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NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS
Official Journal of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics
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1.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Vol. 1, 2005
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,
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Transcranial duplex
monitoring
discloses hemorrhagic complications following rtPA thrombolysis.
Kaps M, Seidel G, Gerriets T, Traupe H.
Transcranial duplex monitoring discloses hemorrhagic complications following rtPA thrombolysis.
read the entire text >>
Disgnosis of MCA-occlusion and
monitoring
of systemic thrombolytic therapy with contrast enhanced transcranial duplex-sonography.
Maurer M, Mullges W, Becker G.
Disgnosis of MCA-occlusion and monitoring of systemic thrombolytic therapy with contrast enhanced transcranial duplex-sonography.
read the entire text >>
The use of transcranial Doppler sonography (TCD) with
monitoring
of the mean flow velocity (MFV) in the middle cerebral artery (MCA) gives possibility for noninvasive evaluation of the autoregulatory response when assessing the cerebral autoregulation (CA).
The use of transcranial Doppler sonography (TCD) with monitoring of the mean flow velocity (MFV) in the middle cerebral artery (MCA) gives possibility for noninvasive evaluation of the autoregulatory response when assessing the cerebral autoregulation (CA).
Different stimuli for alteration of the mean blood pressure (MBP) during the autoregulatory tests have been applied: thigh cuff, Valsalva, carotid compression, neck suction, orthostatic stress, cognitive tasks. CA could also be examined by calculation of the phase shift between the spontaneous oscillations of the MBP and the MFV in the MCA.
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Continuous
monitoring
of cerebrovasculsr Autoregulation: a Validation Study.
Lang EW, Mehdorn HM, Dorsch NW, Czoznyka M.
Continuous monitoring of cerebrovasculsr Autoregulation: a Validation Study.
read the entire text >>
Orthostatic dysregulation in progressive autonomic failure: a transcranial Doppler sonographiy
monitoring
.
Titinova E, Karakaneva S, Velcheva I.
Orthostatic dysregulation in progressive autonomic failure: a transcranial Doppler sonographiy monitoring.
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Vasomotor reactivity of middle cerebral atreries in patients with cerebrovascular diseases: a transcranial Doppler sonography
monitoring
.
Velcheva I, Titianova E, Alexandrova D, Damianov P.
Vasomotor reactivity of middle cerebral atreries in patients with cerebrovascular diseases: a transcranial Doppler sonography monitoring.
In : Annual proceedings.
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Classical topics such as carotid plaque characterization, emboli detection
monitoring
, ultrasound contrast imaging, ultrasound diagnosis of foramen ovale, ultrasound application during carotid surgery and functional assessment of cerebral hemodynamics were also presented.
The 10th Meeting of the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) focused the attention in different topics. Specific sessions were devoted to emerging problems as the role of the ultrasounds in stroke units (perfusion imaging and sonothrombolysis) is known to be very important. Ultrasounds in non vascular brain diseases, hyperbaric medicine, imaging brain parenchyma and cerebral venous system were another innovative topics along with arterial wall imaging including intima-media tichkness (IMT) and distensibility studies.
Classical topics such as carotid plaque characterization, emboli detection monitoring, ultrasound contrast imaging, ultrasound diagnosis of foramen ovale, ultrasound application during carotid surgery and functional assessment of cerebral hemodynamics were also presented.
The advance in neurosonology, connected with echo-contrast bolus traking for analysis of cerebral circulation time, the assessment of the global cerebral blood volume and ultrasound evaluation of movement disorders, was discussed in a separate session. Proper time was dedicated to training and certification in Neurosonology in the European community.
read the entire text >>
2.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 1, 2005, No. 2
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Transcranial Doppler
monitoring
of microembolic signals (MES) in both middle cerebral arteries was performed.
symptomatic. The following risk factors – diabetes, smoking, hyperlipidemia, arterial hypertension, ischemic heart diseases, and peripheral artery diseases were recorded.
Transcranial Doppler monitoring of microembolic signals (MES) in both middle cerebral arteries was performed.
The relationship between MES and the presence of the risk factors for cerebrovascular diseases was studied.
read the entire text >>
Microembolic signals with serial transcranial doppler
monitoring
in acute focal ischemic deficit.
Del Sette M, Angeli S, Stara I, Finocchi C, Gandolfo C.
Microembolic signals with serial transcranial doppler monitoring in acute focal ischemic deficit.
A local phenomenon?
read the entire text >>
3.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 1
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,
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Skin perfusion
monitoring
reflects variations of microcirculatory and sympathetic responses to orthostatism.
Skin perfusion monitoring reflects variations of microcirculatory and sympathetic responses to orthostatism.
The application of orthostatic test with assessment of skin perfusion changes by laser Doopler flowmetry does not contribute to differentiation of primary from secondary Raynaud’s phenomenon in individual patients but it helps for group analysis of microcirculatory and vasomotor manifestations of orthostatic intolerance in separate forms. Laser Doppler flowmetry is a valuable method for investigation of skin microcirculatory dysfunctions.
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4.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 2
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,
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High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler
Monitoring
.
Alexandrov AV, Demchuk AM, Felberg RA, Christou I, Barber PA, Burgin WS, Malkoff M, Wojner AW, Grotta JC.
High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler Monitoring.
read the entire text >>
Microbubble Administration Accelerates Clot Lysis During Continuous 2-MHz Ultrasound
Monitoring
in Stroke Patients Treated With Intravenous Tissue Plasminogen Activator.
n J.
Microbubble Administration Accelerates Clot Lysis During Continuous 2-MHz Ultrasound Monitoring in Stroke Patients Treated With Intravenous Tissue Plasminogen Activator.
read the entire text >>
Бяха представени и протичащите 4 клинични ултразвукови мултицентрови проучвания – Asymtomatic Carotid Emboly Study (ACES), The ELIGIBLE Study (използване на цветното транскраниално дуплексскениране в първите 3 часа от началото на мозъчния инфаркт), Neurosonological
Monitoring
in Acute stroke (MEMO) и Dynamic Vascular Analysis (DVA).
зъчна исхемия, за оценка на мозъчната перфузия и за диагноза на персистиращия дефект на междупредсърдната преграда (foramen ovale), ултразвуковата характеристика на мозъчния паренхим, лечението на екстраи интракраниалните артериални стенози и диагностичните и терапевтични аспекти на приложението на ултразвуковите методи. Специално внимание бе отделено на сонотромболизата с и без използване на тъканен рекомбинантен плазминоген активатор. В отделна сесия бе дискутирана ролята на ултразвуковото мониториране по време на стентиране на екстракраниални и интракраниални артерии.
Бяха представени и протичащите 4 клинични ултразвукови мултицентрови проучвания – Asymtomatic Carotid Emboly Study (ACES), The ELIGIBLE Study (използване на цветното транскраниално дуплексскениране в първите 3 часа от началото на мозъчния инфаркт), Neurosonological Monitoring in Acute stroke (MEMO) и Dynamic Vascular Analysis (DVA).
read the entire text >>
5.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 1
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,
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Improve diagnosis and
monitoring
routines by applying cybernetic
Promote the understanding of cerebrovascular and cardiovascular hemodynamics.
Improve diagnosis and monitoring routines by applying cybernetic
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monitoring
for cerebral emboli.
monitoring for cerebral emboli.
read the entire text >>
6.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 1
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,
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Noninvasive
monitoring
of internal carotid artery dissection.
Steinke W, Rautenberg W, Schwartz A, Hennerici M.
Noninvasive monitoring of internal carotid artery dissection.
read the entire text >>
7.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 2
,
,
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Brain computer tomography (CT), digital subtraction angiography (DSA) and multirange Doppler sonography
monitoring
of the blood flow velocity in carotid and basal
А 17 years old men with clinical diagnosis of brain death is described – by repeated examination the loss of brainstem reflexes was confirmed.
Brain computer tomography (CT), digital subtraction angiography (DSA) and multirange Doppler sonography monitoring of the blood flow velocity in carotid and basal
read the entire text >>
Ultrasound
monitoring
of the cerebral hemodynamics is an easy and informative non-invasive method for evalustion of cerebral circulatory arrest in brain death.
Ultrasound monitoring of the cerebral hemodynamics is an easy and informative non-invasive method for evalustion of cerebral circulatory arrest in brain death.
read the entire text >>
Diagnosis and
monitoring
of subarachnoid hemorrhage by transcranial color-coded realtime sonography. Neurosurgery
Becker G, Greiner K, Kaune B, Winkler J, Brawanski A, Warmuth-Metz M, Bogdahn U.
Diagnosis and monitoring of subarachnoid hemorrhage by transcranial color-coded realtime sonography. Neurosurgery
read the entire text >>
The proved advantages of ultrasound examinations are: harmlessness, protection of slow virus infections, possibility for repeated
monitoring
, comparable results, low prime cost of results, high advantages in comparing with the other neuroimaging methods.
Images of stretch of functional axis of muscles are hipoechogenic fibers. There is ultrasound effect – the effect of the comb. The assessment of blood vesicles of muscles are accomplishing by colour and power Doppler examination. The examination is made in time of contraction using a 7-10 MHz linear transducer. The ultrasound distinguishment of surrounding tissues (skin, bones and fat) is important.
The proved advantages of ultrasound examinations are: harmlessness, protection of slow virus infections, possibility for repeated monitoring, comparable results, low prime cost of results, high advantages in comparing with the other neuroimaging methods.
The usage of myosonology in neurology has high sense in inflamed and degerative diseases, tumors, traumas, biopsy and other diagnostic problems.
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8.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 5, 2009, No. 1
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A further advantage of TCCS lies in the
monitoring
of stroke patients during and after therapy.
contrast enhancement is needed in many cases for an unequivocal diagnosis of high-grade stenosis of the intracranial vertebral or basilar arteries, although no data from systematic large series are available [8].
A further advantage of TCCS lies in the monitoring of stroke patients during and after therapy.
read the entire text >>
9.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 5, 2009, No. 1
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Monitoring
of venous hemodynamics in patients with cerebral venous thrombosis by transcranial Doppler ultrasound.
Valdueza JM, Hoffmann O, Weih M, Mehraein S, Einhоupl KM.
Monitoring of venous hemodynamics in patients with cerebral venous thrombosis by transcranial Doppler ultrasound.
read the entire text >>
Transorbital sonographic
monitoring
of optic nerve diameter in patients with severe brain injury.
Transorbital sonographic monitoring of optic nerve diameter in patients with severe brain injury.
read the entire text >>
10.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 1
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Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-
Monitoring
Study.
SITS-MOST: Wahlgren N, Ahmed N, Dávalos A, Ford G, Grond M, Hacke W, Hennerici M, Kaste M, Kuelkens S, Larrue V.
Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study.
read the entire text >>
Safe Implementation ofThrombolysis in Stroke-
Monitoring
(SITS-MOST)
Safe Implementation ofThrombolysis in Stroke-Monitoring (SITS-MOST)
read the entire text >>
The Safe Implementation of Thrombolysis in Stroke-
Monitoring
Study (SITS-MOST) was a multicentre, multinational observational study which confirmed that rt-PA, compared to placebo, is as effective and safe in the routine clinical practice as it was reported by previous large randomised controlled trials [63, 65, 68].
The Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was a multicentre, multinational observational study which confirmed that rt-PA, compared to placebo, is as effective and safe in the routine clinical practice as it was reported by previous large randomised controlled trials [63, 65, 68].
TL for selected patients presenting with AIS between 3 and 4.5 hours was currently also included in the European labelling [modified January 2009], on the bases of ECASS-III study results [31]. Eligible patients with AIS for the ECASS-III were between 18 and 80 years of age. An absolute improvement of 7.2% for the rt-PA group, with an adjusted OR of favourable outcome (mRS 0-1) of 1.42, 1.02-1.98. Mortality rates did not differ significantly (7.7% versus 8.4%) between the groups. Cerebral hemorrhage was not observed with increased risk after rt-PA application (2.4% vs 0.2%) [31].
read the entire text >>
Noninvasive
monitoring
of the BP and cardiac rhythm is obligatory fot the proper care.
45 minutes from being ordered. A designated SU should be available and ready for the stroke patients beyond the acute treatment period. All arrangements and actions should be prespecified and written beforehand. The SU must be equipped with modern tools and technology to care for stroke patients.
Noninvasive monitoring of the BP and cardiac rhythm is obligatory fot the proper care.
read the entire text >>
Monitoring
for complications such as, secondary haemorrhage, space-occupying oedema, seizures, infections, decubital ulcers, deep venous thrombosis, pulmonary embolism, etc.
The location for such a unit in Austria follows a maximum of 90-min isochrones (transport time) to the hospital. In such a unit, a rapid diagnosis is made, confirmed by neuroimaging, followed by early treatment and minimizing residual disability. In addition, prevention, early recognition as well as treatment of complications arising from the stroke are an important domain of SUs. Even within the acute phase, rehabilitation is initiated to be followed by seamless further treatment and neurorehabilitation outside the SU [11-14]. In the SUs it is essential to watch out for: cardiac arrhythmia, dehydration/ fluid overload, electrolyte disturbances, systemic diseases, metabolic management, BP control, intracranial pressure, aspiration pneumonia, body temperature, progression of symptoms.
Monitoring for complications such as, secondary haemorrhage, space-occupying oedema, seizures, infections, decubital ulcers, deep venous thrombosis, pulmonary embolism, etc.
is made.
read the entire text >>
– specialized personnel is present in a facility that permits modern acute neuro-intervention, acute investigations and close
monitoring
as well as communication and direct responsibility;
– specialized personnel is present in a facility that permits modern acute neuro-intervention, acute investigations and close monitoring as well as communication and direct responsibility;
read the entire text >>
advanced ultrasound technology in the diagnosis, treatment and
monitoring
of AIS [48]: sonothrombolysis and rt-PA aiming to increase recanalization rates [2, 6, 10, 59]; ultrasonography and enhanced bubbles [51];
advanced ultrasound technology in the diagnosis, treatment and monitoring of AIS [48]: sonothrombolysis and rt-PA aiming to increase recanalization rates [2, 6, 10, 59]; ultrasonography and enhanced bubbles [51];
read the entire text >>
Microbubble Administration Accelerates Clot Lysis During Continuous 2-MHz Ultrasound
Monitoring
in Stroke Patients Treated With Intravenous Tissue Plasminogen Activator.
Molina CA, Ribo M, Rubiera M, Montaner J, Santamarina E, Delgado-Mederos R, Arenillas JF, Huertas R, Purroy F, Delgado P, Alvarez-Sabin J.
Microbubble Administration Accelerates Clot Lysis During Continuous 2-MHz Ultrasound Monitoring in Stroke Patients Treated With Intravenous Tissue Plasminogen Activator.
read the entire text >>
Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke
Monitoring
Study (SITS-MOST).
Wahlgren N, Ahmed A, Eriksson N, Aichner F, Bluhmki E, Dávalos A, Erilä T, Ford GA, Grond M, Hacke W, Hennerici M, Kaste M, Köhrmann M, Larrue V, Lees KR, Machnig T, Roine RO, Toni D, Vanhooren G, for the SITSMOST investigators.
Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST).
read the entire text >>
11.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 1
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,
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Sleep examination: All the patients are polysomnographically examined using a
monitoring
system MEPAL (MAP, MedizinTechnologie, Martinsried, Germany).
Sleep examination: All the patients are polysomnographically examined using a monitoring system MEPAL (MAP, MedizinTechnologie, Martinsried, Germany).
According to the known diagnostic standards, the minimal time for examination is 6 hours. For documentation of the sleep we use a standard 16-18 channel polysomnography, including electroencephalogram (C3–A2, C4–A1, О1-А2, О2-А1), electrooculograms, electromyograms (EMG) of left/right extremity, electrocardiogram (ECG), heart rate, nasal and oral air flow, thoracic and abdominal movements, registration of snoring, position of the body, pulsoxymetry
read the entire text >>
24-hour ambulatory ECG
monitoring
was performed in July 2010, which revealed atrial flutter with a variable degree of atrio-ventricular block, without significant pauses.
s. There had been incontinence during 2 of the episodes and in these situations the relatives observed jerking motions.
24-hour ambulatory ECG monitoring was performed in July 2010, which revealed atrial flutter with a variable degree of atrio-ventricular block, without significant pauses.
In the beginning of August 2010 he underwent an electroencephalogram, the diagnosis Epilepsy was accepted and an antiepileptic treatment initiated (Convulex 2 x 300 mg) which resulted in increasing the frequency and duration of the syncopal episodes.
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Results of the noninvasive diagnostic tests before TTT showed: ECG atrial flutter with atrioventricular block 3:1 and ventricular rate 75 beats/ min, RBBB, LAFB; 24-hour ECG
monitoring
: atrial flutter with a variable degree of atrio-ventricular block 2:1 to 4:1 and ventricular rate from 50 to
Results of the noninvasive diagnostic tests before TTT showed: ECG atrial flutter with atrioventricular block 3:1 and ventricular rate 75 beats/ min, RBBB, LAFB; 24-hour ECG monitoring: atrial flutter with a variable degree of atrio-ventricular block 2:1 to 4:1 and ventricular rate from 50 to
read the entire text >>
As an event-related neuroimaging method
monitoring
blood flow changes in middle cerebral arteries it has been applied for determining the brain lateralization of language and other cognitive functions.
Functional transcranial Doppler ultrasound (fTDU) with application of different tests is a complementary neuroimaging tool evaluating changes of blood perfusion caused by neuronal activation during cognitive assessment. Like other neuroimaging methods, sensitive to perfusion, such as PET and fMRI, fTDU is based on the close relationship between changes of cerebral blood flow and neuronal activity. This method assures much better temporal resolution compared to other neuroimaging techniques. Other advantages include low dependence on motion artifacts, easy application even in children and in uncooperative patients, and noninvasiveness.
As an event-related neuroimaging method monitoring blood flow changes in middle cerebral arteries it has been applied for determining the brain lateralization of language and other cognitive functions.
A significant increase in velocity has been registered in the dominant hemisphere during a cognitive task [8, 42]. At the same time, fTDU spectroscopy assures a more understandable picture of changes related to the influence of a given mental stimulus [25, 52].
read the entire text >>
It is a practical guide for early diagnosis, prevention, right therapeutic approach and long-term
monitoring
of patients with carotid pathology.
The Consensus regulates the ultrasound diagnostics of different types of carotid pathology and principles of diagnostic and therapeutic approach depending on its location, type, severity and clinical characteristics.
It is a practical guide for early diagnosis, prevention, right therapeutic approach and long-term monitoring of patients with carotid pathology.
Its application by different medical specialists contribute to the high quality of diagnostic, therapeutic and preventive health services in all units of outpatient and inpatient care. The algorhitm is consistent with the level of competence of each hospital and the individual characteristics of vascular pathology.
read the entire text >>
It serves as a practical guide for early diagnosis, adequate prevention, choosing the right therapeutic approach and long-term
monitoring
of threatened stroke risk population.
The consensus regulates noninvasive ultrasound diagnosis of carotid pathology and principles of behavior depending on its location, type, severity and functional characteristics.
It serves as a practical guide for early diagnosis, adequate prevention, choosing the right therapeutic approach and long-term monitoring of threatened stroke risk population.
Its application by different professionals contribute for high quality diagnostic, therapeutic and preventive health services in all units of outpatient and hospital care that are consistent with the level of competence of the hospital and the individual characteristics of the vascular pathology. The Consensus includes recommendations based on results of multicenter randomized clinical trials or meta-analysis (level of evidence A), single-center or non-randomized studies (level of evidence B) and expert advice or therapeutic standards (level of evidence C). Therapeutic and procedural recommendations are graded as required (class I), recommended (Class
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12.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 2
,
,
,
A clear inverse relationship between the degree of angiographic spasm and the TCD velocities was found, and
monitoring
of cerebral vasospasm remains one of the most useful and widespread applications of the technique.
Cerebral vasospasm is a dreaded complication of subarachnoid hemorrhage that can lead to brain infarction and in severe cases, death. Angiography was at that time practically the only modality to diagnose the arterial narrowing caused by vasospasm. In Bern we were lucky to have a neuroradiologist, Prof. Peter Huber, who was an expert in this field and who had developed a technique to accurately measure the diameter of the intracranial arteries.
A clear inverse relationship between the degree of angiographic spasm and the TCD velocities was found, and monitoring of cerebral vasospasm remains one of the most useful and widespread applications of the technique.
read the entire text >>
Due to its portability and small probe, conventional TCD is the preferred instrumentation for
monitoring
during surgical procedures and in the ICU.
Due to its portability and small probe, conventional TCD is the preferred instrumentation for monitoring during surgical procedures and in the ICU.
It is also the only practical equipment for monitoring embolic events.
read the entire text >>
It is also the only practical equipment for
monitoring
embolic events.
Due to its portability and small probe, conventional TCD is the preferred instrumentation for monitoring during surgical procedures and in the ICU.
It is also the only practical equipment for monitoring embolic events.
read the entire text >>
Recent developments in micro electronics have facilitated development of a small TCD instrument suitable for ambulatory
monitoring
during normal daily activities.
Recent developments in micro electronics have facilitated development of a small TCD instrument suitable for ambulatory monitoring during normal daily activities.
Running on battery power, continuous monitoring and recording of the raw Doppler signal for extensive time periods (8 hours) is possible. This is especially important for emboli detection, as the events typically come
read the entire text >>
Running on battery power, continuous
monitoring
and recording of the raw Doppler signal for extensive time periods (8 hours) is possible.
Recent developments in micro electronics have facilitated development of a small TCD instrument suitable for ambulatory monitoring during normal daily activities.
Running on battery power, continuous monitoring and recording of the raw Doppler signal for extensive time periods (8 hours) is possible.
This is especially important for emboli detection, as the events typically come
read the entire text >>
in clusters so that longer
monitoring
time is required to avoid false negatives.
in clusters so that longer monitoring time is required to avoid false negatives.
A lightweight and comfortable probe fixation has been designed on the basis of a spectacles frame, with 2-axes robotic probe control so that the signal can be maintained even during sporting activities. This instrumentation hopefully will be available soon commercially and open up for the development of new diagnostic and monitoring TCD applications.
read the entire text >>
This instrumentation hopefully will be available soon commercially and open up for the development of new diagnostic and
monitoring
TCD applications.
in clusters so that longer monitoring time is required to avoid false negatives. A lightweight and comfortable probe fixation has been designed on the basis of a spectacles frame, with 2-axes robotic probe control so that the signal can be maintained even during sporting activities.
This instrumentation hopefully will be available soon commercially and open up for the development of new diagnostic and monitoring TCD applications.
read the entire text >>
We emphasize on the specialized diagnostic testing and
monitoring
of these deficits in dynamics.
The presented case demonstrates a complex combination and difficult differentiation of visual and visual-spatial disturbances in parietooccipital hemorrhage. We observed a rare combination of hemineglect and hemianopsia, as well as cardinal signs of Gerstman syndrome.
We emphasize on the specialized diagnostic testing and monitoring of these deficits in dynamics.
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For differentiation of cardinal features of Gerstmann syndrome a target neuropsychological testing with gnosis, praxis and language functions
monitoring
is applied.
In 1940 Josef Gerstmann united the symptoms finger agnosia, acalculia, agrafia and leftright disorientation in a single syndrome. He considered that the syndrome had a localization value and was a result from damage of the parietal lobe of dominant for language functions hemisphere – left gyrus angularis in particular. According to Gerstmann the syndrome was a result of the "unique fingerprint sense" impairment and the presence of the other symptoms derived from it [15, 16]. Gerstmann syndrome rarely occurs in pure form, which causes disputes for its localization importance. Its clinical expression is usually accompanied by additional symptoms: alexia, amnesic aphasia, constructive apraxia, right-sided central hemipalsy, right homonymous hemianopsia, forming the extended Gerstmann syndrome [2].
For differentiation of cardinal features of Gerstmann syndrome a target neuropsychological testing with gnosis, praxis and language functions monitoring is applied.
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The prospective
monitoring
is important.
The study shows that the diagnosis of enlarged Gerstmann syndrome with hemianopsia and hemineglect requires a multidisciplinary approach and is supported by the combined use of clinical, neuropsychological, neurophysiologic and ophthalmological examinations.
The prospective monitoring is important.
Application of neuroimaging methods contributes to objectify the location, severity and type of damage in the brain parenchyma and its evolution.
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Microvascular skin reactivity is assessed in reactive hyperemia test by
monitoring
of skin perfusion by means of laser-Doppler flowmeter Periflux4001 (Perimed, Stockholm).
Microvascular skin reactivity is assessed in reactive hyperemia test by monitoring of skin perfusion by means of laser-Doppler flowmeter Periflux4001 (Perimed, Stockholm).
The reactive hyperemia test is done by temporary arterial occlusion with a blood pressure cuff inflated to suprasystolic values up to 220 mm Hg and followed by sharp deflation inducing sudden reactive hyperemic response and increase of skin circulation. The reactive hyperemia of the first tiptoes after three minutes occlusion of the blood circulation was measured. The investigation was performed at 320С superficial skin temperature, controlled by temperature transducer in order to reduce the temperature influence on the hyperemic reaction [23]. Standardized reactive hyperemia test is a reliable non-invasive method for investigation of endothelial function in clinical practice.
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Laser-Doppler flowmetry is an easy non-invasive method of investigation of skin microcirculation and vasomotor reactivity and its
monitoring
during reactive hyperemia testing is reliable for assessment of microvascular endothelial dysfunctions.
thy. Endothelial-derived dilator microcirculatory reactions were damaged in diabetic polyneuropathy patients.
Laser-Doppler flowmetry is an easy non-invasive method of investigation of skin microcirculation and vasomotor reactivity and its monitoring during reactive hyperemia testing is reliable for assessment of microvascular endothelial dysfunctions.
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For that funding, the participants in providing health and safety at work are obliged to organize periodical check-up examinations, health
monitoring
and specific services related to the work environment.
effectiveness and quality [3, 5]. The ensuring of a good occupational health practice is of a great importance because the money paid by the employers is one of the sources of funding for the health system in Bulgaria, providing screening, research and specific services related to work environment.
For that funding, the participants in providing health and safety at work are obliged to organize periodical check-up examinations, health monitoring and specific services related to the work environment.
Payment for occupational health services is an indirect source of income by which the employer buys prophylactic, diagnostic and hospital services for the people employed by him, in order to reduce the health risks, arising from the workplace and improvement of the working conditions.
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13.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 8, 2012, No. 1
,
,
,
Patients experienced carotid dissection, are subject to active
monitoring
, modification of vascular risk factors and periodic sonographic control.
Patients experienced carotid dissection, are subject to active monitoring, modification of vascular risk factors and periodic sonographic control.
read the entire text >>
TMS is used for preoperative assessment of specific cortical areas (identification of the dominant hemisphere, localization of speech or motor areas), and intraoperative
monitoring
of corticospinal tract.
TMS is used for preoperative assessment of specific cortical areas (identification of the dominant hemisphere, localization of speech or motor areas), and intraoperative monitoring of corticospinal tract.
Combining TMS with functional MRI optimizes surgery and reduces the risk of postoperative deficit [39, 40]. Application of high-frequency rTMS at lower frontal lobe of the dominant hemisphere leads to "speech arrest", which allows precise localization of cortical speech areas [14].This test is used as an alternative to the Wada test in preoperative preparation for temporal lobectomy. In spinal cord surgery the function of anterior and lateral tracts is monitored by TMS in contrast to somatosensory evoked potentials (SSEP) evaluating the conductivity of posterior tracts. The combined use of both methods, monitoring afferent and efferent conduction pathways, significantly reduces postoperative risk. The negative influence of inhalatory anesthetics on MEP generation at this stage is overcome by the application of
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The combined use of both methods,
monitoring
afferent and efferent conduction pathways, significantly reduces postoperative risk.
TMS is used for preoperative assessment of specific cortical areas (identification of the dominant hemisphere, localization of speech or motor areas), and intraoperative monitoring of corticospinal tract. Combining TMS with functional MRI optimizes surgery and reduces the risk of postoperative deficit [39, 40]. Application of high-frequency rTMS at lower frontal lobe of the dominant hemisphere leads to "speech arrest", which allows precise localization of cortical speech areas [14].This test is used as an alternative to the Wada test in preoperative preparation for temporal lobectomy. In spinal cord surgery the function of anterior and lateral tracts is monitored by TMS in contrast to somatosensory evoked potentials (SSEP) evaluating the conductivity of posterior tracts.
The combined use of both methods, monitoring afferent and efferent conduction pathways, significantly reduces postoperative risk.
The negative influence of inhalatory anesthetics on MEP generation at this stage is overcome by the application of
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tive transcranial magnetic stimulation
monitoring
in spinal column surgery.
tive transcranial magnetic stimulation monitoring in spinal column surgery.
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Total intravenous anesthesia for intraoperative
monitoring
of the motor pathways: an integral view combining clinical and experimental data.
Scheufler KM, Zentner J.
Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data.
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Cardio-vascular system evaluation is of paramount importance for the further diagnostic and therapeutic work-up, as well as for prognosis, and includes: 12-lead ECG, continuous ECG
monitoring
– in-hospital or ambulatory with Holter ECG, implantable loop-event recorders, telemonitoring, electrophysiological study, signal-averaged ECG, carotid sinus massage, echocardiography, stress ECG test, tilt-table test.
syncope includes a thorough anamnesis, physical examination and some basic laboratory parameters.
Cardio-vascular system evaluation is of paramount importance for the further diagnostic and therapeutic work-up, as well as for prognosis, and includes: 12-lead ECG, continuous ECG monitoring – in-hospital or ambulatory with Holter ECG, implantable loop-event recorders, telemonitoring, electrophysiological study, signal-averaged ECG, carotid sinus massage, echocardiography, stress ECG test, tilt-table test.
It has been proved that liquor investigation, Doppler-sonography of carotid arteries, cerebral angiography, brain computed tomography and electroencephalography do not contribute to the diagnostic work-up in the absence of clinical signs of a neurological disease. Nevertheless neurological examination is warranted in case of a clinical suspicion of neurological disease, as well as when traumatic brain damage could not be ruled out. Psychiatric patients’ evaluation is appropriate in cases of multifold recurrent episodes of loss of consciousness in young adults and other co-existing nonspecific complaints.
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Modern neuroimaging technologies allow
monitoring
of neurophysiologic changes and expand the knowledge about the factors affecting the rehabilitation processes [4].
combined with a therapy program. Dopaminergic and acetylcholinesterase inhibitors improve memory. Benzodiazepines and antipsychotics appear to slow recovery after traumatic brain injury and stroke.
Modern neuroimaging technologies allow monitoring of neurophysiologic changes and expand the knowledge about the factors affecting the rehabilitation processes [4].
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Close
monitoring
and avoidance of fatigue are paramount.
It is proved that patients with Parkinson’s disease benefit from regular physical exercises focusing on balance and gait [22]. Appropriate goals and therapies are specific for the disease stage and the needs and values of the individual patient. Preliminary evidence supports moderate aerobic and strengthening regimens in these patients.
Close monitoring and avoidance of fatigue are paramount.
Assistive technologies play an ever-increasing role in maintaining independence during all stages of the disease. Home modifications and adaptive equipment are frequently needed. Exercises have to be carefully monitored in patients with neuromuscular disorders to avoid injury and increased weakness from overuse. Noninvasive positive pressure breathing devices are helpful in progressive neuromuscular disorders causing respiratory compromise. Most activities of daily living are performed at 20% to 30% of maximal normal muscle tension, so with disease progression even normal activities can produce overload and muscle damage.
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14.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2012, No. 2
,
,
,
This will allow not only the
monitoring
of muscle tissue volume during processes of atrophy or after exercise, but also
monitoring
the effect of medicalor physiotherapies on movements e.g.
US of muscles was first used during examinations of athletes to detect muscle injuries like bleedings or disruption after exercise. Even more, the position of needle electrodes for biopsy or injections of medications – e.g. botulinum toxins or local anesthetics opens new quality improvement for the treatment of patients. Using tissue velocity imaging (TVI) we are able to investigate the dynamics of movements in identified muscles. The US method provides advantage compared to EMG or MRI/CT, since the muscle motion could be better detected and quantified in terms of velocity and accelerations as well as synchronicity of muscle contraction.
This will allow not only the monitoring of muscle tissue volume during processes of atrophy or after exercise, but also monitoring the effect of medicalor physiotherapies on movements e.g.
during rehabilitation or sports.
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This US technique provides a simple and mobile method which also allows us measuring of the kinetic of movements during disease progression or as treatment
monitoring
and is therefore ideal for
monitoring
exercise therapies or drug effects [13].
We have analyzed by using TVI the contraction rate of voluntaric hand opening and closing movements in healthy subjects and stroke patients. The recording of indicated muscles of the proximal forearm reveals reproducible values for the contraction and relaxation behavior as well as a measure for the repetition frequency. In stroke patients with hemispheric strokes, a significant reduction in these parameters is found. It also reflects a significant decrease to the contralateral "healthy" side indicating a systematic slowing of movements in stroke patients.
This US technique provides a simple and mobile method which also allows us measuring of the kinetic of movements during disease progression or as treatment monitoring and is therefore ideal for monitoring exercise therapies or drug effects [13].
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Neuroimaging methods – ultrasound of cerebral intracranial venous circulation and Magnetic Resonance Angiography (MRA) are increasingly used in clinical practice for the diagnosis and
monitoring
of venous circulation disturbances.
The diagnosis of intracranial venous pathology is difficult.
Neuroimaging methods – ultrasound of cerebral intracranial venous circulation and Magnetic Resonance Angiography (MRA) are increasingly used in clinical practice for the diagnosis and monitoring of venous circulation disturbances.
Neuroimaging methods have the leading
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Different opportunities of Telesonology were presented: prevention of stroke,
monitoring
during operations and Neurosonology training.
tianova (Bulgaria) presented the possibilities of multimodal neurosonology for differentiating the severity of m. triceps surae lesions in various diseases. A very interesting and innovative session was “Telemedicine”.
Different opportunities of Telesonology were presented: prevention of stroke, monitoring during operations and Neurosonology training.
The forum was preceded by a course of Neurosonology followed by a theoretical and practical examination to obtain an international certificate.
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15.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 1
,
,
,
To identify the IJV with certainty, researchers should either continue ultrasound
monitoring
of the IJV as the subject stands or sits up or perform a short VM to dilate the IJV.
Collapse of the IJVs in upright position is a physiological effect of the drop in hydrostatic pressure and should not be considered a pathological phenomenon. Therefore, lack of posturaldependent IJV collapse may indicate proximal venous obstruction and has been observed in a few cases in one of our own studies [21]. However, in subsequent examinations we found that we had probably mistaken other veins for the IJV in the upright position, as the IJV was frequently completely collapsed.
To identify the IJV with certainty, researchers should either continue ultrasound monitoring of the IJV as the subject stands or sits up or perform a short VM to dilate the IJV.
Furthermore, to assess the real hemodynamic relevance in cases of absent venous postural collapse the differences of blood flow volume between the supine and sitting body position should be analysed. In the only one published work using blood flow volume measurements we found a significant higher decrease of blood volume flow in the sitting position in normal subjects, suggesting an even better venous drainage via the IJVs in this position in MS patients [21].
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Monitoring
of venous hemodynamics in patients with cerebral venous thrombosis by transcranial Doppler ultrasound.
upl KM.
Monitoring of venous hemodynamics in patients with cerebral venous thrombosis by transcranial Doppler ultrasound.
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Monitoring
and Functional Studies
Monitoring and Functional Studies
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16.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2
,
,
,
Monitoring
the Critically Ill Patient.
Monitoring the Critically Ill Patient.
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Monitoring
the Brain During Invasive Cardiovascular Examinations and Surgery.
Monitoring the Brain During Invasive Cardiovascular Examinations and Surgery.
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Is Automatic Embolus
Monitoring
Ready for Real Life Application?
Is Automatic Embolus Monitoring Ready for Real Life Application?
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TCD-EEG
Monitoring
in Paroxysmal Neurological Diseases.
TCD-EEG Monitoring in Paroxysmal Neurological Diseases.
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Determining the Ideal Time Window for Angioplasty in an Unconscious SAH Patient with Severe Cerebral Vasospasm: a Multimodal
Monitoring
Approach.
Determining the Ideal Time Window for Angioplasty in an Unconscious SAH Patient with Severe Cerebral Vasospasm: a Multimodal Monitoring Approach.
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Transcranial Doppler and Oximetry Tissue Catheter
Monitoring
in Diffuse Brain Vasospasm.
Transcranial Doppler and Oximetry Tissue Catheter Monitoring in Diffuse Brain Vasospasm.
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Cerebral Autoregulation in Patients with Orthostatic Intolerance: a Transcranial Doppler Sonography
Monitoring
.
Cerebral Autoregulation in Patients with Orthostatic Intolerance: a Transcranial Doppler Sonography Monitoring.
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Transcranial Doppler
Monitoring
during Hypothermic Circulation Arrest.
Transcranial Doppler Monitoring during Hypothermic Circulation Arrest.
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Does Long-Term Continuous Transcranial Doppler
monitoring
Require a Pause for Safer Use?
Nakagawa K, Ishibashi T, Matsushima M, Tanifuji Y, Amaki Y, Furuhata H.
Does Long-Term Continuous Transcranial Doppler monitoring Require a Pause for Safer Use?
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MONITORING
THE CRITICAL ILL PATIENTS
MONITORING THE CRITICAL ILL PATIENTS
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Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside
monitoring
to determine flow velocities indicative of changes in vascular caliber.
Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside monitoring to determine flow velocities indicative of changes in vascular caliber.
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To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for
monitoring
of cerebral hemodynamics in neurotrauma.
It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH).
To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
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TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous
monitoring
of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP.
TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous monitoring of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP.
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monitoring
, neurocritical care, ultrasonography.
monitoring, neurocritical care, ultrasonography.
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In contrast to many authors who have used clot weight changes to characterize the effects of insonation, we have used a visual assessment with a camera allowing continuous
monitoring
over the treatment time.
In contrast to many authors who have used clot weight changes to characterize the effects of insonation, we have used a visual assessment with a camera allowing continuous monitoring over the treatment time.
This allowed us to get more reproducible values and important information related to the rate of lysis, which can help in characterizing the effects of different pulsing sequences at various acoustic pressures. More specifically, we have studied the respective roles of fibrinolysis and haemolysis in the observed clot lysis. In essence, our results indicate an absence of fibrinolysis at acoustic pressure levels up to 1.3 MPa per se but a pure haemolysis in the absence of rtPA. Conversely, at this acoustic pressure level, the presence of 3 µg/ml rtPA led to a significant fibrinolysis when combined with US and microbubbles.
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Neurosurgeons, neurologists and neurointensivists, including military, have a large armamentarium of invasive
monitoring
modalities available to detect secondary brain injury and guide therapy.
Critical care management of patients with traumatic brain injury (TBI) has undergone tremendous advances.
Neurosurgeons, neurologists and neurointensivists, including military, have a large armamentarium of invasive monitoring modalities available to detect secondary brain injury and guide therapy.
The primary goal monitoring is to prevent secondary insults to the brain, primarily cerebral ischemia due to the posttraumatic vasospasm (PTV), and intracranial hypertension (ICH). This lecture summarizes the advantages and the specific roles of transcranial Doppler (TCD) ultrasound to establish and monitor the presence of PTV and ICH.
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The primary goal
monitoring
is to prevent secondary insults to the brain, primarily cerebral ischemia due to the posttraumatic vasospasm (PTV), and intracranial hypertension (ICH).
Critical care management of patients with traumatic brain injury (TBI) has undergone tremendous advances. Neurosurgeons, neurologists and neurointensivists, including military, have a large armamentarium of invasive monitoring modalities available to detect secondary brain injury and guide therapy.
The primary goal monitoring is to prevent secondary insults to the brain, primarily cerebral ischemia due to the posttraumatic vasospasm (PTV), and intracranial hypertension (ICH).
This lecture summarizes the advantages and the specific roles of transcranial Doppler (TCD) ultrasound to establish and monitor the presence of PTV and ICH.
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Because PTV and ICH represent significant events in a high proportion of patients after wartime TBI, close daily TCD
monitoring
is recommended for the management of such patients.
This means it that TCD has greater value and helps to improve the management of patients with TBI. Too often, the first sign is a neurologic deficit, which may be too late to reverse. However, use of TCD may predict PTV before clinical sequelae. TCD assists in the clinical decisionmaking regarding further diagnostic evaluation and therapeutic interventions and has become a regularly employed tool in neurocritical care. Accumulated today experience suggests that there is an important guiding significance in early diagnosis and treatment of PTV and ICH in TCD.
Because PTV and ICH represent significant events in a high proportion of patients after wartime TBI, close daily TCD monitoring is recommended for the management of such patients.
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MONITORING
THE BRAIN DURING INVASIVE CARDIOVASCULAR EXAMINATIONS AND SURGERY
MONITORING THE BRAIN DURING INVASIVE CARDIOVASCULAR EXAMINATIONS AND SURGERY
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IS AUTOMATIC EMBOLUS
MONITORING
READY FOR REAL LIFE APPLICATION?
IS AUTOMATIC EMBOLUS MONITORING READY FOR REAL LIFE APPLICATION?
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TCD-EEG
MONITORING
IN PAROXYSMAL NEUROLOGICAL DISEASES
TCD-EEG MONITORING IN PAROXYSMAL NEUROLOGICAL DISEASES
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We aim to investigate the feasibility of realtime TCD-EEG
monitoring
in patients with paroxysmal neurological diseases.
We aim to investigate the feasibility of realtime TCD-EEG monitoring in patients with paroxysmal neurological diseases.
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The TCD-EEG
monitoring
includes 10-20 system 16 channels EEG and bilateral middle cerebral artery blood flow velocity (CBFV)
monitoring
.
This is an on-going single-center observational study. Six hours Real-time TCD-EEG (Delica NSD-8100) is performed in pre-surgical patients with refractory epilepsy and pre-surgical patients with Moyamoya disease and transient ischemic attacks.
The TCD-EEG monitoring includes 10-20 system 16 channels EEG and bilateral middle cerebral artery blood flow velocity (CBFV) monitoring.
To further investigate TCD value in the localization of epileptogenic focus, SPECT is performed, if available, in patients with seizure attacks for comparative analysis. To induce transient ischemic attacks, 3 minutes hyperventilation is performed in patients with Moyamoya disease. In patients with seizure attacks, we observe: 1) the synchronicity between CBFV changes and epileptic discharges;2) the consistency between CBFV changes and SPECT findings; 3) the relationship between CBFV changes and epileptogenic focus as defined by EEG and SPECT;4) the correlation between TCD-EEG findings and prognosis after operation. In patients with Moaymoya disease, we observe: 1)the EEG and CBFV changes during hyperventilation; 2) the synchronicity between clinical symptoms and TCD-EEG findings;3) the correlation between TCD-EEG findings and prognosis after operation. We expect to enroll 60 patients for each group in one year (2013-2014).
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Although the technique of TCD-EEG
monitoring
requires modifications, it has showed promising value in patients with paroxysmal neurological diseases.
Although the technique of TCD-EEG monitoring requires modifications, it has showed promising value in patients with paroxysmal neurological diseases.
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monitoring
, paroxysmal neurological diseases, TCD-EEG.
monitoring, paroxysmal neurological diseases, TCD-EEG.
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There was no skin trouble and discomfort of the cervix during
monitoring
.
1) MES of artificial emboli were measured by novel probe stably for two hours. The count number of MES was somewhat small in comparison with other TCD device. 2) In all three volunteers, we could measured stable sonogram of carotid artery for 30 minutes.
There was no skin trouble and discomfort of the cervix during monitoring.
Fixation time of novel probe attached to the cervix was within a few minutes, which was fast and easy.
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Diagnosis requires cerebral angiography confirmation and ultrasound
monitoring
.
RCVS is a cerebrovascular disorder associated with multifocal arterial constriction. The primary clinical manifestation is recurrent sudden-onset and severe headache.
Diagnosis requires cerebral angiography confirmation and ultrasound monitoring.
Our aim is to determine the difference of ultrasound data and clinical manifestation between RCVS and different forms of headache.
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The association of the results of duplex was compared with ICP and systemic
monitoring
.
We coadministered intramuscular ketamine at dose of 15mg/ kgand xylazine at a dose of 2 mg/kg. The experimental hypertension was performed with an intracranial balloon. At each intervention we performed a neurological assessment of the pupils and Doppler exam (Ultrasound color duplex SonoSite-Micromax). Continuous intracranial pressure measurement by intraparenchymal and extradural catheters was also performed. The animals underwent to a baseline measurement, a pre-balloon insufflation, a post-balloon insufflation before and after saline solution infusion.
The association of the results of duplex was compared with ICP and systemic monitoring.
In complementary we measured
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TRANSCRANIAL DOPPLER AND OXIMETRY TISSUE CATHETER
MONITORING
IN DIFFUSE BRAIN VASOSPASM
TRANSCRANIAL DOPPLER AND OXIMETRY TISSUE CATHETER MONITORING IN DIFFUSE BRAIN VASOSPASM
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Multimodal
monitoring
can detect brain flow decrease and patients with high risk to develop brain ischemic lesions.
Intracranial vasospasm is an important cause of brain ischemia when associated to subarachnoid hemorrhage.
Multimodal monitoring can detect brain flow decrease and patients with high risk to develop brain ischemic lesions.
TCD can detect and measure vasospasm intensity in the large intracranial arteries. Usually the oximetry catheter is implanted in the area most likely to occur vasospasm, which is near of brain bleeding. It can measure brain tissue oxygen (PtiO2) in areas with oligoemia associated to vasospasm. They give support to plane treatment to improve brain blood flow in patients suffering brain vasospasm.
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The aim of this study was to describe the detection of some MES during routine vasospasm
monitoring
by transcranial Doppler (TCD).
The cerebral vasospasm is considered one of the most common and serious complications of Subarachnoid hemorrhage (SAH) can be a cause of neurological ischemic transient or permanent, and contributes to increased rates of morbidity and mortality of patients. Previous studies suggested that intracranial aneurysms can act as sources of distal embolization. Spontaneous thrombus can be observed within the aneurysmal sac, presumably because of turbulence and slow flow.
The aim of this study was to describe the detection of some MES during routine vasospasm monitoring by transcranial Doppler (TCD).
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Although detection of emboli was relatively rare in this study (4 of 105), rates of emboli occurrence may increase if systematic
monitoring
is used.
TCD ultrasound can detect presence of microembolic signals in patients diagnosed with SAH.
Although detection of emboli was relatively rare in this study (4 of 105), rates of emboli occurrence may increase if systematic monitoring is used.
The detection MES after SAH surgery may be an indicator for prophylactic antithrombotic treatment.
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A TRANSCRANIAL DOPPLER SONOGRAPHY
MONITORING
A TRANSCRANIAL DOPPLER SONOGRAPHY MONITORING
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TCD
monitoring
of cerebral autoregulation is an important approach for topical diagnosis of the orthostatic intolerance and may help for selecting the best therapeutic strategies.
TCD monitoring of cerebral autoregulation is an important approach for topical diagnosis of the orthostatic intolerance and may help for selecting the best therapeutic strategies.
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orthostatic intolerance, orthostatic tests, peripheral muscle pump, TCD
monitoring
.
orthostatic intolerance, orthostatic tests, peripheral muscle pump, TCD monitoring.
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Simultaneous transcranial Doppler, blood pressure and heart rate
monitoring
was performed at rest and after cold stress, deep breathing and head-up tilt.
mellitus type 2 (age range 45-67years) and 10 presumed healthy age and sex matched controls were included in the study.
Simultaneous transcranial Doppler, blood pressure and heart rate monitoring was performed at rest and after cold stress, deep breathing and head-up tilt.
The systolic (SBP), diastolic (DBP) and mean blood pressure (MBP) were measured and the blood flow velocity (BFV) parameters of the middle cerebral artery (MCA) were recorded. Comparison of the effects of the different stimuli on the blood pressure and BFV was performed.
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TRANSCRANIAL DOPPLER
MONITORING
DURING HYPOTERMIC CIRCULATION ARREST
TRANSCRANIAL DOPPLER MONITORING DURING HYPOTERMIC CIRCULATION ARREST
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Also we used trascranial doppler
monitoring
with embol detection.
Ten patients (mean age of 52±8,3 years) were monitored. We monitored maximum blood flow velocities of bilateral middle cerebral arteries using the transcranial doppler (Multi-Dop T, Oxford Medical) at four periods: after induction of anestesia, during cardiopulmonary bypass, during antegrade cerebral perfusion and after termination of cardiopulmonary bypass.
Also we used trascranial doppler monitoring with embol detection.
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Transcranial doppler
monitoring
is important method of assessment the cerebral blood flow in operation on aortic arch during hypotermic circulation arrest.
Transcranial doppler monitoring is important method of assessment the cerebral blood flow in operation on aortic arch during hypotermic circulation arrest.
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cerebral perfusion, transcranial
monitoring
.
cerebral perfusion, transcranial monitoring.
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During the procedure, continuous
monitoring
of right middle
During the procedure, continuous monitoring of right middle
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TCD
monitoring
may provide useful and real-time data on the physiopathological mechanisms underlying the risk of ischemic brain injury during TAVI, identifying phases at higher risk.
TCD monitoring may provide useful and real-time data on the physiopathological mechanisms underlying the risk of ischemic brain injury during TAVI, identifying phases at higher risk.
Further research is needed to validate these findings.
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Ultrasound
monitoring
showed recanalization immediately after the procedure in 2 patients, and 3 hours later in 1 patient.
symptoms onset to start of IAT was 175 min. Mean initial NIHSS was 14.6. Diffusion MRI demonstrated large MCA territory lesion > 1/3 in 1 patient, and small zones in 2 other. TICI scores were 2b, 3, 1. None of the patients had iatrogenic haemorrhage.
Ultrasound monitoring showed recanalization immediately after the procedure in 2 patients, and 3 hours later in 1 patient.
On control vascular imaging, that result was stable on the second day. Control CT revealed an infarct area with edema only in one patient. Mean NIHSS score on day 7 was 6, on day 30 was 4.6. Mean mRS on day 7 was 3, on day 30 was 2.
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A 15-min protocol, comprising 4 repeats of a sequence of 120s T-beam followed by 30-s D-beam and then 5-min T-beam deactivation
monitoring
with D-beam, was repeated 4 times.
1.We applied a developed probe to Macaca monkey brain via sonication of the MCA through a temporal window. Each three cynomolgus monkeys were maintained for 1 day and 7 days after sonication. And more two elder rhesus monkeys were sonicated under the alteplase (0.9 mg/kg) i.v., and maintained for 7 days. An automatic switching circuit operated a therapeutic US (T-beam) generator for thrombolysis (490 kHz; CW-US, Ispta 0.72 W/cm2) and diagnostic TC-CFI (D-beam; 2.5 MHz; Ispta 0.20 W/cm2).
A 15-min protocol, comprising 4 repeats of a sequence of 120s T-beam followed by 30-s D-beam and then 5-min T-beam deactivation monitoring with D-beam, was repeated 4 times.
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17.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 1
,
,
,
Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-
Monitoring
Study (SlTS-MOST): an observational study.
valos A.
Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SlTS-MOST): an observational study.
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Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profle in randomized controlled trials: Safe lmplementation of Thrombolysis in Stroke-
Monitoring
Study (SlTS-MOST).
hrmann M, Larrue W, Lees K, Machnig T, Roine R, Toni D, Vanhooren G.
Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profle in randomized controlled trials: Safe lmplementation of Thrombolysis in Stroke-Monitoring Study (SlTS-MOST).
read the entire text >>
18.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 2
,
,
,
Particularly in the case of a cryptogenic stroke with embolic characteristics, paroxysmal AF has to be exhaustively searched and might require long-term cardiac rhythm
monitoring
systems, which have been recently developed.
Fortunately, there have been important scientific breakthroughs on diagnosis and treatment of AF. Paroxysmal AF presents the same cardioembolic risk as the continuous AF, although it is often difficult to diagnose.
Particularly in the case of a cryptogenic stroke with embolic characteristics, paroxysmal AF has to be exhaustively searched and might require long-term cardiac rhythm monitoring systems, which have been recently developed.
Other new achievements are the therapeutic advances in oral anticoagulation treatment, allowing increased efficacy and safety, along with a better convenience to the patient.
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a narrow therapeutic window, which, coupled with unpredictable pharmacology, necessitates regular coagulation
monitoring
and dose adjustments,
a narrow therapeutic window, which, coupled with unpredictable pharmacology, necessitates regular coagulation monitoring and dose adjustments,
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the possibility of being administered at fixed doses without routine coagulation
monitoring
;
the possibility of being administered at fixed doses without routine coagulation monitoring;
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However, if a paroxysmal AF is suspected, it should be searched with a 24-hour electrocardiogram
monitoring
, a 7or 30-day external event recorder, or even an implantable cardiac monitor [2, 19].
It is crucial to detect AF before and after a cardioembolic stroke. The clinician should take all the opportunities to check the patient’s cardiac rhythm, as in the physical examination at each visit. If there is a suspicion of arrhythmia by the doctor, or if the patient has this complaint, an electrocardiogram should be performed.
However, if a paroxysmal AF is suspected, it should be searched with a 24-hour electrocardiogram monitoring, a 7or 30-day external event recorder, or even an implantable cardiac monitor [2, 19].
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In the acute stroke scenario, the generalized recommendation for at least 24 hours of hemodynamic
monitoring
in a stroke unit might not be enough for diagnosing paroxysmal AF, since it was shown in a study that its median detection time was 43 hours, emphasizing the importance of longer continuous
monitoring
[12].
In the acute stroke scenario, the generalized recommendation for at least 24 hours of hemodynamic monitoring in a stroke unit might not be enough for diagnosing paroxysmal AF, since it was shown in a study that its median detection time was 43 hours, emphasizing the importance of longer continuous monitoring [12].
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P. Continuous
monitoring
versus HOLTER ECG for detection
P. Continuous monitoring versus HOLTER ECG for detection
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Heart-rhythm
monitoring
for evaluation of cryptogenic stroke.
Kamel H.
Heart-rhythm monitoring for evaluation of cryptogenic stroke.
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Executive functions are encompassing a number of cognitive abilities which generally have been conceptualized as controlling or guiding behavior in a top-down fashion such as decision-making, planning, self
monitoring
, and behavior initiation, organization and inhibition [4].
However, in recent years, the literature has reported that, while episodic memory is the hallmark of patients with amnestic MCI, they are impaired on a variety of tasks that have commonly been considered a measure of executive functions [5].
Executive functions are encompassing a number of cognitive abilities which generally have been conceptualized as controlling or guiding behavior in a top-down fashion such as decision-making, planning, self monitoring, and behavior initiation, organization and inhibition [4].
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Transcranial Doppler (TCD) allows a continuous and non-invasive
monitoring
of cerebral blood flow velocities in the basal cerebral arteries, which change according to distal arterioles vasomotor variations.
Transcranial Doppler (TCD) allows a continuous and non-invasive monitoring of cerebral blood flow velocities in the basal cerebral arteries, which change according to distal arterioles vasomotor variations.
Functional TCD is a tool designed to measure the increase of local cerebral blood flow due to regional cortical neuronal activation, accomplished by the neurovascular coupling.
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Since its first development, described in 1982 by Rune Aaslid, transcranial Doppler has allowed a continuous and non-invasive
monitoring
of cerebral blood flow velocities in the basal cerebral arteries, through temporal bone “windows” [1].
Since its first development, described in 1982 by Rune Aaslid, transcranial Doppler has allowed a continuous and non-invasive monitoring of cerebral blood flow velocities in the basal cerebral arteries, through temporal bone “windows” [1].
Although TCD does not register directly CBF in the small vasoactive arteriolar system, but rather in the cerebral basal distribution arteries, distal arteriolar calibre variation in response to physiologic stimuli will induce flow variations on basal arteries, and therefore blood flow velocity. It could be argued that TCD measures CBF velocities and does not measure the CBF itself. Nevertheless, since flow is equal to the product of area and velocity, and calibre in insonated basal cerebral vessels remains constant with pressure changes of up to 20 mmHg, flow velocity changes correlate closely to flow changes. So, TCD allows continuous non-invasive monitoring of regional CBF variations, doing it with an excellent temporal resolution [2, 9, 19].
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So, TCD allows continuous non-invasive
monitoring
of regional CBF variations, doing it with an excellent temporal resolution [2, 9, 19].
Since its first development, described in 1982 by Rune Aaslid, transcranial Doppler has allowed a continuous and non-invasive monitoring of cerebral blood flow velocities in the basal cerebral arteries, through temporal bone “windows” [1]. Although TCD does not register directly CBF in the small vasoactive arteriolar system, but rather in the cerebral basal distribution arteries, distal arteriolar calibre variation in response to physiologic stimuli will induce flow variations on basal arteries, and therefore blood flow velocity. It could be argued that TCD measures CBF velocities and does not measure the CBF itself. Nevertheless, since flow is equal to the product of area and velocity, and calibre in insonated basal cerebral vessels remains constant with pressure changes of up to 20 mmHg, flow velocity changes correlate closely to flow changes.
So, TCD allows continuous non-invasive monitoring of regional CBF variations, doing it with an excellent temporal resolution [2, 9, 19].
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During the whole
monitoring
, marks should signal the beginning and the end of the stimulation phase, for posterior analysis.
Functional TCD is a tool designed to measure the increase of local cerebral blood flow caused by regional cortical neuronal activation, accomplished by the neurovascular coupling. For this purpose, CBF velocity in the cerebral basal distribution artery related to the simulated cortex is monitored, and velocities in “rest” and while performing the task are compared [5]. It is important to find which duration of the stimulation is adequate to the stimulus, and also a resting phase long enough to allow the velocity to reach the basal levels.
During the whole monitoring, marks should signal the beginning and the end of the stimulation phase, for posterior analysis.
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One possible way of evaluating NVC consists in
monitoring
posterior cerebral artery during visual stimulation.
One possible way of evaluating NVC consists in monitoring posterior cerebral artery during visual stimulation.
The P2 segment of the posterior cerebral artery is a very good option to study NVC, because functionally it supplies mostly the visual cortex, so the low spatial resolution of the technique is not a limitation in this case. Thus, when monitoring P2, after asking the subject to make a normal task like reading a text, we can
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Thus, when
monitoring
P2, after asking the subject to make a normal task like reading a text, we can
One possible way of evaluating NVC consists in monitoring posterior cerebral artery during visual stimulation. The P2 segment of the posterior cerebral artery is a very good option to study NVC, because functionally it supplies mostly the visual cortex, so the low spatial resolution of the technique is not a limitation in this case.
Thus, when monitoring P2, after asking the subject to make a normal task like reading a text, we can
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While age ranging from 10 – 60 years did not affect NVC in a functional transcranial Doppler (TCD) study with a visual stimulation task and
monitoring
posterior cerebral artery [17], another study involving young and old subjects that assessed NVC in the anterior and posterior cerebral arteries during visual and executive function tasks found that overall NVC seems to be altered with aging [21].
While age ranging from 10 – 60 years did not affect NVC in a functional transcranial Doppler (TCD) study with a visual stimulation task and monitoring posterior cerebral artery [17], another study involving young and old subjects that assessed NVC in the anterior and posterior cerebral arteries during visual and executive function tasks found that overall NVC seems to be altered with aging [21].
While the younger group showed taskspecific flow activation in one territory at a time, the older group showed a generalized increase in blood flow in both the territories in response to both tasks suggesting generalization of cerebral activity to compensate for age related loss of region specific function. Similar generalization of cerebral activity was also reported with functional MRI during cognitive tasks in elderly people [6].
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Stroke is a dynamic disease, consequently static neuroimaging studies (CT, MRI) characterize this process only partially; ultrasound
monitoring
in parallel with clinical evaluation offer in-
Stroke is a dynamic disease, consequently static neuroimaging studies (CT, MRI) characterize this process only partially; ultrasound monitoring in parallel with clinical evaluation offer in-
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Transcranial ultrasound is the only diagnostic method that can detect clinically silent emboli; this requires continuous
monitoring
of the major intracranial arteries and according to the current consensus the duration of the
monitoring
should be at least one hour.
Transcranial ultrasound is the only diagnostic method that can detect clinically silent emboli; this requires continuous monitoring of the major intracranial arteries and according to the current consensus the duration of the monitoring should be at least one hour.
Microembolic signal (MES) detection identifies patients who are at higher risk of atheroembolic stroke, thus allowing to select those patients who could benefit from a more aggressive treatment. MES are also valid surrogate markers for verifying antithrombotic efficacy and a key for individualized stroke medicine.
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Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound
monitoring
in stroke patients treated with intravenous tissue plasminogen activator.
n J.
Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator.
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High rate of recanalization of middle cerebral artery occlusion during 2-MHz transcranial color coded Doppler continuous
monitoring
without thrombolytic drug.
Cintas P, Le Traon AP, Larrue V.
High rate of recanalization of middle cerebral artery occlusion during 2-MHz transcranial color coded Doppler continuous monitoring without thrombolytic drug.
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inhalation.
Monitoring
of the mean blood flow velocity in the middle cerebral artery (MCA) by transcranial doppler
inhalation. Monitoring of the mean blood flow velocity in the middle cerebral artery (MCA) by transcranial doppler
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Vasomotor reactivity of middle cerebral atreries in patients with cerebrovascular diseases: a transcranial Doppler sonography
monitoring
. In:
Velcheva, I., Titianova, E., Alexandrova, D., Damianov, P.
Vasomotor reactivity of middle cerebral atreries in patients with cerebrovascular diseases: a transcranial Doppler sonography monitoring. In:
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19.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 1
,
,
,
quired
monitoring
of safety outcomes and a pro
quired monitoring of safety outcomes and a pro
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He was asked to present the SITS concept and the possibility to perform safety
monitoring
if the drug was approved for marketing for stroke treatment.
ation Agency (EMEA).
He was asked to present the SITS concept and the possibility to perform safety monitoring if the drug was approved for marketing for stroke treatment.
At the April meet
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The meeting ended with two results: a randomized controlled trial of rt-PA for patients who would be treated between 3 and 4 hours after the stroke onset (ECASS III), and a safety
monitoring
study of all patients treated after an approval, based on the SITS registry (SITS-MOST).
gren and prof Kennedy Lees from Glasgow were invited to the discussions as advisers to the manufacturer, Boehringer-Ingelheim.
The meeting ended with two results: a randomized controlled trial of rt-PA for patients who would be treated between 3 and 4 hours after the stroke onset (ECASS III), and a safety monitoring study of all patients treated after an approval, based on the SITS registry (SITS-MOST).
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SIECV-SITS is an observational
monitoring
study in the countries of South and Latin America.
SIECV-SITS is an observational monitoring study in the countries of South and Latin America.
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Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke
Monitoring
Study (SITS-MOST).
hrmann M, Larrue V, Lees KR, Machnig T, Roine RO, Toni D, Vanhooren G. For the SITS-MOST investigators.
Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST).
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20.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 2
,
,
,
After its first use in
monitoring
of cerebral vasospasm and intracranial collaterals in carotid occlusive disease, a wide range of investigational and clinical applications followed.
In 1982, the introduction of the Transcranial Doppler (TCD) modality opened a new window on the cerebral circulation.
After its first use in monitoring of cerebral vasospasm and intracranial collaterals in carotid occlusive disease, a wide range of investigational and clinical applications followed.
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Continuous glucose
monitoring
(CGM) performs multiple blood glucose measurements and is used for defining the control and changing the treatment regimen in diabetic patients, especially those with varying glucose levels and experiencing frequent hypoglycemic episodes.
Continuous glucose monitoring (CGM) performs multiple blood glucose measurements and is used for defining the control and changing the treatment regimen in diabetic patients, especially those with varying glucose levels and experiencing frequent hypoglycemic episodes.
iPro 2
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Professional is a forth generation continuous glucose
monitoring
system, valuable for detecting high and low glucose fluctuations and is small enough for patient to forget they have it on.
Professional is a forth generation continuous glucose monitoring system, valuable for detecting high and low glucose fluctuations and is small enough for patient to forget they have it on.
iPro2 Professional CGM uses a tiny glucose sensor to record 288 glucose readings over a 24-hour period. Glucose data are captured in the system and are uploaded to CareLink iPro Software. The reports are useful for educating and motivating patients to implement changes in their diabetes management after viewing what effects specific foods, exercise, stress and medications have on their glucose levels.
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Combining insulin pump technology with continuous blood glucose
monitoring
system improves real-time control of the blood sugar level.
The continuous subcutaneous insulin infusion therapy (insulin pump) is a medical device used for the administration of short acting insulin and is thought to be the most physiological way for insulin replacement. Recently it is used not only in type 1, but also in type 2 diabetes.
Combining insulin pump technology with continuous blood glucose monitoring system improves real-time control of the blood sugar level.
Closing the loop will allow the system to function as an artificial pancreas.
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The implemented on time and directed neurosonology examination may have a key role in the diagnosis and
monitoring
of treatment outcomes of patients with stroke.
The implemented on time and directed neurosonology examination may have a key role in the diagnosis and monitoring of treatment outcomes of patients with stroke.
Adequate assistance and best results can be achieved with a specialized team prepared for treating strokes, including a clinical center with availability of diagnostic imaging, laboratory, resuscitation and neurosonology specialists.
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Non-invasive
monitoring
of heart rate, blood pressure and respiration at rest and during autonomic tests (metronomic breathing, head-up tilt and handgrip) was performed.
Non-invasive monitoring of heart rate, blood pressure and respiration at rest and during autonomic tests (metronomic breathing, head-up tilt and handgrip) was performed.
The time domain and spectral analysis parameters of the heart rate variability were calculated. The autonomic examination was also applied in 57 age-matched healthy subjects.
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21.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 1
,
,
,
According to a study of the California Birth
Monitoring
Programme the role of the sporadic mutations is shown by the fact that the risk of anomalies of the corpus callosum is three times higher at maternal age over 40 [3, 5, 8].
gestation week and are caused mainly by the exposure of the fetus to risk factors, such as toxic substances (fetal alcohol syndrome), infectious agents, as well as the presence of metabolic disorders and etc. It is accepted that different genetic mechanisms may also be the cause of the anomalies of the corpus callosum – autosomal dominant, autosomal recessive and X-linked mutations, but also sporadic de novo mutations.
According to a study of the California Birth Monitoring Programme the role of the sporadic mutations is shown by the fact that the risk of anomalies of the corpus callosum is three times higher at maternal age over 40 [3, 5, 8].
From the chromosomal mutations, most frequent are trisomy of the 13 (Patau syndrome), 18 (Edwards syndrome) and 21 (Down syndrome) chromosome [8].
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Според проучване на California Birth
Monitoring
Programme ролята на спорадичните мутации се доказва от факта, че рискът за поява на аномалии на корпус калозум се увеличава трикратно при възраст на майката над 40 години [3, 5, 8].
Аномалиите в развитието на корпус калозум са полиетиологични и могат да възникнат по време на различни периоди от пренаталното му развитие при невронната и глиялна пролиферация, аксоналния растеж, невроналното насочване от комисуралните аксони и невроналната миграция. До 20 гестационна седмица се изгражда окончателната форма на мазолестото тяло, като аксоналният растеж и други структурни промени продължават и след раждането [3, 5, 10]. Аномалиите възникват най-често до 12-та гестационна седмица и са обусловени главно от излагането на плода на рискови фактори като токсични вещества (фетален алкохолен синдром), инфекциозни агенти, метаболитни заболявания и др. Приема се, че различни генетични механизми могат също да са причина за аномалиите на корпус калозум – автозомно доминантни, автозомно рецесивни и Х-свързани мутации, както и спорадични de novo мутации.
Според проучване на California Birth Monitoring Programme ролята на спорадичните мутации се доказва от факта, че рискът за поява на аномалии на корпус калозум се увеличава трикратно при възраст на майката над 40 години [3, 5, 8].
От хромозомните мутации най-чести са тризомиите на 13 (синдром на Патау), 18 (синдром на Едуардс) и 21 (синдром на Даун) хромозома [8].
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The combined use of clinical, para-clinical and neuroimaging methods (CT with contrast, MRI with MR – angiography) enables the diagnosis and
monitoring
the disease.
the blood sugar and thyroid hormones [3, 7, 8, 9].
The combined use of clinical, para-clinical and neuroimaging methods (CT with contrast, MRI with MR – angiography) enables the diagnosis and monitoring the disease.
Multimodal neurosonology helps to assess the optic bulb, optical disk and optic nerve, however, they have limited possibilities in the study of retrobulbar processes.
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Stenosis may develop also on the contralateral carotid artery and such patients have increased risk of stroke [29] indicating the importance of the
monitoring
of the contralateral carotid artery [30].
Restenosis following CEA and leading to increased risk of stoke may occur and has been reported in up to 15% of cases [28].
Stenosis may develop also on the contralateral carotid artery and such patients have increased risk of stroke [29] indicating the importance of the monitoring of the contralateral carotid artery [30].
On the other hand, there are effective techniques that can reduce the incidence of restenosis.
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She presented the iPro
monitoring
system, a two-day-continuous-
monitoring
of the blood sugar levels in patients with diabetes mellitus, thus allowing to specify the therapy.
Acad. Prof. Dr. Ivona Daskalova presented the experience of the Department of Endocrinology and Metabolic Diseases in MMA in the screening and early diagnosis of metabolic diseases using EZ SCAN test, lasting only two minutes. Combined with a blood test this modern method gives a clear picture of the metabolic changes in the patient’s body.
She presented the iPro monitoring system, a two-day-continuous-monitoring of the blood sugar levels in patients with diabetes mellitus, thus allowing to specify the therapy.
The small screen is of a 1-lev-coin size and no cable, which facilitates patients. Acad. Daskalova focused on the clinical experience with the use of insulin pumps in patients with diabetes mellitus.
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22.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 2
,
,
,
The present study proves that EDS and TCCD are the noninvasive and real-time high sensitive
monitoring
tools assessing the structural and hemodynamic status of all arteries providing the posterior blood circulation.
Rotational vertebrobasilar ischemia can be very incapacitating because of the temporary impairment of cerebral blood flow to the brainstem, thalamus, and occipital lobes and possible posterior circulation stroke. An accurate diagnosis depends not only on clinical symptoms, but also on hemodynamic and angiographic studies. The recognition of its peculiar characteristics and the use of TCCD are important for proper selection of patients for surgical treatment [19, 20].
The present study proves that EDS and TCCD are the noninvasive and real-time high sensitive monitoring tools assessing the structural and hemodynamic status of all arteries providing the posterior blood circulation.
They can confirm the etiology of hypoperfusion in cerebrovascular insufficiency, TlA or stroke by suggesting a drop in blood flow in the presence of arterial stenosis. These methods give the possibility to evaluate the blood supply in different body positions, to detect the decrease in peak systolic velocity and MFV in BA in patients with positive RFT, estimate the collateral supply, and detect embolic
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phenomena. TCCD
monitoring
is very important in selecting a treatment strategy and follow-up.
phenomena. TCCD monitoring is very important in selecting a treatment strategy and follow-up.
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Dynamic TCCD
monitoring
is very helpful in identifying TIAs or strokes due to hypoperfusion in patients with PCD [21].
Dynamic TCCD monitoring is very helpful in identifying TIAs or strokes due to hypoperfusion in patients with PCD [21].
Further studies are needed to validate TCCD findings in the heterogeneous group of patients with symptomatic and asymptomatic extraand intracranial arterial stenosis.
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We performed an US Doppler examination on the 6th day of treatment introduction which helped us in establishing the definitive diagnosis of SOVT and also
monitoring
the positive therapy effects.
Before additional diagnostics, we suspected Tolosa-Hunt syndrome, but after the MRl we diverted the examination to SOVT. MRl is sensitive even in early stages of the disease, and is recommended when there is a suspicion of SOVT or cavernous sinus thrombosis. MRl may demonstrate a dilated SOV, and extraocular muscle enlargement [2, 9]. ln our case, orbital MR examination was of crucial importance for the diagnosis. Some authors suggest Doppler imaging with ultrasound to confirm the lack of flow in the SOV [6].
We performed an US Doppler examination on the 6th day of treatment introduction which helped us in establishing the definitive diagnosis of SOVT and also monitoring the positive therapy effects.
On the same day we performed a control СT of the brain and orbits which was in compliance with the US findings and the good early clinical outcome. ln the early stages a mildly enlarged SOVT may be missed on СT scans, and decreased blood flow through the SOV and cavernous sinus may not be apparent [9]. However, six days after LMWH and antibiotics were started, the СT scan was very indicative of SOVT.
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In emergency departments, treatment commonly includes airway support, blood pressure control, intracranial pressure
monitoring
and management, and if necessary, anticoagulation reversal.
In emergency departments, treatment commonly includes airway support, blood pressure control, intracranial pressure monitoring and management, and if necessary, anticoagulation reversal.
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Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside
monitoring
to determine flow velocities indicative of changes in vascular caliber.
Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside monitoring to determine flow velocities indicative of changes in vascular caliber.
It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma. TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous monitoring of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP. Growing body of literature demonstrates the usefulness of transbulbar B-mode sonography of the optic nerve for detecting increased ICP in patients requiring neurocritical care. TCD findings compatible with the diagnosis of brain death include systolic spikes without diastolic flow or with diastolic reversed flow, and no demonstrable flow in a patient in who flow had been clearly documented on a previous examination.
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To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for
monitoring
of cerebral hemodynamics in neurotrauma.
Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside monitoring to determine flow velocities indicative of changes in vascular caliber. It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH).
To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous monitoring of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP. Growing body of literature demonstrates the usefulness of transbulbar B-mode sonography of the optic nerve for detecting increased ICP in patients requiring neurocritical care. TCD findings compatible with the diagnosis of brain death include systolic spikes without diastolic flow or with diastolic reversed flow, and no demonstrable flow in a patient in who flow had been clearly documented on a previous examination. Assessment of cerebral autoregulation using TCD blood flow velocity has been previously validated to be predictive of outcome following traumatic brain injury. The commonly used bedside methods of determining the status of autoregulation include the transient hyperemic response test, the leg-cuff deflation test and reaction to spontaneous blood pressure fluctuations.
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TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous
monitoring
of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP.
Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside monitoring to determine flow velocities indicative of changes in vascular caliber. It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous monitoring of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP.
Growing body of literature demonstrates the usefulness of transbulbar B-mode sonography of the optic nerve for detecting increased ICP in patients requiring neurocritical care. TCD findings compatible with the diagnosis of brain death include systolic spikes without diastolic flow or with diastolic reversed flow, and no demonstrable flow in a patient in who flow had been clearly documented on a previous examination. Assessment of cerebral autoregulation using TCD blood flow velocity has been previously validated to be predictive of outcome following traumatic brain injury. The commonly used bedside methods of determining the status of autoregulation include the transient hyperemic response test, the leg-cuff deflation test and reaction to spontaneous blood pressure fluctuations. TCD PI has emerged as a surrogate marker for ICP.
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23.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 1
,
,
,
Avoidance of hypoglycemia requires frequent glucose
monitoring
; in many hospitals this necessitates admission to an intensive care unit, which may otherwise not be needed
Similar to the high blood pressure, there are several detrimental effects of hyperglycemia, such as tissue acidosis, increased blood–brain barrier permeability, decreased vascular reactivity, and risk of hemorrhagic transformation, which are most probably pathophysiological substrates of poor outcome in stroke patients with hyperglycemia. First studies considering the effect of hyperglycemia on stroke outcome have been conducted on animal models [25]; there are many studies and much evidence that acute hyperglycemia predicts increased risk of in-hospital mortality and poor functional recovery after AIS in non-diabetic stroke survivors. This conclusion has been made by Capes and his colleagues, after a literature review of 32 studies [23, 26]. However, currently there is no clinical evidence that targeting the blood glucose to a particular level during AIS will improve outcomes. The main risk from aggressive hyperglycemia correction is the possible hypoglycemia.
Avoidance of hypoglycemia requires frequent glucose monitoring; in many hospitals this necessitates admission to an intensive care unit, which may otherwise not be needed
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Serum glucose level
monitoring
;
Serum glucose level monitoring;
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monitoring
of serum glucose level is recommended.
monitoring of serum glucose level is recommended.
Treat serum glucose levels over 180 mg/dL (over 10 mmol/L) with insulin titration.
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24.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 2
,
,
,
Resident in Internal Medicine, Hospital of Nyon, Switzerland (1998–1999); Resident in Neurology, Department of Neurology, CHUV, University Hospital of Lausanne, Switzerland (1999–2002); Clinical and Research Fellow, Neurosonology & Cerebrovascular Units, Department of Neurology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany (2002– 2004); Member of the European research project group UMEDS: Ultrasonographic
Monitoring
and Early Diagnosis of Stroke (2003–2004); Instructor (Cheffe de clinique), Department of Neurology, HUG, University Hospital, Geneva, Switzerland (2004–2007); Instructor (Cheffe de clinique), Departments of Neurology, Interventional Neuroradiology and Neurosurgery, HUG, University Hospital, Geneva (2007–2008); Attending (Médecin adjointe), Department of Neurology, HUG, University Hospital, Geneva (since 2008); Attending Neurovascular and Neurosonology Unit, Dept of Neurology, HUG, University Hospital, Geneva (since 2009).
Resident in Internal Medicine, Hospital of Nyon, Switzerland (1998–1999); Resident in Neurology, Department of Neurology, CHUV, University Hospital of Lausanne, Switzerland (1999–2002); Clinical and Research Fellow, Neurosonology & Cerebrovascular Units, Department of Neurology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany (2002– 2004); Member of the European research project group UMEDS: Ultrasonographic Monitoring and Early Diagnosis of Stroke (2003–2004); Instructor (Cheffe de clinique), Department of Neurology, HUG, University Hospital, Geneva, Switzerland (2004–2007); Instructor (Cheffe de clinique), Departments of Neurology, Interventional Neuroradiology and Neurosurgery, HUG, University Hospital, Geneva (2007–2008); Attending (Médecin adjointe), Department of Neurology, HUG, University Hospital, Geneva (since 2008); Attending Neurovascular and Neurosonology Unit, Dept of Neurology, HUG, University Hospital, Geneva (since 2009).
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1. Because of the necessity for
monitoring
the safe implementation of recanalization treatment of ischemic strokes, a local register of such
1. Because of the necessity for monitoring the safe implementation of recanalization treatment of ischemic strokes, a local register of such
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The data from the ESO Registry on
monitoring
quality indicators in the treatment of ischemic stroke patients, RES-Q, confirm once again the data from the National Centre for Health Information that in Bulgaria the percentage of patients hospitalized for acute ischemic stroke is about 90%.
The data from the ESO Registry on monitoring quality indicators in the treatment of ischemic stroke patients, RES-Q, confirm once again the data from the National Centre for Health Information that in Bulgaria the percentage of patients hospitalized for acute ischemic stroke is about 90%.
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This effect is also preserved on the third month of the
monitoring
with a tendency of another 6% of improved patients.
The longitudinal study of patients at hospitalization, dehospitalization and on the third month establishes a significant difference in the severity of stroke, assessed by NIHSS and mRS, between the two groups (with/ without TL treatment). Thrombolysis patients are hospitalized with a severe neurological deficit (13 p. on average, measured by NIHSS scale), significantly improved in 53% of the patients at dehospitalization.
This effect is also preserved on the third month of the monitoring with a tendency of another 6% of improved patients.
Patients who have not undergone TL therapy are hospitalized with a more severe neurological deficit (15p. on average, measured by NIHSS scale), with recorded improvement at dehospitalization in just 38%. At the end of the third month, a significant improvement in up to 54% of the patients is established. It can be related to the processes of spontaneous recovery and brain reorganization after stroke [6].
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severity of neurological deficit at dehospitalization, but is not associated with a significant impact on these indicators on the third month of the
monitoring
process, as compared to patients with undifferentiated treatment.
severity of neurological deficit at dehospitalization, but is not associated with a significant impact on these indicators on the third month of the monitoring process, as compared to patients with undifferentiated treatment.
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TCS reliably and safely displays deep brain stimulation electrodes in patients with movement disorders and allows intraand postoperative
monitoring
of electrode location.
Hyperechogenicity of the substantia nigra (SN), a TCS finding seen in about 90% of patients with idiopathic Parkinson's disease (PD), is already present in presymptomatic disease stages and indicates an increased risk of developing PD, especially if present in combination with other risk markers. The TCS finding of SN hyperechogenicity well discriminates PD from other Parkinsonian disorders such as multiple-system atrophy and welding-related Parkinsonism. In turn, normal SN echogenicity in combination with lenticular nucleus hyperechogenicity indicates an atypical Parkinsonian syndrome rather than PD with a specificity of more than 95%. TCS detects characteristic basal ganglia changes also in other movement disorders such as lenticular nucleus hyperechogenicity in idiopathic dystonia and Wilson's disease and caudate nucleus hyperechogenicity in Huntington's disease. Reduced echogenicity of midbrain raphe is frequent in depressive disorders and correlated with both suicidal ideation and responsiveness to serotonin reuptake inhibitors.
TCS reliably and safely displays deep brain stimulation electrodes in patients with movement disorders and allows intraand postoperative monitoring of electrode location.
Upcoming technologies such as digitized image analysis and TCS-MRI fusion imaging will promote novel diagnostic applications of TCS in neurodegenerative brain disorders.
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Monitoring
of velocity, acceleration and synchronicity of muscle contraction is another aspect of ultrasound investigation.
Monitoring of velocity, acceleration and synchronicity of muscle contraction is another aspect of ultrasound investigation.
Such information can be obtained by means of a
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Although this method is commonly used in many fields of medicine (cardiology, angiology, etc.), its application in neurology is restricted predominantly to the
monitoring
of carotid artery motion and hand tremor frequency [25].
. It gives temporal changes in echoes of the moving structures in which the depth of echo-producing interfaces is displayed along one axis (toward and away from the transducer) with time along the second axis.
Although this method is commonly used in many fields of medicine (cardiology, angiology, etc.), its application in neurology is restricted predominantly to the monitoring of carotid artery motion and hand tremor frequency [25].
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Monitoring
of hand tremors;
Monitoring of hand tremors;
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Furthermore, the US technique allows measuring of the kinetics of movements during disease progression and therefore it is ideal for
monitoring
exercise therapies or drug effects [23].
early diagnosis, selection and evaluation of the therapeutic approach (fig. 4). A decreased muscle volume of the paretic calf, asymmetric bilaterally enlarged hyperechoic septa of fibrous and fatty tissue in triceps surae perimisium and sonographic data for changed myoarchitectonics significantly expressed on the side of paresis have been reported – replacement of the normal grain grid structure of triceps surae muscle by a more coarse granular one, due to the inactivity hypotrophy, intramuscular connective tissue proliferation and fatty degeneration [21]. Using TVI non-synchronous muscle activity is also established on the spastic paretic side with reduced velocity of contraction, relaxation and repetition of movements. A significant decrease in contractility of the contralateral "healthy" side indicating a systematic slowing of movements in stroke patients is also seen.
Furthermore, the US technique allows measuring of the kinetics of movements during disease progression and therefore it is ideal for monitoring exercise therapies or drug effects [23].
However, the application of myosonology in patients who have experienced stroke is mostly experimental.
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Therefore, the M-mode ultrasound
monitoring
can be used mostly as a screening method for differentiating of various hand tremors based on their frequency (fig. 6).
artifacts could compromise the results.
Therefore, the M-mode ultrasound monitoring can be used mostly as a screening method for differentiating of various hand tremors based on their frequency (fig. 6).
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The application of myosonology in every day neurorehabilitation is still very restricted to: (a) estimation of muscle volume, degree of muscle atrophy and muscle fibre contractility before, during and after rehabilitation; (b)
monitoring
the muscle fiber kinetics during active or passive movements or EMG stimulation; (c) ultrasound navigation of needle positioning for botulinum injections; (d) testing the peripheral muscle pump efficacy due to orthostatic training; (e) evaluating the impact of other co-factors (surrounding tissue, contractures, etc) for peripheral nerve and muscle recovery; (f) clinical or experimental research for post-stroke
The application of myosonology in every day neurorehabilitation is still very restricted to: (a) estimation of muscle volume, degree of muscle atrophy and muscle fibre contractility before, during and after rehabilitation; (b) monitoring the muscle fiber kinetics during active or passive movements or EMG stimulation; (c) ultrasound navigation of needle positioning for botulinum injections; (d) testing the peripheral muscle pump efficacy due to orthostatic training; (e) evaluating the impact of other co-factors (surrounding tissue, contractures, etc) for peripheral nerve and muscle recovery; (f) clinical or experimental research for post-stroke
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25.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 1
,
,
,
They confirm the existence of brain cells that are activated when performing and/or
monitoring
a particular action.
use implanted electrodes, mainly applied experimentally in animals, and from 2010 – in humans [27].
They confirm the existence of brain cells that are activated when performing and/or monitoring a particular action.
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Lack of μ-wave suppression when
monitoring
an action [28];
Lack of μ-wave suppression when monitoring an action [28];
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All of this is executed by
monitoring
the hemodynamic response of the cardio-pulmonary system at the beginning, in the middle and at the end of the procedure.
In a properly constructed program, the active exercises contribute to a more rapid recovery of the normal voluntary movements of the affected body part. Their main task is overcoming the muscle imbalance and achieving coordinated global movements. On the other hand, the intact side has been found to exhibit a reduced use of muscles, which is a result of damage to the noncrosslinked nerve fibers. Moreover, the participation of the undamaged brain hemisphere in creating new neural connections and compensating the neurological deficits is significant [6]. Therefore, exercising the healthy limbs leads to better functioning and independence in everyday life.
All of this is executed by monitoring the hemodynamic response of the cardio-pulmonary system at the beginning, in the middle and at the end of the procedure.
Limiting factors are the existence of anginal pain, heart rhythm and conduction disturbances, sudden fatigue, weakness, pallor, dyspnea, increased pulse rate by more than 20 beats/min, a drop in systolic arterial pressure by more than 20 mmHg and in diastolic, by more than 10 mmHg, and ECG changes [4].
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26.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 2
,
,
,
Furthermore, MES presence and rate were assessed by 60-minute bilateral TCD
monitoring
of the middle cerebral artery both in patients and in 30 healthy subjects.
We enrolled 96 consecutive patients (55 males; mean age 43.7±8.8 years) discharged from our Stroke Unit with a diagnosis of cryptogenic stroke. During follow-up, cardiovascular events, recurrent TIAs/strokes or death were recorded.
Furthermore, MES presence and rate were assessed by 60-minute bilateral TCD monitoring of the middle cerebral artery both in patients and in 30 healthy subjects.
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Since its first application in the field of cerebrovascular diseases in the late 1990s, MES detection improved in several technical aspects, such as reliability of automated MES count and exclusion of artifacts during continuous TCD
monitoring
[3, 27, 1, 2, 18].
Transcranial Doppler (TCD) is a safe and sensitive technique for real-time detection of microembolic signals (MES) in the intracranial cerebral arteries. MES have been defined as short lasting (3 dB) transients within the Doppler frequency spectrum; they appear randomly during the cardiac cycle and produce a “whistle”, “chirp”, or “click” sound when passing through the sample volume; they have been proven to represent microemboli passing within cerebral arteries [24, 14, 7, 5, 22, 36].
Since its first application in the field of cerebrovascular diseases in the late 1990s, MES detection improved in several technical aspects, such as reliability of automated MES count and exclusion of artifacts during continuous TCD monitoring [3, 27, 1, 2, 18].
MES have been detected in a large number of clinical conditions, such as carotid artery stenosis (especially due to unstable plaques) [25, 21, 31, 20, 19, 38, 23, 29], aortic arch plaques [25, 6], cardiac sources of cerebral embolism (i.e. atrial fibrillation, prosthetic heart valves, valvular thrombosis) [6, 4, 17, 12], patent foramen ovale (PFO) [32, 33], and during carotid surgery and endovascular procedures (i.e. stent implantation) [16, 26, 35, 34]. In all these conditions, the presence of MES within the cerebral circulation has shown to indicate an increased risk of stroke in both asymptomatic and symptomatic patients [36, 15, 13]. In symptomatic cases, after an index stroke, MES detection identifies patients at higher risk for recurrent stroke.
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The aim of our study was to assess the reliability of TCD
monitoring
in the setting of cryptogenic stroke and to investigate the relationship between MES detection, stroke mechanism, and risk of recurrence.
stent implantation) [16, 26, 35, 34]. In all these conditions, the presence of MES within the cerebral circulation has shown to indicate an increased risk of stroke in both asymptomatic and symptomatic patients [36, 15, 13]. In symptomatic cases, after an index stroke, MES detection identifies patients at higher risk for recurrent stroke. Most studies about MES detection concern patients with carotid artery stenosis, but some tried to detect MES in different stroke subtypes disclosing a higher MES number when the underlying mechanism was a cardiac embolism [17, 12]. There are few data about MES detection in patients with cryptogenic stroke, and about its relationship with the different stroke subtypes, especially with the recently proposed category of embolic stroke of undetermined source (ESUS) [10].
The aim of our study was to assess the reliability of TCD monitoring in the setting of cryptogenic stroke and to investigate the relationship between MES detection, stroke mechanism, and risk of recurrence.
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All patients underwent a complete diagnostic workup: cerebral CT/MRI at admission, extracranial colorcoded duplex sonography, transcranial colorcoded sonography (TCCS), CT angiography (CTA) or magnetic resonance angiography (MRA) if CTA was contraindicated, 24-hours cardiac
monitoring
, trans-thoracic echocardiography (TTE) completed by trans-esophageal echocardiography (TEE) if appropriate, and coagulation studies.
their demographics, clinical characteristics, routine blood tests, and vascular risk factors.
All patients underwent a complete diagnostic workup: cerebral CT/MRI at admission, extracranial colorcoded duplex sonography, transcranial colorcoded sonography (TCCS), CT angiography (CTA) or magnetic resonance angiography (MRA) if CTA was contraindicated, 24-hours cardiac monitoring, trans-thoracic echocardiography (TTE) completed by trans-esophageal echocardiography (TEE) if appropriate, and coagulation studies.
Diagnosis of right-to-left shunt (RLS) was made by contrastenhanced TCCS (cTCCS) performed at rest and after Valsalva maneuver, and the presence of a patent foramen ovale (PFO) was confirmed by a contrast TTE or TEE; RLS was graded according to the number of bubbles detected by cTCCS: low-grade (1-10 MES), medium-grade (>10 MES), high-grade (shower or curtain effect). During hospitalization, the vital parameters of all enrolled patients were continuously monitored for the first 72 hours in order to detect and treat any alteration in heart rate, heart rhythm, respiratory dynamics, oxyhemoglobin saturation, arterial blood pressure and body temperature. A 24-hours brain MRI/CT was performed along with a brain MRI just before hospital discharge. In case of a neurologic deterioration – an increase in National Institutes of Health Stroke Scale (NIHSS) score
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Clinical Follow-up and Ultrasound
Monitoring
.
Clinical Follow-up and Ultrasound Monitoring.
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During the follow-up period, all selected patients with a suitable transtemporal acoustic window underwent a 60-minutes bilateral TCD
monitoring
of the middle cerebral artery in order to detect MES.
Clinical and functional statuses were assessed with the NIHSS and the modified Rankin Scale (mRS), respectively, at discharge and at 1, 3, 6 months and yearly thereafter. All patients were followed prospectively and cardiovascular events, recurrent TIA/strokes or death were recorded.
During the follow-up period, all selected patients with a suitable transtemporal acoustic window underwent a 60-minutes bilateral TCD monitoring of the middle cerebral artery in order to detect MES.
The arteries were insonated at a mean depth of 54±4 mm using a low-frequency probe (1-3 MHz), fixed to a headframe, following a validated
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Automated MES counting software was activated, but an operator was always present throughout the
monitoring
period to exclude artifacts and to reposition the probes if necessary.
protocol which included the examination of the contralateral homologous artery [1]. The settings of the sonograph (Spencer ST3 Power M-mode Transcranial Doppler, Spencer Technologies, Redmond WA, USA) were appropriately adjusted to maximize the possibility of detection and the safety for long ultrasound exposure.
Automated MES counting software was activated, but an operator was always present throughout the monitoring period to exclude artifacts and to reposition the probes if necessary.
All examinations were performed with the patient in supine position by an experienced neurosonographer (A.P.). MES detection was also performed in 30 young healthy adults (10 males, mean age 28.1±7 years) without history of cerebrovascular or cardiac disease, without any vascular risk factors and not taking any drugs.
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TCD
monitoring
/ ТДС мониториране
TCD monitoring / ТДС мониториране
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Most patients were receiving antithrombotic treatment at the time of TCD
monitoring
.
This study has several potential methodological drawbacks that must be taken into account: 1. Patients were rarely examined immediately after stroke onset; 2.
Most patients were receiving antithrombotic treatment at the time of TCD monitoring.
Nonetheless, as we have already mentioned, MES detected far from neurological symptom onset and irrespective of treatment are associated with a higher risk of stroke recurrence [11]. Furthermore, in our study the timing of TCD monitoring did not show any correlation with MES incidence and number; 3. The monitoring duration of 60 minutes may be too short for cryptogenic stroke patients. However, most of the studies were carried out within this time frame, which is the shortest duration with still high sensitivity [24, 36] and represents a good compromise between monitoring needs and patient cooperation. At this time there are no data, which document that longer monitoring allows a greater accuracy in this setting.
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Furthermore, in our study the timing of TCD
monitoring
did not show any correlation with MES incidence and number; 3.
This study has several potential methodological drawbacks that must be taken into account: 1. Patients were rarely examined immediately after stroke onset; 2. Most patients were receiving antithrombotic treatment at the time of TCD monitoring. Nonetheless, as we have already mentioned, MES detected far from neurological symptom onset and irrespective of treatment are associated with a higher risk of stroke recurrence [11].
Furthermore, in our study the timing of TCD monitoring did not show any correlation with MES incidence and number; 3.
The monitoring duration of 60 minutes may be too short for cryptogenic stroke patients. However, most of the studies were carried out within this time frame, which is the shortest duration with still high sensitivity [24, 36] and represents a good compromise between monitoring needs and patient cooperation. At this time there are no data, which document that longer monitoring allows a greater accuracy in this setting. Despite our study limitations, we think that these results encourage the inclusion of TCD
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The
monitoring
duration of 60 minutes may be too short for cryptogenic stroke patients.
This study has several potential methodological drawbacks that must be taken into account: 1. Patients were rarely examined immediately after stroke onset; 2. Most patients were receiving antithrombotic treatment at the time of TCD monitoring. Nonetheless, as we have already mentioned, MES detected far from neurological symptom onset and irrespective of treatment are associated with a higher risk of stroke recurrence [11]. Furthermore, in our study the timing of TCD monitoring did not show any correlation with MES incidence and number; 3.
The monitoring duration of 60 minutes may be too short for cryptogenic stroke patients.
However, most of the studies were carried out within this time frame, which is the shortest duration with still high sensitivity [24, 36] and represents a good compromise between monitoring needs and patient cooperation. At this time there are no data, which document that longer monitoring allows a greater accuracy in this setting. Despite our study limitations, we think that these results encourage the inclusion of TCD
read the entire text >>
However, most of the studies were carried out within this time frame, which is the shortest duration with still high sensitivity [24, 36] and represents a good compromise between
monitoring
needs and patient cooperation.
Patients were rarely examined immediately after stroke onset; 2. Most patients were receiving antithrombotic treatment at the time of TCD monitoring. Nonetheless, as we have already mentioned, MES detected far from neurological symptom onset and irrespective of treatment are associated with a higher risk of stroke recurrence [11]. Furthermore, in our study the timing of TCD monitoring did not show any correlation with MES incidence and number; 3. The monitoring duration of 60 minutes may be too short for cryptogenic stroke patients.
However, most of the studies were carried out within this time frame, which is the shortest duration with still high sensitivity [24, 36] and represents a good compromise between monitoring needs and patient cooperation.
At this time there are no data, which document that longer monitoring allows a greater accuracy in this setting. Despite our study limitations, we think that these results encourage the inclusion of TCD
read the entire text >>
At this time there are no data, which document that longer
monitoring
allows a greater accuracy in this setting.
Most patients were receiving antithrombotic treatment at the time of TCD monitoring. Nonetheless, as we have already mentioned, MES detected far from neurological symptom onset and irrespective of treatment are associated with a higher risk of stroke recurrence [11]. Furthermore, in our study the timing of TCD monitoring did not show any correlation with MES incidence and number; 3. The monitoring duration of 60 minutes may be too short for cryptogenic stroke patients. However, most of the studies were carried out within this time frame, which is the shortest duration with still high sensitivity [24, 36] and represents a good compromise between monitoring needs and patient cooperation.
At this time there are no data, which document that longer monitoring allows a greater accuracy in this setting.
Despite our study limitations, we think that these results encourage the inclusion of TCD
read the entire text >>
monitoring
into the diagnostic work-up of patients with cryptogenic stroke.
monitoring into the diagnostic work-up of patients with cryptogenic stroke.
Indeed, cryptogenic strokes represent an obstacle to stroke recurrence reduction, as absence of a clear etiology precludes any targeted secondary prevention strategy. MES detection even several months after stroke likely provides a marker of hidden but still active embolic source. However, studies on a wider population are warranted in order to establish the relationship between the presence of MES and the risk of recurrent stroke in this setting.
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Therefore, TCD
monitoring
should be included in the diagnostic assessment of these patients, because of its potential role in tailoring secondary prevention stroke treatment.
In summary, the current study shows that MES detection is feasible in cryptogenic stroke patients and identifies the embolic subgroup, independently from the presence of common cerebrovascular risk factors.
Therefore, TCD monitoring should be included in the diagnostic assessment of these patients, because of its potential role in tailoring secondary prevention stroke treatment.
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Microembolic signal
monitoring
of TOAST-classified cerebral infarction patients.
Jiang J, Jiang Y, Feng S, Sun D, Zhuang A, Zeng Q, Zhang Y, Huang H, Nie H, Zhou F.
Microembolic signal monitoring of TOAST-classified cerebral infarction patients.
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Long-term ambulatory
monitoring
for cerebral emboli using transcranial Doppler ultrasound.
Mackinnon AD, Aaslid R, Markus HS.
Long-term ambulatory monitoring for cerebral emboli using transcranial Doppler ultrasound.
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Transcranial Doppler
monitoring
during stenting of the carotid bifurcation: evalu-
Rubartelli P, Brusa G, Arrigo A, Abbadessa F, Giachero C, Vischi M, Ricca MM, Ottonello GA.
Transcranial Doppler monitoring during stenting of the carotid bifurcation: evalu-
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Detection of cerebral microemboli by means of transcranial Doppler
monitoring
before and after carotid endarterectomy.
Van Zuilen EV, Moll FL, Vermeulen FE, Mauser HW, van Gijn J, Ackerstaff RG.
Detection of cerebral microemboli by means of transcranial Doppler monitoring before and after carotid endarterectomy.
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Novel Methods for Continuing Glucose
Monitoring
.
Novel Methods for Continuing Glucose Monitoring.
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CONTINUOUS GLUCOSE
MONITORING
OF BLOOD SUGARS – A ROLE OF NEW TECHNOLOGIES IN DIABETIC PATIENT FOLLOW-UP
CONTINUOUS GLUCOSE MONITORING OF BLOOD SUGARS – A ROLE OF NEW TECHNOLOGIES IN DIABETIC PATIENT FOLLOW-UP
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Various methods are used to determine the degree of disease control: measuring blood glucose alone, determining glycated hemoglobin and other glycated proteins, continuous 24-hour glucose
monitoring
for different time period.
The incidence of diabetes mellitus is increasing significantly recent decades and exceeding so far the expectations, and despite the current treatment and follow-up options, a large number of patients do not achieve the desired therapeutic goals.
Various methods are used to determine the degree of disease control: measuring blood glucose alone, determining glycated hemoglobin and other glycated proteins, continuous 24-hour glucose monitoring for different time period.
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Continuous glucose
monitoring
(CGM) is a device used to measure glucose in the inerstiual fluid at a certain time interval over a different period.
Continuous glucose monitoring (CGM) is a device used to measure glucose in the inerstiual fluid at a certain time interval over a different period.
The information is stored in a special memory or displayed on the device screen. The method is minimally invasive and involves measuring glucose concentrations in the interstitial and converting these values to blood sugar levels. Most currently used devices are consisting of an enzyme-coated electrode (sensor), most commonly a glucooxidase. A large number of modern monitoring systems have the ability to synchronize with devices for continuous subcutaneous insulin infusion (insulin pumps) to adjust the dose regimen and optimize their effectiveness.
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A large number of modern
monitoring
systems have the ability to synchronize with devices for continuous subcutaneous insulin infusion (insulin pumps) to adjust the dose regimen and optimize their effectiveness.
Continuous glucose monitoring (CGM) is a device used to measure glucose in the inerstiual fluid at a certain time interval over a different period. The information is stored in a special memory or displayed on the device screen. The method is minimally invasive and involves measuring glucose concentrations in the interstitial and converting these values to blood sugar levels. Most currently used devices are consisting of an enzyme-coated electrode (sensor), most commonly a glucooxidase.
A large number of modern monitoring systems have the ability to synchronize with devices for continuous subcutaneous insulin infusion (insulin pumps) to adjust the dose regimen and optimize their effectiveness.
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flash
monitoring
– the measurement is performed only when a reader is presented to the sensor – FreeStyle Libre (Abbott).
The most used in practice are iPro (Medtronic), Guardian-REAL-Time/Paradigm-REAL-Time (Medtronic), FreeStyle Navigator (Abbott), Dexcom G4, G5 (Dexcom) because of proven reliability and safety. In recent years a new methodology was introduced, i.e.
flash monitoring – the measurement is performed only when a reader is presented to the sensor – FreeStyle Libre (Abbott).
At the beginning of 2018, a new long-life sensor was introduced that presents the glycemia for a sustained 90-day period – Eversense (Roche).
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diabetis mellitus, glucose
monitoring
, new technologies
diabetis mellitus, glucose monitoring, new technologies
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не (continuous glucose
monitoring
, CGM) включва устройства, замерващи глюкозата в инерстициума през определен интервал от време в продължение на различен период.
не (continuous glucose monitoring, CGM) включва устройства, замерващи глюкозата в инерстициума през определен интервал от време в продължение на различен период.
Информацията се запазва в специална памет или се представя на екрана на устройството. Методът е минимално инвазивен, измерва глюкозни концентрации в интерстициума и конвертира тези стойности към кръвно-захарни нива. Повечето съвременни устройства използват електрод (сензор) с ензимно покритие, най-често глюкооксидаза. Голяма част от мониториращите системи имат възможност за синхронизиране с устройства за постоянна подкожна инсулинова инфузия (инсулинови помпи), с което се прецизира дозовия режим и се оптимизира ефективността им. Понастоящем най-често използвани, с доказана надеждност и безопасност, са следните типове системи – iPro (Medtronic), Guardian-REAL-Time/ Paradigm-REAL-Time (Medtronic), FreeStyle Navigator (Abbott), Dexcom G4, G5 (Dexcom).
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With the help of continuous
monitoring
of cerebral blood velocity (e.g.
With the help of continuous monitoring of cerebral blood velocity (e.g.
in the middle cerebral artery), the efficacy of t-PA and new fibrinolytic agents in acute ischemic stroke patients can be evaluated.
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embolus detection, continuous noninvasive cerebral blood velocity
monitoring
).
both extraand intracranial US methods proved their usefulness in the evaluation of pharmacological interventions. They are attractive techniques due to their low cost, non-invasive characteristics, excellent time resolution and unique abilities (e.g.
embolus detection, continuous noninvasive cerebral blood velocity monitoring).
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Ultrasound (transcranial Doppler cerebral blood flow
monitoring
, myosonography, ect.) and electromyographic studies are rearely used for assessment of brain autoregulation amd the efficacy of the PMP.
The publications are predominantly devoted to orthostatic hypotension, Postural Orthostatic Tachycardia Syndrome (POTS) and vasovagal syncope as the main OI clinical manifestations. Only few authors analyze the importance of the anti-gravity mechanisms for their occurrence. Cardiological tests and various modifications of the passive orthostatic test are mostly used in the assessment of OI.
Ultrasound (transcranial Doppler cerebral blood flow monitoring, myosonography, ect.) and electromyographic studies are rearely used for assessment of brain autoregulation amd the efficacy of the PMP.
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27.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 15, 2019, No. 1
,
,
,
Prospective left retinal blood flow
monitoring
before CE.
Prospective left retinal blood flow monitoring before CE.
Increased vascular resistance on day 3 of the symptoms’ onset
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In addition to the questionnaire, the cardiovascular autonomic function was also evaluated by short-term heart rate variability
monitoring
(HRV).
In addition to the questionnaire, the cardiovascular autonomic function was also evaluated by short-term heart rate variability monitoring (HRV).
The study was conducted in a specialized laboratory at 23°-24°C without visual and/or acoustic stimuli. Heart rate and breathing were monitored in lying position (10 minutes) and during 5-minute head-up tilt at sixty degrees. The R-R intervals were registered by a MP100 computerized system with an ECG module (Biopac system Inc., USA). The time parameters: mean R-R interval (ms), mean heart rate (bpm), mean standard deviation of the R-R interval (SDNN) and, low-frequency (LF, 0,04-0,15 Hz), high-frequency (HF 0,15-0,40 Hz) spectral characteristics and their ratio (LF/HF) were calculated. In order to eliminate the interindividual (intragroup) differences in the spectral characteristics, the relative spectral characteristics were calculated by applying standardization of the low – and high-frequency spectral components as follows: LF%=LF/ (LF+HF)*100 and HF%=HF/((LF+HF)*100.
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