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1-07-26 Measurement of transforming growth factor-β (TGF-β) and tumor necrosis factor-α (TNF-α) in patients with acute ischemic stroke
Cerebrovascular l-07-25
Cerebrovascular regulation diabetic patients
and risk for stroke in
G. Micieli, D. Bosone, A. Cavallini, M. Poli, S. Roatla, M. Passatore, Neurovascolar Unit, “C. Mondino” Found, Universify of Pavia, Italy
G. Nappi.
Diabetes Mellitus (DM) is known to be a primary risk factor for stroke, determining pathological modifications in large and small blood vessels. Although several studies have focused on the effects of DM on the peripheral circulation, the role played by DM on the cerebral circulation affecting the neurogenic modulation is still partially unclear. Cold Pressor Test (CPT) is a sympathetic test which can induce significant decreases in mean blood flow velocity in healthy subjects monitored by means of transcranial Doppler at MCA level when a significant increase of Mean Arterial Pressure (MAP) is obtained (215 mmHg). Twenty-six diabetic patients (insulin and non-insulin dependent DM) and 11 healthy controls underwent a prolonged (5min) cold pressor test (CPT) to evaluate the cerebral haemodynamic changes induced by this thermal/painful stimulus. MCA Vm changes were monitored during the test and the subsequent recovery phase by means of a bilateral TCD device (Multidop X). Changes in MAP and heart rate (HR) were continuously recorded by Finapres (Ohmeda). A complete autonomic cardiovascular evaluation preceeded the test to detect possible dysfunctioning of neurovegetative tone induced by DM. DM subjects showed an erratic response to CPT either in terms of MAP increases, or of MCA Vm decreases; in particular, in diabetic patients with severe autonomic failure Vm at MCA level showed highly variable patterns, mostly characterized by the absence of significant decreases also in the presence of adequate increases in systemic MAP; moreover pulsatility index in diabetics was almost unchanged during CPT, suggesting a reduced neurogenic regulation. Diabetic patients showed a derangement in sympathetic responses to cold pressor test in both terms of systemic cardiovascular parameters and of cerebrovascular reactivity when compared to healthy controls. Failure of neurogenic homeostatic mechanisms of cerebral circulation is suggested as a possible mechanism for cerebrovascular ischemic lesions in diabetes mellitus.
l-07-26
Measurement of transforming growth factor-p (TGF-p) and tumor necrosis factor-a (TNF-a) in patients with acute ischemic stroke
R. Mihajlovic, M. Jovanovic, Medical Research, Military ’ Department of Neurology
D. Djordjevic’ , A. Jovicic ‘. Department of Medical Academy; Belgrade, Yugoslavia, Military Medical Academy, Be/grade, Yugoslavia
It is known that some cytokines play an important role in pathogenesis of ischemic stroke. However, only few studes investigated proinflamatory and immunomodulatory cytokines, and mainly in plasma. The aim of this study was to investigate levels of TNF-cz and TGF-B in cerebrospinal fluid (CSF) and plasma of patients with acute ischemic stroke (AIS). ELISA test was performed in 30 patients with AIS an in 20 patients with other neurological disease. We found significant increase of TNF-cy in CSF and plasma of AIS of patients and significant decrease of TGF-B in CSF and plasma, more pronounced in plasma. In conclusion, in patients with AIS there are changes of TNF-a! and TGF-j3 in CSF and plasma, more expressed in CSF.
l-07-27
Traumatic carotid-cavernous neurosurgical approach
fistule-classic
L.J. Mini6 ‘, R. CtiC ‘, A. JoviEiC *, R. RaiEeviC *, L.J. MarkoviC. ’ Department of Neurosurgery, Military Medical Academy; Belgrade, Yugoslavia, *Department of Neurofog~ Military Medical Academy Belgrade, Yugoslavia, 3 Institute for Radio/w Military Medical Academy, Belgrade, Yugoslavia Due to the fast development of endovascular neurosurgery, the embolization ballons become the treatment of choice for internal carotid-cavernous fistule (CCF). Because of rapid arteriovenous shunting between cavernous sinus and internal carotid artery (ICA), CCF in a short period can cause severe damage to the cavernous sinus structures and orbits due to compressive effect, as well as brain damage. So an urgent treatment is necessary in aim to eliminate fistula and to restore the wall of ICA. We reported four traumatic CCF cases after missile injury. All patients were clinically and neuroradiologically confirmed as CCF. They ware treated with classical neurosurgical technique. All patients were treated with ligation of the ICA at the neck (Cl) and clipping ICA intracranialy before ophthalmic artery arise from ICA (C3). Control angiography was done to all patients and confirmation of exclusion of all ICA segments up to C4 was obtained. All patients are without neurological deficit, actually. Classic neurosurgical approach in treating CCF has it’s place in special conditions (war time, lack of technical support for endovascular embolisation procedure, etc.) when modern methods can’t be applied.
Diseases l-07-26 G. Montiel, S. Muchnik.
s13 Cerebral blood flow (CBF) changes during breath-holding (BH) from residual volume (RV) S. Cocorullo, P. Schloltmann, R. Toro, Parera /DIM, Buenos Aires, Argentina
I. Casas,
Objective: To examine from RV while breathing
the CBF changes that occurred during BH initiated room air, using Transcranial Doppler (TCD). Materlal and Methods: Three normal volunteers were studied, aged 35-40 years. The subjects were placed in supine position and underwent a brief training period in which they were taught to breath-hold from RV during 30 seconds on verbal command. The subjects were instructed not to perform Mueller or Valsalva maneuvers during the BH. Cerebral blood flow velocity (CBFV) were continuously recorded during the study, with a 2 MHz pulsed TCD (DWL), transtemporal window. Each subject underwent two BH runs. The study was staged as follows: l- Basal, 2- BH lo,20 and 30 seconds, 3- Post BH 10 and 20 seconds. Results: Comparison of baseline values with BH and Post BH values, revealed significant differences for CBFV.
CBFV Syst. CBFVDyast.
BaSsI
BH 10 sec.
BH 20 sec.
BH 30 sec.
Post BH 10
Post BH 20
loof lOof
105f 12 117f23
117f 10 142f29
126& 11 161 f26
122* 10 145f23
66f4 61f12
%XztSD
Discussion: CBFV changes during BH may be explained by increase CBF and vasodilatation due to arterial blood gas changes during BH (drop in Pa02 and increase in PaC02).
1 07 29 I__I
Embolic brain infarction posterior communicating
L. Mossuto-Agatiello, SMOM-Rome, ltaly
P. Calisse.
in the territory of the artery (PCoA)
San Giovanni
Battista
Hospital
Infarction in the territory supplied by the PCoA is rather uncommon and embolism may be an important cause. The aim of the study was to define topographic patterns and mechanisms of this infarcts in which embolism from whatever source was suspected. On the basis of the anatomical distribution of the lesions as revealed by CTNRI scans and on the presence of potential causes of embolism, 50 patients (23 males, 27 females: 21-86 years) where selected for this study. In 3 cases, infarction was restrk%d to the PCoA territory whereas in 47 patients there was involvement of other vascular territories. In 26 cases the stroke was classified as cardioembolic, in 14 as thromboembolic and in 11 the embolic source was undetermined. The distribution of the lesions within the territory of the PCoA showed that the anterior thalamus was the structure most consistently affected. Slightly large lesions involving the anterior thalamus and extended laterally to the adjacent internal capsule or caudally to the posterior hypothalamus or both represents a distinctive pattern of infarction. In the setting of an embolic stroke in the PCoA territory, embolic material may enter directly in the penetrating branches from the communicating vessel or lodged in the distal portion of the intracranial carotid artery or the proximal segment of the posterior cerebral artery so as to block the origin of the PCoA. In this latter case infarction may occur from two basic mechanisms: first, from distal extension of the clot through the trunk of the PCoA; or, second from a rapid failure of perfusion pressure within the PCoA and consequent ischemia in the terminal supply area of one of its perforators.
l-07-30
Clinical predictors of ST depression and ventricular arrhytmias in patients with acute ischemic stroke
R. Raicevic, A. Jovicic, Neurology, DepaHment Yugoslavia
D. Djordjevic, of Cardiology
D. Tavcioski, E. Dincic. Department of Military Medical Academy Belgrade,
ST depression and ventricular arrhytmias (VA) mean higher risk for morbidity and mortality in patients with coronaty heart disease (CHD). But, they are also present in patients with acute ischemic stroke (AIS). So, the aim of our study was evaluation of their frequency and correlation with clinical parameters. In 40 patients with AIS (clinical and neuroimaging confirmation), without clinical signs of CHD, 24 hours-Halter ECG monitoring was performed. Heart disease, atherosclerotic risk factors, age, cardiological theraphy and hemispheric localisation of AIS were used as independent variables, while presence of ST depression and VA were dependent variables in logistic regression analysis. In 37.5% patients ST depression was present and 74% of them had rightsided hemispheric AIS. They were also 5.4 years older. VA were present in 35% patients and 64.3% had rightsided hemispheric AIS. Hemispheric localisation of AIS was found to be significant for ST depression VA appearance, while age was significant only for ST depression appearance. In conclusion, ST depression in patients with AIS might have prognostic value - meaning more severe outcome.
Cerebrovascular regulation diabetic patients
and risk for stroke in
G. Micieli, D. Bosone, A. Cavallini, M. Poli, S. Roatla, M. Passatore, Neurovascolar Unit, “C. Mondino” Found, Universify of Pavia, Italy
G. Nappi.
Diabetes Mellitus (DM) is known to be a primary risk factor for stroke, determining pathological modifications in large and small blood vessels. Although several studies have focused on the effects of DM on the peripheral circulation, the role played by DM on the cerebral circulation affecting the neurogenic modulation is still partially unclear. Cold Pressor Test (CPT) is a sympathetic test which can induce significant decreases in mean blood flow velocity in healthy subjects monitored by means of transcranial Doppler at MCA level when a significant increase of Mean Arterial Pressure (MAP) is obtained (215 mmHg). Twenty-six diabetic patients (insulin and non-insulin dependent DM) and 11 healthy controls underwent a prolonged (5min) cold pressor test (CPT) to evaluate the cerebral haemodynamic changes induced by this thermal/painful stimulus. MCA Vm changes were monitored during the test and the subsequent recovery phase by means of a bilateral TCD device (Multidop X). Changes in MAP and heart rate (HR) were continuously recorded by Finapres (Ohmeda). A complete autonomic cardiovascular evaluation preceeded the test to detect possible dysfunctioning of neurovegetative tone induced by DM. DM subjects showed an erratic response to CPT either in terms of MAP increases, or of MCA Vm decreases; in particular, in diabetic patients with severe autonomic failure Vm at MCA level showed highly variable patterns, mostly characterized by the absence of significant decreases also in the presence of adequate increases in systemic MAP; moreover pulsatility index in diabetics was almost unchanged during CPT, suggesting a reduced neurogenic regulation. Diabetic patients showed a derangement in sympathetic responses to cold pressor test in both terms of systemic cardiovascular parameters and of cerebrovascular reactivity when compared to healthy controls. Failure of neurogenic homeostatic mechanisms of cerebral circulation is suggested as a possible mechanism for cerebrovascular ischemic lesions in diabetes mellitus.
l-07-26
Measurement of transforming growth factor-p (TGF-p) and tumor necrosis factor-a (TNF-a) in patients with acute ischemic stroke
R. Mihajlovic, M. Jovanovic, Medical Research, Military ’ Department of Neurology
D. Djordjevic’ , A. Jovicic ‘. Department of Medical Academy; Belgrade, Yugoslavia, Military Medical Academy, Be/grade, Yugoslavia
It is known that some cytokines play an important role in pathogenesis of ischemic stroke. However, only few studes investigated proinflamatory and immunomodulatory cytokines, and mainly in plasma. The aim of this study was to investigate levels of TNF-cz and TGF-B in cerebrospinal fluid (CSF) and plasma of patients with acute ischemic stroke (AIS). ELISA test was performed in 30 patients with AIS an in 20 patients with other neurological disease. We found significant increase of TNF-cy in CSF and plasma of AIS of patients and significant decrease of TGF-B in CSF and plasma, more pronounced in plasma. In conclusion, in patients with AIS there are changes of TNF-a! and TGF-j3 in CSF and plasma, more expressed in CSF.
l-07-27
Traumatic carotid-cavernous neurosurgical approach
fistule-classic
L.J. Mini6 ‘, R. CtiC ‘, A. JoviEiC *, R. RaiEeviC *, L.J. MarkoviC. ’ Department of Neurosurgery, Military Medical Academy; Belgrade, Yugoslavia, *Department of Neurofog~ Military Medical Academy Belgrade, Yugoslavia, 3 Institute for Radio/w Military Medical Academy, Belgrade, Yugoslavia Due to the fast development of endovascular neurosurgery, the embolization ballons become the treatment of choice for internal carotid-cavernous fistule (CCF). Because of rapid arteriovenous shunting between cavernous sinus and internal carotid artery (ICA), CCF in a short period can cause severe damage to the cavernous sinus structures and orbits due to compressive effect, as well as brain damage. So an urgent treatment is necessary in aim to eliminate fistula and to restore the wall of ICA. We reported four traumatic CCF cases after missile injury. All patients were clinically and neuroradiologically confirmed as CCF. They ware treated with classical neurosurgical technique. All patients were treated with ligation of the ICA at the neck (Cl) and clipping ICA intracranialy before ophthalmic artery arise from ICA (C3). Control angiography was done to all patients and confirmation of exclusion of all ICA segments up to C4 was obtained. All patients are without neurological deficit, actually. Classic neurosurgical approach in treating CCF has it’s place in special conditions (war time, lack of technical support for endovascular embolisation procedure, etc.) when modern methods can’t be applied.
Diseases l-07-26 G. Montiel, S. Muchnik.
s13 Cerebral blood flow (CBF) changes during breath-holding (BH) from residual volume (RV) S. Cocorullo, P. Schloltmann, R. Toro, Parera /DIM, Buenos Aires, Argentina
I. Casas,
Objective: To examine from RV while breathing
the CBF changes that occurred during BH initiated room air, using Transcranial Doppler (TCD). Materlal and Methods: Three normal volunteers were studied, aged 35-40 years. The subjects were placed in supine position and underwent a brief training period in which they were taught to breath-hold from RV during 30 seconds on verbal command. The subjects were instructed not to perform Mueller or Valsalva maneuvers during the BH. Cerebral blood flow velocity (CBFV) were continuously recorded during the study, with a 2 MHz pulsed TCD (DWL), transtemporal window. Each subject underwent two BH runs. The study was staged as follows: l- Basal, 2- BH lo,20 and 30 seconds, 3- Post BH 10 and 20 seconds. Results: Comparison of baseline values with BH and Post BH values, revealed significant differences for CBFV.
CBFV Syst. CBFVDyast.
BaSsI
BH 10 sec.
BH 20 sec.
BH 30 sec.
Post BH 10
Post BH 20
loof lOof
105f 12 117f23
117f 10 142f29
126& 11 161 f26
122* 10 145f23
66f4 61f12
%XztSD
Discussion: CBFV changes during BH may be explained by increase CBF and vasodilatation due to arterial blood gas changes during BH (drop in Pa02 and increase in PaC02).
1 07 29 I__I
Embolic brain infarction posterior communicating
L. Mossuto-Agatiello, SMOM-Rome, ltaly
P. Calisse.
in the territory of the artery (PCoA)
San Giovanni
Battista
Hospital
Infarction in the territory supplied by the PCoA is rather uncommon and embolism may be an important cause. The aim of the study was to define topographic patterns and mechanisms of this infarcts in which embolism from whatever source was suspected. On the basis of the anatomical distribution of the lesions as revealed by CTNRI scans and on the presence of potential causes of embolism, 50 patients (23 males, 27 females: 21-86 years) where selected for this study. In 3 cases, infarction was restrk%d to the PCoA territory whereas in 47 patients there was involvement of other vascular territories. In 26 cases the stroke was classified as cardioembolic, in 14 as thromboembolic and in 11 the embolic source was undetermined. The distribution of the lesions within the territory of the PCoA showed that the anterior thalamus was the structure most consistently affected. Slightly large lesions involving the anterior thalamus and extended laterally to the adjacent internal capsule or caudally to the posterior hypothalamus or both represents a distinctive pattern of infarction. In the setting of an embolic stroke in the PCoA territory, embolic material may enter directly in the penetrating branches from the communicating vessel or lodged in the distal portion of the intracranial carotid artery or the proximal segment of the posterior cerebral artery so as to block the origin of the PCoA. In this latter case infarction may occur from two basic mechanisms: first, from distal extension of the clot through the trunk of the PCoA; or, second from a rapid failure of perfusion pressure within the PCoA and consequent ischemia in the terminal supply area of one of its perforators.
l-07-30
Clinical predictors of ST depression and ventricular arrhytmias in patients with acute ischemic stroke
R. Raicevic, A. Jovicic, Neurology, DepaHment Yugoslavia
D. Djordjevic, of Cardiology
D. Tavcioski, E. Dincic. Department of Military Medical Academy Belgrade,
ST depression and ventricular arrhytmias (VA) mean higher risk for morbidity and mortality in patients with coronaty heart disease (CHD). But, they are also present in patients with acute ischemic stroke (AIS). So, the aim of our study was evaluation of their frequency and correlation with clinical parameters. In 40 patients with AIS (clinical and neuroimaging confirmation), without clinical signs of CHD, 24 hours-Halter ECG monitoring was performed. Heart disease, atherosclerotic risk factors, age, cardiological theraphy and hemispheric localisation of AIS were used as independent variables, while presence of ST depression and VA were dependent variables in logistic regression analysis. In 37.5% patients ST depression was present and 74% of them had rightsided hemispheric AIS. They were also 5.4 years older. VA were present in 35% patients and 64.3% had rightsided hemispheric AIS. Hemispheric localisation of AIS was found to be significant for ST depression VA appearance, while age was significant only for ST depression appearance. In conclusion, ST depression in patients with AIS might have prognostic value - meaning more severe outcome.