TY  - JOUR
AU  - Szatmári, Szilárd Attila
AU  - Végh, Tamás
AU  - Csomós, Ákos
AU  - Hallay, Judit
AU  - Takács, István
AU  - Molnár, Csilla
AU  - Fülesdi, Béla
TI  - Impaired cerebrovascular reactivity in sepsis-associated encephalopathy studied by acetazolamide test
JF  - CRITICAL CARE
J2  - CRIT CARE
VL  - 14
PY  - 2010
IS  - 2
PG  - 7
SN  - 1364-8535
DO  - 10.1186/cc8939
UR  - https://m2.mtmt.hu/api/publication/1743119
ID  - 1743119
AB  - Introduction: The pathophysiology of sepsis-associated encephalopathy (SAE) is not entirely clear. One of the possible underlying mechanisms is the alteration of the cerebral microvascular function induced by the systemic inflammation. The aim of the present work was to test whether cerebral vasomotor-reactivity is impaired in patients with SAE. Methods: Patients fulfilling the criteria of clinical sepsis and showing disturbance of consciousness of any severity were included (n = 14). Non-septic persons whithout previous diseases affecting cerebral vasoreactivity served as controls (n = 20). Transcranial Doppler blood flow velocities were measured at rest and at 5, 10, 15 and 20 minutes after intravenous administration of 15 mg/kgBW acetazolamide. The time course of the acetazolamide effect on cerebral blood flow velocity (cerebrovascular reactivity, CVR) and the maximal vasodilatory effect of acetazolemide (cerebrovascular reserve capacity, CRC) were compared among the groups. Results: Absolute blood flow velocities after adminsitration of the vasodilator drug were higher among control subjects than in SAE. Assessment of the time-course of the vasomotor reaction showed that patients with SAE reacted slower to the vasodilatory stimulus than control persons. When assessing the maximal vasodilatory ability of the cerebral arterioles to acetazolamide during vasomotor testing, we found that patients with SAE reacted to a lesser extent to the drug than did control subjects (CRC controls: 46.2 +/- 15.9%, CRC SAE: 31,5 +/- 15.8%, P < 0.01). Conclusions: We conclude that cerebrovascular reactivity is impaired in patients with SAE. The clinical significance of this pathophysiological finding has to be assessed in further studies.
LA  - English
DB  - MTMT
ER  - 

TY  - JOUR
AU  - Vajda, Zsolt
AU  - Büki, András
AU  - Vető, Ferenc
AU  - Horváth, Zsolt
AU  - Sándor, János
AU  - Dóczi, Tamás Péter
TI  - Transcranial Doppler-determined pulsatility index in the evaluation of endoscopic third ventriculostomy (preliminary data)
JF  - ACTA NEUROCHIRURGICA
J2  - ACTA NEUROCHIR
VL  - 141
PY  - 1999
IS  - 3
SP  - 247
EP  - 250
PG  - 4
SN  - 0001-6268
DO  - 10.1007/s007010050294
UR  - https://m2.mtmt.hu/api/publication/1033940
ID  - 1033940
AB  - OBJECTIVE: Endoscopic 3rd ventriculostomy has become the method of choice in the 
management of occlusive hydrocephalus. The treatment is accompanied by
significantly less peri-operative complications than the cerebrospinal fluid
shunting procedures previously employed. Close surveillance of patients, however,
is necessary to avoid the consequences of raised intracranial pressure that may
develop in case of obstruction of the artificial outlet of the 3rd ventricle. The
aim of this study was to confirm the value of transcranial Doppler-determined
pulsatility index (PI) in the assessment of the patency of endoscopic 3rd
ventriculostomy and to elucidate its usefulness in early postoperative
recognition of increased intracranial pressure. METHODS: In twenty-two patients
suffering from occlusive hydrocephalus, transcranial Doppler sonography (TCD) was
performed before, immediately after, and five days after endoscopic fenestration 
of the floor of the 3rd ventricle. PI was defined with fast Fourier
transformation. Mean PI values were determined in both middle cerebral arteries
(MCA), over five cardiac cycles. RESULTS: In nineteen cases, PI values showed a
significant decrease immediately as well as five days after the intervention as
compared to the pre-operative values, and flow-sensitive MRI confirmed the
patency of the fenestration in all cases. In one patient the operation failed to 
produce an effective diversion of cerebrospinal fluid as shown by flow-sensitive 
MRI, and the pulsatility index was unchanged. In two patients, a significant
immediate postfenestration drop in PI was followed by a recurrence of PI to
pre-operative levels without any clinical deterioration. CONCLUSIONS: Preliminary
results suggest that the transcranial Doppler-determined pulsatility index is a
useful non-invasive tool for the evaluation of the patency of the fenestration in
the early follow-up of patients who underwent endoscopic third ventriculostomy.
LA  - English
DB  - MTMT
ER  -