BACKGROUND: The cerebral blood flow velocity (CBFV) and rate pressure product (RPP) have been reported to benefit hemodynamics more during exercise in the recumbent position than during that in the upright position. However, it is unclear which angle is of the greatest benefit to hemodynamics during exercise in the recumbent position. This study aimed to evaluate the effect of the recumbent angle on CBFV and RPP during exercise. METHODS: In a balanced crossover study, 15 healthy volunteers (age, 18.7±1.1 years) were asked to perform the bicycle exercise four times in the upright and at recumbent angles of 67° (R), 47°R, and 15°R, with weekly intervals between each condition. The exercise intensity was set initially at 50 W and increased by 25 W every 2 minutes up to 150 W. CBFV in the middle cerebral artery (MCA) was measured using transcranial doppler sonography. All data were analyzed using two-way repeated-measures analysis of variance. RESULTS: CBFV at 15°R was significantly higher than that in the upright position and at 67°R at 10 minutes recovery (69±16 vs. 56±7 and 58±10 cm/s, respectively; P<0.05). The RPP was significantly lower at 67°R, 47°R, and 15°R than in the upright position immediately after exercise (176±23, 177±22, and 173±26, respectively, vs. 241±42 mmHg×beats/min×10⁻²; P<0.001). CONCLUSIONS: At an angle of less than 67°R, exercise increases CBFV and reduces RPP, relative to those during exercise in the upright position. This hemodynamic effect was most prominent at 15°R, where cerebral circulation was further increased in the recovery phase.
Cerebrovascular Circulation ; Cross-Over Studies ; Healthy Volunteers ; Hemodynamics ; Middle Cerebral Artery ; Posture ; Ultrasonography, Doppler, Transcranial

BackgroundCompared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants.

MethodsTotally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children's Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.

ResultsThe consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively).

ConclusionsVery premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.

Brain ; diagnostic imaging ; Brain Injuries ; diagnostic imaging ; Cerebral Hemorrhage ; diagnostic imaging ; Echoencephalography ; Female ; Gestational Age ; Humans ; Hydrocephalus ; diagnostic imaging ; Infant, Premature ; Infant, Premature, Diseases ; diagnostic imaging ; Magnetic Resonance Imaging ; Pregnancy ; Retrospective Studies

Background: Brain death is the irreversible cessation of the function of the brain including the brainstem. In 2013, the Brain Injury Evaluation Quality Control Centre (BQCC) of the National Health and Family Planning Commission issued criteria and practical guidelines for the determination of brain death. This study aimed to evaluate whether the institutions have adopted these guidelines and to make suggestions for the improvement of the current criteria and practical guidelines for brain death determination in China. Methods: Consecutive brain death cases from 44 hospitals were evaluated for summary statistics for the following data: the performance of BQCC criteria and practical guidelines, clinical examination, apnea testing, ancillary testing, and the number of examinations as well as the waiting periods between examinations and details of who determined brain death. Data analysis was conducted from January 2013 to December 2017. Results: A total of 550 cases were obtained. All patients were determined to have deep coma and met the prerequisites for clinical testing. The performance rates of four brainstem reflex examinations (except cough reflex) ranged from 97.5% to 98.0%, and the completion rate as well as the coincidence rate were both 100.0%. The 238 cases (50.7%) completed apnea testing, and 231 cases (42.0%) had to stop apnea testing during the examination because of instability. The performance rates of the three ancillary tests, including electroencephalogram, short-latency somatosensory evoked potential, and transcranial Doppler, were 89.5%, 67.5%, and 79.5%, respectively; furthermore, the coincidence rates were 98.6%, 96.5%, and 99.5%, respectively. The combination of two ancillary tests was more accurate than one single ancillary test. A total of 401 (72.9%) cases successfully underwent two separate examinations to determine brain death with at least a 12-h waiting period. All brain death cases were determined by at least two qualified physicians. Conclusion This study might provide suggestions for brain death determination in China.
Brain Death ; diagnosis ; physiopathology ; Electroencephalography ; Evoked Potentials, Somatosensory ; Humans ; Ultrasonography, Doppler, Transcranial

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches with or without other acute neurological symptoms, and diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. A 44-year-old woman underwent heart transplantation due to primary amyloidosis with heart involvement. She started to have a seizure after three hours after the heart transplantation, and her consciousness was not recovered. Computed tomography and transcranial doppler sonography were used to diagnose RCVS, and contracted vessels were recovered after oral nimodipine administration.
Adult ; Amyloidosis ; Cerebral Arteries ; Consciousness ; Constriction ; Female ; Headache ; Heart Transplantation* ; Heart* ; Humans ; Nimodipine ; Seizures ; Ultrasonography, Doppler, Transcranial ; Vasoconstriction*

PURPOSE: To evaluate the efficacy and safety of cerebral monitoring by transcranial Doppler ultrasonography (TCD) for the detection of cerebral ischemia during carotid endarterectomy (CEA). METHODS: From August 2004 to December 2013, 159 CEAs were performed in a tertiary hospital. All procedures were performed under general anesthesia. Intraoperative TCD was routinely used to detect cerebral ischemia. Of the 159 patients, 102 patients were included in this study, excluding 27 patients who had a poor transtemporal isonation window and 30 patients who used additional cerebral monitoring systems such as electroencephalography or somatosensory evoked potentials. When mean flow velocity in the ipsilateral middle cerebral artery decreased by >50% versus baseline during carotid clamping carotid shunting was selectively performed. The carotid shunt rate and incidence of perioperative (<30 days) stroke or death were investigated by reviewing medical records. RESULTS: Carotid shunting was performed in 31 of the 102 patients (30%). Perioperative stroke occurred in 2 patients (2%); a minor ischemic stroke caused by embolism in one and an intracerebral hemorrhage in the other. Perioperative death developed in the latter patient. CONCLUSION: TCD is a safe cerebral monitoring tool to detect cerebral ischemia during CEA. It can reduce use of carotid shunt.
Anesthesia, General ; Brain Ischemia ; Cerebral Hemorrhage ; Constriction ; Electroencephalography ; Embolism ; Endarterectomy, Carotid* ; Evoked Potentials, Somatosensory ; Humans ; Incidence ; Medical Records ; Middle Cerebral Artery ; Stroke ; Tertiary Care Centers ; Ultrasonography, Doppler, Transcranial*

BACKGROUND: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. METHODS: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. RESULTS: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. CONCLUSION: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.
Anesthesia, General ; Atrial Fibrillation ; Carotid Artery Diseases ; Constriction, Pathologic ; Embolism ; Endarterectomy, Carotid* ; Humans ; Hypoglossal Nerve Injuries ; Incidence ; Mortality ; Multivariate Analysis ; Neurologic Manifestations ; Postoperative Complications ; Postoperative Period ; Retrospective Studies* ; Risk Factors ; Stroke ; Ulcer ; Ultrasonography, Doppler, Transcranial ; Wounds and Injuries

BACKGROUNDFew studies have addressed whether abnormalities in the lenticular nucleus (LN) are characteristic transcranial sonography (TCS) echo features in patients with primary dystonia. This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia.

METHODScross-sectional observational study was performed between December 2013 and December 2014 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects. TCS was performed in patients and control subjects. Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups.

RESULTSThirteen individuals were excluded due to poor temporal bone windows, and two subjects were excluded due to disagreement in evaluation by sonologists. Totally, 70 patients (cervical dystonia, n = 30; blepharospasm, n = 30; oromandibular dystonia, n = 10) and 50 normal controls were included in the final analysis. LN hyperechogenicity was observed in 51% (36/70) of patients with primary focal dystonia, compared with 12% (6/50) of controls (P < 0.001). Substantia nigra hyperechogenicity did not differ between the two groups. LN hyperechogenicity was observed in 73% (22/30) of patients with cervical dystonia, a greater prevalence than in patients with blepharospasm (33%, 10/30, P = 0.002) and oromandibular dystonia (40%, 4/10, P = 0.126). LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls (73% vs. 12%, P < 0.001); however, no significant difference was detected in patients with blepharospasm (33% vs. 12%, P = 0.021) or oromandibular dystonia (40% vs. 12%, P = 0.088).

CONCLUSIONSLN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls. It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.

Adult ; Aged ; Blepharospasm ; diagnostic imaging ; Corpus Striatum ; diagnostic imaging ; Cross-Sectional Studies ; Dystonic Disorders ; diagnostic imaging ; Echoencephalography ; Female ; Humans ; Male ; Middle Aged

PURPOSE: Lacunar stroke, in the context of small vessel disease, is a type of cerebral infarction caused by occlusion of a penetrating artery. Pulsatility index (PI) is an easily measurable parameter in Transcranial Doppler ultrasound (TCD) study. PI reflects distal cerebral vascular resistance and has been interpreted as a surrogate marker of small vessel disease. We hypothesized that an increased PI, a marker of small vessel disease, might be associated with a larger infarct volume in acute lacunar stroke. MATERIALS AND METHODS: This study included 64 patients with acute lacunar stroke who underwent TCD and brain MRI. We evaluated the association between the mean PI value of bilateral middle cerebral arteries and infarct volume on diffusion-weighted MRI using univariate and multivariate linear regression. RESULTS: The mean infarct volume and PI were 482.18±406.40 mm3 and 0.86±0.18, respectively. On univariate linear regression, there was a significant positive association between PI and infarct volume (p=0.001). In the multivariate model, a single standard deviation increase of PI (per 0.18) was associated with an increase of 139.05 mm3 in infarct volume (95% confidence interval, 21.25 to 256.85; p=0.022). CONCLUSION: We demonstrated that PI was an independent determinant of infarct volume in acute lacunar stroke. The PI value measured in acute stroke may be a surrogate marker of the extent of ischemic injury.
Aged ; Cerebral Infarction/*diagnostic imaging/*physiopathology ; *Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Middle Cerebral Artery ; Pulsatile Flow/physiology ; Retrospective Studies ; Stroke, Lacunar/*diagnostic imaging/*physiopathology ; *Ultrasonography, Doppler, Transcranial ; Vascular Resistance/physiology

PURPOSE: To measure and compare the ocular blood-flow velocity of ophthalmic artery in patients with central serous chorioretinopathy (CSC); affected eyes, asymptomatic fellow eyes, and CSC resolved eyes using transcranial Doppler ultrasonography. METHODS: A total of 31 patients (age 20-52 years) with CSC were evaluated using power motion mode Doppler 150 digital transcranial Doppler ultrasonography. The peak systolic velocity (PSV), peak diastolic velocity (PDV), and resistance index (RI) were measured in the ophthalmic artery of both affected and asymptomatic fellow eyes. After 2 months, 23 patients with resolved serous retinal detachment underwent repeated measurement of the above hemodynamic indices. RESULTS: The PSV and PDV of the ophthalmic artery were 30.05 ± 5.34 cm/sec and 14.07 ± 2.90 cm/sec in affected eyes and 33.03 ± 2.00 cm/sec and 17.17 ± 2.76 cm/sec in asymptomatic fellow eyes, respectively. Both indices were significantly lower in affected eyes (p = 0.004, p < 0.001, respectively). The RI was 0.52 ± 0.08 in affected eyes and 0.43 ± 0.04 in fellow eyes, a significant difference (p < 0.001). After 2 months, in 23 eyes with resolved CSC, the PSV and PDV were 32.94 ± 6.24 cm/sec and 15.54 ± 2.88 cm/sec, respectively. Both indices were significantly higher than at baseline (p = 0.031, p = 0.045, respectively). However, RI was 0.48 ± 0.04 and was not significantly different (p = 0.073). CONCLUSIONS: The CSC-affected eyes showed lower ocular blood-flow velocity and higher RI than the asymptomatic fellow eyes. The ocular blood-flow velocity was increased as CSC was resolved. These findings provide insights into the ophthalmic arterial vascular factors related to the pathogenesis of CSC.
Central Serous Chorioretinopathy* ; Hemodynamics ; Humans ; Ophthalmic Artery ; Retinal Detachment ; Ultrasonography, Doppler, Transcranial*

OBJECTIVETo compare agitated saline solution (AS) and the mixture of AS with blood (ASb) as the contrast agents in contrast transcranial Doppler (c-TCD) in the diagnosis of patent foramen ovale (PFO).

METHODSWe recruited 248 consecutive patients for c-TCD examination between November 2015 and January 2016, and the sequence of the use of AS (9 mL saline solution mixed with 1 mL air) and ASb (9 mL saline solution and a drop of the patient's blood mixed with 1 mL air) was determined by coin-tossing method. Before the examination, the contrast agent was injected with or without Valsalva maneuvers (VM), and the number of microbubbles within 25 s after the contrast agent injection and the time of first appearance of microbubbles were recorded by observing the TCD spectrum. Each injection was repeated twice and the interval between tests was at least 5 min. We classified PFO according to the number of microbubbles into negative (no microbubble), grade I (1-10 microbubbles), grade II (>10 microbubbles but no curtain), and grade III (with curtain).

RESULTSs The positivity rates in diagnosis with AS without VM, AS with VM, ASb without VM, and ASb with VM tests were 10.9%, 23.8%, 12.1% and 25.8%, respectively. AS with VM test had a higher positive rate than AS without VM test (23.8% vs 10.9%, P=0.001), and ASb with VM test had a higher positive rate than ASb without VM test (25.8% vs 12.1%, P=0.001). The positive rates were similar between ASb without VM and AS without VM test (12.1% vs 10.9%, P=0.250) and between ASb with VM test and AS with VM test (25.8% vs 23.8%, P=0.125).

CONCLUSIONVM can improve the positive rate of PFO diagnosis in c-TCD examination, and the positive rates are comparable between examinations using the contrast agents AS and ASb.

Contrast Media ; chemistry ; Foramen Ovale, Patent ; diagnostic imaging ; Microbubbles ; Sensitivity and Specificity ; Sodium Chloride ; Ultrasonography, Doppler, Transcranial ; Valsalva Maneuver