artery(ACA) in ischemic stroke was significantly higher than that of the control(P0.05).The physiological ph enomenon of MCA VmACA Vm disappeared.②The MCA Vm of the stem and the penetrat ing arteries occlusion in the MCA area reduced significantly.③The MCA Vm was in creasing with the effective therapy.Conclusion:The c hanges of Vm may be of help to find the area of ischemic stroke,to select the c linical therapeutic method and to evaluate the therapeutic effects.
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Anterior cerebral artery
Stroke
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Objective: To observe the middle cerebral artery(MCA) flow velocity changes after stent assisted angioplasty of symptomatic MCA stenostic patients. Methods: Twenty-two MCA stenostic patients underwent stent assisted angioplasty. Transcranial Doppler ultrasound(TCD) was performed before and after treatment. Results: ①TCD findings before treatment: the velocity of MCA is remarkably increased in MCA stenostic patients. ②TCD changes after treatment: most patients' MCA velocity decreased in different degrees, one case appeared transient ischemic attack(TIA) due to MCA spasm. ③During follow-up over 1～15 months(mean 4.6 months), one case appeared restenosis after 11 months. The remaining patients experienced alleviation of symptoms without TIA and apoplexy during short term follow up. Angiograph showed that the stenostic degree reduced from 82% to 5%. Follow up by TCD showed good patency of stented lesions. The TCD diagnosis is consistent with DSA. Conclusions: TCD is a sensitive means to diagnose MCA stenosis, and to assess the effect of stent assisted angioplasty. It can be used to evaluate the results of treatment and as a tool of follow-up.
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Doppler ultrasound
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Background: To investigate the optimal values of transcranial doppler (TCD) index in the evaluation of leptomeningeal collateral circulation (CC) in patients with middle cerebral artery (MCA) stenosis. Methods: Forty-one patients, with angiographically confirmed single stenosis or occlusion of the M1 segment of the MCA, were studied with TCD and brain MRI. Patients were divided into two groups according to the existence of CC though ipsilateral anterior cerebral artery on transfemoral cerebral angiography (TFCA). Mean flow velocities (mFV) of anterior and middle cerebral arteries (ACA, MCA) were analyzed. We then investigated the optimal values of TCD flow i ndex: 1) ipsilateral mFV ACA/MCA (AMVR), 2) ACA velocity ratio (ACAVR), 3) mFVACA. We then correlated TCD flow index with TFCA results. Results: TFCA revealed single moderate to severe M1 stenosis (n=35) and occlusion (n=6). Presence of CC was found in 11 (27%), absence of CC in 30 (73%). The mean of AMVR, ACAVR and mFVACA differed between the two groups: 1.76±0.69, 1.43±36, 86.27±31.73 cm/s in the presence of CC; 0.48±0.24, 1.21±0.39, 65.93±23.24 in the absence of CC. The optimal cutoff values for detection of CC were found at AMVR≥0.9, ACAVR≥1.30 and mFVACA≥80 cm/s. The combination of individual TCD indexes had improved the specificity and positive predicted value in the detection of CC. Conclusions: TCD enables detecting the existence of CC in patients with MCA stenoocclusion. These optimal values may provide a noninvasive method for evaluate the pathomechanism of stroke and prospect the prognosis of these patients. J Korean Neurol Assoc 23(2):165-171, 2005
Transcranial Doppler
Anterior cerebral artery
Collateral circulation
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The objective of this study was to evaluate the effect of preeclampsia and its severity on maternal mean middle cerebral artery blood flow velocity (mean MCA-CBFV) using transcranial doppler sonography (TCD), as well as the effect of magnesium on mean MCA-CBFV in preeclampsia. This study used a prospective, comparative design. TCD was used to examine maternal mean MCA-CBFV in both healthy subjects (controls) and preeclamptic subjects (cases). The two groups were similar in age, gestational age, and parity. Healthy subjects were categorized into three groups: Group 1, 6–14 weeks, n = 10; Group II, 24–40 weeks, n = 27; Group III, postpartum n = 15, 12–36 h. Serial TCD examinations of the middle cerebral artery were completed in 21 preeclamptic subjects at four different points in time: Time 1 is an initial measurement before delivery; Time 2 is also before delivery but after magnesium had been administered; Time 3 is postpartum while on magnesium (12–24 h), Time 4 is postpartum off magnesium, (24–48 h). Preeclamptic subjects had significantly increased mean MCA-CBFV when compared to healthy subjects: antepartum (mean 78.2 vs. 55.1 cm/sec, P < 0.0005); postpartum (mean 101.3 vs. 69.8 cm/sec, P < 0.0001). Severe preeclamptics had significantly higher mean MCA-CBFV than mild preeclamptics at each point in time: Time 1: P < 0.016; Time 2: P < 0.040; Time 3: P < 0.002; and Time 4: P < 0.028. These data support the theory that cerebral vasospasm of the smaller diameter vessels is a major component of preeclampsia. © 1996 Wiley-Liss, Inc.
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Cerebral Vasospasm
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