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S74. Hemodynamic changes in the prefrontal cortex as measured by functional near-infrared spectroscopy and their relationships to neurobehavioral outcomes in children with FASD
Abstracts / Clinical Neurophysiology 129 (2018) e142–e212
centro-posterior region, followed by a gradual increase in left hemispheric delta slowing. Subsequent neurologic exam off sedation revealed a new right hemiparesis; brain MRI showed an acute left middle cerebral artery infarct. QEEG showed immediate prominent and persistent decreases in delta, theta, and alpha power, as well as large reductions in the amplitude-integrated EEG (aEEG) over the left hemisphere. There was also a slight decline in beta power over the left. A delayed decrease in the ADR over the left side was seen approximately 20 min later. Conclusion: Visual EEG inspection in this case revealed acute lasting focal left hemispheric attenuation, with subsequent increased slowing after the time of presumed infarct. Interestingly, QEEG analysis showed simultaneous decreases in absolute power values and aEEG prior to change in the ADR. An automatic alarm system monitoring multiple QEEG parameters could therefore be helpful in monitoring for cerebral ischemia in the ICU, particularly when a trained neurophysiologist is not available. doi:10.1016/j.clinph.2018.04.432
patients with a stroke mimics, or TIA patients and evidence of ischemic stroke on Neuro imaging. There was no significant difference for any US measures when comparing TIA patients and patients with and without a recurrent event at follow up. Though such studies are non-invasive in acute TIA patients continued follow up and larger sample sizes may be necessary to identify a functional or structural biomaker for poor strke outcome. This study was made possible by grant NPRP 6-565-3-141 from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the author[s]. doi:10.1016/j.clinph.2018.04.433
S74. Hemodynamic changes in the prefrontal cortex as measured by functional near-infrared spectroscopy and their relationships to neurobehavioral outcomes in children with FASD—Julie A. Kable *, Claire Coles (USA) ⇑
S73. Cerebral blood flow and auto-regulation in acute TIA patients from a general hospital in Qatar—Leopold J. Streletz *, Adham Musthak, Hoda Y. Gad, Naveed Akhtar, Ahmed El Setouhy, Rayaz Malik (Qatar) ⇑
Presenting author.
Introduction: The Arabian Gulf region is rapidly developing, with major changes in lifestyle that can increase the risk of cardiovascular diseases, including TIA and stroke. Stroke constitutes a major cause of morbidity and mortality in Qatar. Cerebral auto-regulation (AR) is an intrinsic protective mechanism guaranteeing hemodynamic integrity of cerebral circulation. It modulates cerebral blood flow (CBF) in order to meet regional perfusion demands despite variations in arterial blood pressure. Impaired cerebral AR is associated with poor functional and prognostic outcomes in patients with ischemic stroke. Our research investigated the feasibility of TCD study of cerebral AR as a biomarker for Stroke outcome inTIA patients in a large General Hospital in Qatar. Methods: Fifty-eight patients (47 men, mean age, 49.7 yrs) with acute TIA and 66 patients (58 men, mean age 51.0) with small strokes (TIAs with tissue evidence of infarction) were enrolled between 2015 and 2017 for a total sample of 124. They were evaluated with bilateral, simultaneous TCD studies of their MCAs CBF within 72 h of the indexed event. In addition to the usual CBF parameters (mean/peak flow velocities), cerebrovascular reactivity (AR) to hypercapnia as measured by the Breath-Holding Index was calculated. On best medical therapy, the patients were followed up at one year for outcomes measures of death, stroke or recurrent TIAs in an attempt to correlate these TCD with poor stroke outcome. Results: There was no significant difference for any of the TCD variables including BHI when comparing TIA patients to stroke mimics and patients with small strokes. These variables also failed to distinguish, thus far, acute TIA or small stroke patients from patients with death or a recurrent ischemic event at one year follow up (Statistically significant difference using independent samples ttest P-value < 0.05). There was no significant difference for any of the flow or structural measures on carotid ultrasound of the right or left carotid arteries when comparing TIA patients, small stroke or mimic groups or between patients with and without a recurrent event at follow up. Conclusion: There was no significant difference for any of the TCD variables including BHI when comparing TIA patients compared to
e169
Presenting author.
Introduction: Children with a history of prenatal alcohol exposure (PAE) have been found to have altered hemodynamic changes in the prefrontal cortical (PFC) as measured by functional near-infrared spectroscopy (fNIRS) relative to both typically developing children and those who have other neurobehavioral problems. The purpose of this study was to evaluate the relationships between indices of PFC functioning and the neurobehavioral outcomes in children with FASD and to determine if these relationships differed from other groups of children. Methods: Levels of oxygenated (HBO) and deoxygenated (HBR) hemoglobin were assessed during a computer task designed to elicit arousal in children with a history of PAE (n = 33) and children without PAE who were typically developing (Controls, n = 25) or had other neurobehavioral problems (Clinical Contrast group, n = 22). The task elicits emotional arousal by alternating positive (Win) and negative (Loss) arousal while playing a game. The linear relationships between neurobehavioral outcomes (behavioral problems and word generation skills) and the mean levels of HBO and HBR for each of the conditions were assessed for group differences using the Potthoff regression procedure, which allows for simultaneous and separate tests of regression intercepts and slopes across groups. Results: Within the entire sample, indices of PFC activation were related to externalizing problem behaviors and word generation skills, a measure of executive functioning, but PFC activation in the lateral areas of the PFC differentiated children in the PAE group from both other groups. Specifically, slopes of the relationship between Left Lateral HBO levels and rule-breaking behavior were higher in children with PAE and slopes of the relationship between Lateral Left HBR levels and withdrawn/depression symptoms were more negative. Performance on a word generation task was differentially predicted by indices of Right Lateral PFC activation with children in the PAE group having more negative slopes in the linear relationships with HBR levels than both other groups. Conclusion: Children with a history of PAE had unique characteristics in the relationships between the indices of PFC functioning and neurobehavioral problems that may be useful in differentiating alcohol-exposed children from typically developing children and those who have neurobehavioral problems not associated with PAE. doi:10.1016/j.clinph.2018.04.434
centro-posterior region, followed by a gradual increase in left hemispheric delta slowing. Subsequent neurologic exam off sedation revealed a new right hemiparesis; brain MRI showed an acute left middle cerebral artery infarct. QEEG showed immediate prominent and persistent decreases in delta, theta, and alpha power, as well as large reductions in the amplitude-integrated EEG (aEEG) over the left hemisphere. There was also a slight decline in beta power over the left. A delayed decrease in the ADR over the left side was seen approximately 20 min later. Conclusion: Visual EEG inspection in this case revealed acute lasting focal left hemispheric attenuation, with subsequent increased slowing after the time of presumed infarct. Interestingly, QEEG analysis showed simultaneous decreases in absolute power values and aEEG prior to change in the ADR. An automatic alarm system monitoring multiple QEEG parameters could therefore be helpful in monitoring for cerebral ischemia in the ICU, particularly when a trained neurophysiologist is not available. doi:10.1016/j.clinph.2018.04.432
patients with a stroke mimics, or TIA patients and evidence of ischemic stroke on Neuro imaging. There was no significant difference for any US measures when comparing TIA patients and patients with and without a recurrent event at follow up. Though such studies are non-invasive in acute TIA patients continued follow up and larger sample sizes may be necessary to identify a functional or structural biomaker for poor strke outcome. This study was made possible by grant NPRP 6-565-3-141 from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the author[s]. doi:10.1016/j.clinph.2018.04.433
S74. Hemodynamic changes in the prefrontal cortex as measured by functional near-infrared spectroscopy and their relationships to neurobehavioral outcomes in children with FASD—Julie A. Kable *, Claire Coles (USA) ⇑
S73. Cerebral blood flow and auto-regulation in acute TIA patients from a general hospital in Qatar—Leopold J. Streletz *, Adham Musthak, Hoda Y. Gad, Naveed Akhtar, Ahmed El Setouhy, Rayaz Malik (Qatar) ⇑
Presenting author.
Introduction: The Arabian Gulf region is rapidly developing, with major changes in lifestyle that can increase the risk of cardiovascular diseases, including TIA and stroke. Stroke constitutes a major cause of morbidity and mortality in Qatar. Cerebral auto-regulation (AR) is an intrinsic protective mechanism guaranteeing hemodynamic integrity of cerebral circulation. It modulates cerebral blood flow (CBF) in order to meet regional perfusion demands despite variations in arterial blood pressure. Impaired cerebral AR is associated with poor functional and prognostic outcomes in patients with ischemic stroke. Our research investigated the feasibility of TCD study of cerebral AR as a biomarker for Stroke outcome inTIA patients in a large General Hospital in Qatar. Methods: Fifty-eight patients (47 men, mean age, 49.7 yrs) with acute TIA and 66 patients (58 men, mean age 51.0) with small strokes (TIAs with tissue evidence of infarction) were enrolled between 2015 and 2017 for a total sample of 124. They were evaluated with bilateral, simultaneous TCD studies of their MCAs CBF within 72 h of the indexed event. In addition to the usual CBF parameters (mean/peak flow velocities), cerebrovascular reactivity (AR) to hypercapnia as measured by the Breath-Holding Index was calculated. On best medical therapy, the patients were followed up at one year for outcomes measures of death, stroke or recurrent TIAs in an attempt to correlate these TCD with poor stroke outcome. Results: There was no significant difference for any of the TCD variables including BHI when comparing TIA patients to stroke mimics and patients with small strokes. These variables also failed to distinguish, thus far, acute TIA or small stroke patients from patients with death or a recurrent ischemic event at one year follow up (Statistically significant difference using independent samples ttest P-value < 0.05). There was no significant difference for any of the flow or structural measures on carotid ultrasound of the right or left carotid arteries when comparing TIA patients, small stroke or mimic groups or between patients with and without a recurrent event at follow up. Conclusion: There was no significant difference for any of the TCD variables including BHI when comparing TIA patients compared to
e169
Presenting author.
Introduction: Children with a history of prenatal alcohol exposure (PAE) have been found to have altered hemodynamic changes in the prefrontal cortical (PFC) as measured by functional near-infrared spectroscopy (fNIRS) relative to both typically developing children and those who have other neurobehavioral problems. The purpose of this study was to evaluate the relationships between indices of PFC functioning and the neurobehavioral outcomes in children with FASD and to determine if these relationships differed from other groups of children. Methods: Levels of oxygenated (HBO) and deoxygenated (HBR) hemoglobin were assessed during a computer task designed to elicit arousal in children with a history of PAE (n = 33) and children without PAE who were typically developing (Controls, n = 25) or had other neurobehavioral problems (Clinical Contrast group, n = 22). The task elicits emotional arousal by alternating positive (Win) and negative (Loss) arousal while playing a game. The linear relationships between neurobehavioral outcomes (behavioral problems and word generation skills) and the mean levels of HBO and HBR for each of the conditions were assessed for group differences using the Potthoff regression procedure, which allows for simultaneous and separate tests of regression intercepts and slopes across groups. Results: Within the entire sample, indices of PFC activation were related to externalizing problem behaviors and word generation skills, a measure of executive functioning, but PFC activation in the lateral areas of the PFC differentiated children in the PAE group from both other groups. Specifically, slopes of the relationship between Left Lateral HBO levels and rule-breaking behavior were higher in children with PAE and slopes of the relationship between Lateral Left HBR levels and withdrawn/depression symptoms were more negative. Performance on a word generation task was differentially predicted by indices of Right Lateral PFC activation with children in the PAE group having more negative slopes in the linear relationships with HBR levels than both other groups. Conclusion: Children with a history of PAE had unique characteristics in the relationships between the indices of PFC functioning and neurobehavioral problems that may be useful in differentiating alcohol-exposed children from typically developing children and those who have neurobehavioral problems not associated with PAE. doi:10.1016/j.clinph.2018.04.434