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3 results

  • EPA-1297 - Lateralization of Cerebral Hemodynamics in Schizophrenia During the Trail Making Test: A Functional Transcranial Doppler Sonography Study

  • S. Egger, J. Ernst, S. Grimm, H. Boeker, S. Vetter, E. Seifritz, D. Schuepbach
  • Journal:
    European Psychiatry / Volume 29 / Issue S1 / 2014
    Published online by Cambridge University Press:
    15 April 2020, p. 1
    • Article
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  • Introduction:

    Schizophrenia is a major mental disorder, with complex symptoms involving psychosis, apathy and cognitive impairment. The Trail Making Test (TMT) is a useful tool to assess cognitive functioning. Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries is a noninvasive technique that allows monitoring of cerebral hemodynamics with a high temporal resolution during cognitive tasks.

    Objectives:

    We assessed cerebral hemodynamics and lateralization in the middle cerebral arteries (MCA) using fTCD while patients with chronic schizophrenia and healthy subjects performed the TMT Part A and B, as well as a control task.

    Methods:

    fTCD was used to asses bilateral mean cerebral blood flow velocity (MFV) changes in the middle (MCA) and anterior (ACA) cerebral arteries. Fifteen patients with chronic Schizophrenia and 20 healthy control subjects with similar sociodemographic characteristics performed the TMT during fTCD measurements of the MCA and ACA.

    Results:

    Schizophrenia patients demonstrated an overall poorer performance, with a significant different lateralization pattern for both forms of TMT than healthy subjects. There was a significant slowing both forms of TMT, schizophrenia was associated with initially left sided lateralization. Healthy subjects showed a bilateral pattern.

    Conclusions:

    These novel results show performance and brain perfusion abnormalities in schizophrenia, supporting the idea that cognitive performance has a pathological functional correlate predominantly in the lateral hemispheres of the brain. It adds to the notion that fTCD is a valuable tool to correlate psychological paradigms with brain perfusion.

  • Case 36 - Awakecraniotomy and intraoperative neurologic decline

  • from Section I - Neuroanesthesia
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 113-116

  • Summary

    Intraoperative neurologic monitoring has been the subject of intense research for many years, the goal being to accurately identify intraoperative cerebral ischemia, and predict which patients may benefit from intraoperative shunting. This chapter presents a case study of a 73-year-old male scheduled for a right carotid endarterectomy (CEA) under general anesthesia. The patient experienced delayed emergence and displayed signs of a left hemiparesis. A diffusion-weighted magnetic resonance imaging confirmed the presence of a right-sided ischemic stroke in the middle cerebral artery (MCA) territory. For patients undergoing CEA under general anesthesia a number of monitoring modalities exist: monitors of cerebral hemodynamics, monitors of cerebral oxygenation and metabolism, and monitors of electrophysiologic parameters. None of the monitoring modalities commonly used for CEA under general anesthesia have been shown to either reliably identify or prevent cerebral ischemia or stroke, nor predict which patients may benefit from shunt placement.

  • 16 - New MR techniques to select patients for thrombolysis in acute stroke

  • Edited by Stephen Davis, Marc Fisher, National Institute of Mental Health, Bethesda, Maryland, Steven Warach, National Institutes of Health, Baltimore
  • Book:
    Magnetic Resonance Imaging in Stroke
    Published online:
    26 August 2009
    Print publication:
    20 March 2003, pp 207-222

  • Summary

    A landmark NINDS IV tPA trial showed that treatment with tPA within 3 hours of symptom onset improved neurologic impairment and functional outcome. Recently novel, semiquantitative PET measurements have been proposed to study the penumbra in humans that partially overcome the complexity of quantitative PET measurements. A perfusion-weighted imaging technique (PWI) is an evolving MR technology to study cerebral hemodynamics. The goal of hemodynamic imaging is to rapidly and accurately identify the area of hypoperfusion. Animal ischemia experiments have demonstrated that the lesion identified on diffusion-weighted imaging is larger than the area where ATP depletion has occurred; indicating that only part of the DWI lesion represents the ischemic core. The rationale of thrombolysis in acute stroke is to open occluded vessels and provide beneficial reperfusion. In animal stroke models, primary evidence of the efficacy of therapeutic intervention is established by a reduction in ischemic lesion volume compared to non-treated animals.