Stroke; a journal of cerebral circulation
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Comparative Study
Comparison of different diagnostic criteria for vascular dementia (ADDTC, DSM-IV, ICD-10, NINDS-AIREN).
Vascular dementia (VD) has been an ill-defined term thus far. Recently detailed criteria for the diagnosis of VD have been proposed (Alzheimer's Disease Diagnostic and Treatment Centers [ADDTC], 1992; Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV], 1994; International Classification of Diseases, 10th revision [ICD-10], 1992, 1993; and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences [NINDS-AIREN], 1993). Until now the clinical feasibility of these diagnostic guidelines has not been evaluated. ⋯ Our results show that the classification according to different diagnostic guidelines yields rather distinct groups of patients. The reasons responsible for these findings are as follows: (1) different criteria for dementia, (2) limitation to ischemic VD in the ADDTC criteria, (3) no further differentiation of VD into subtypes according to CT or MRI findings (DSM-IV), and (4) the multifactorial etiopathology of VD. Major diagnostic difficulties ensue from the very frequent cases with white matter lesions, since their etiology and classification remain widely unknown.
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Near-infrared spectroscopy is a technique that can potentially monitor changes in cerebral oxygenation. There are at present limited clinical data regarding the value of this technology in relating neurological outcome to cerebrovascular hemoglobin oxygen saturation (ScO2). This investigation reports changes in ScO2 due to carotid cross-clamping during carotid endarterectomy in awake patients. ⋯ These results suggest that carotid artery occlusion causes a statistically significant but variable decrease in ScO2 in the majority of patients. Data in this investigation provide a range of ScO2 values that was not associated with a clinically detectable neurological dysfunction.
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In past studies, cerebral outcome after normothermic cardiac arrest of 10 or 12.5 minutes in dogs was improved but not normalized by resuscitative (postarrest) treatment with either mild hypothermia or hypertension plus hemodilution. We hypothesized that a multifaceted combination treatment would achieve complete cerebral recovery. ⋯ After normothermic cardiac arrest of 11 minutes in dogs, resuscitative mild hypothermia plus cerebral blood flow promotion can achieve functional recovery with the least histological brain damage yet observed with the same model and comparable insults.
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Case Reports
Influence of the intra-aortic balloon pump on the transcranial Doppler flow pattern in a brain-dead patient.
Confirmation of clinical brain death with transcranial Doppler (TCD) has been described. With the introduction of mechanical assist devices, it is important to know how these devices influence TCD measurements. ⋯ Application of TCD in a patient with an IABP could lead to false interpretation of results if the TCD mean velocities are not registered with the IABP on standby or if the net flow velocities are not calculated.
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Comparative Study
Comparison of transcranial Doppler ultrasonography and transesophageal echocardiography to monitor emboli during coronary artery bypass surgery.
Transcranial Doppler ultrasonography (TCD) is the standard technique for monitoring emboli in the cerebral circulation. Embolic signals have been detected with the use of this technique in most patients undergoing coronary artery bypass surgery. We previously reported that the majority of emboli are detected after release of aortic cross-clamps and partial occlusion clamps. In this study we compare the intraoperative use of TCD with transesophageal echocardiography (TEE) to monitor cerebral emboli. ⋯ TEE and TCD can both be used to continuously monitor emboli during coronary artery bypass surgery. However, TEE is invasive and justified only if it is being performed for intraoperative assessment of aortic atheromatosis or cardiac function.