Sympathetically-induced changes in microvascular cerebral blood flow and in the morphology of its low-frequency waves

Spontaneous low-frequency oscillations decline in the aging brain

It is well known that aging leads to a degeneration of the vascular system. Hence, one may hypothesize that spontaneous oscillations decrease in the cerebral microvasculature with aging. Accordingly, the authors investigated the age dependency of spontaneous oscillations in the visual cortex during rest and functional activation. Functional near-infrared spectroscopy was used because it is particularly sensitive to the microvasculature. Visual stimulation led to an increase of oxyhemoglobin, total hemoglobin, and a decrease of deoxyhemoglobin, without any influence of age. Peaks of normalized power spectral density were detected for spontaneous low-frequency (0.07 to 0.11 Hz) and very-low-frequency (0.01 to 0.05 Hz) oscillations, with a higher amplitude for oxyhemoglobin than for deoxyhemoglobin. Spontaneous low-frequency oscillations of oxyhemoglobin and deoxyhemoglobin declined strongly with aging during both rest and visual stimulation. Reduction of spontaneous low-frequency oscillations might indicate a declining spontaneous activity in microvascular smooth muscle cells, in conjunction with an increased vessel stiffness with aging.

Noradrenergic constriction of cerebral arteries as detected by transcranial Doppler (TCD) in the rabbit

Interpretation of transcranial Doppler (TCD) recordings requires assumptions about flow or diameter of the insonated vessel. This study aimed at assessing if activation of the sympathetic system could affect blood velocity (bv) in basal cerebral arteries. In anaesthetized rabbits, stimulation of cervical sympathetic nerve (cervSN) was used selectively to activate the sympathetic pathway to the head while monitoring bv in all major cerebral arteries. cervSN stimulation at 10 Hz produced: 1. in internal carotid artery (ICA) and ICA-supplied arteries (ICA-s), a consistent bv increase ranging between 20 and 70%, 2. in the basilar artery, a transient decrease by 15-30%. These effects were mimicked, in both territories, by injection of phenylephrine into the ICA. Because cerebral blood flow is known to be reduced by cervSN stimulation, the increase in bv in ICA and ICA-s must be ascribed to constriction of the insonated vessels. These effects should be considered when monitoring bv during sympathetic activation tests or exercise.

Imaging of spatiotemporal coincident states by DC optical tomography

The utility of optical tomography as a practical imaging modality has, thus far, been limited by its intrinsically low spatial resolution and quantitative accuracy. Recently, we have argued that a broad range of physiological phenomena might be accurately studied by adopting this technology to investigate dynamic states (Schmitz et al., 2000; Barbour et al., 2000; Graber et al., 2000; Barbour et aL, 2001; and Barbour et aL, 1999). One such phenomenon holding considerable significance is the dynamics of the vasculature, which has been well characterized as being both spatially and temporally heterogeneous. In this paper, we have modeled such heterogeneity in the limiting case of spatiotemporal coincident behavior involving optical contrast features, in an effort to define the expected limits with which dynamic states can be characterized using two newly described reconstruction methods that evaluate normalized detector data: the normalized difference method (NDM) and the normalized constraint method (NCM). Influencing the design of these studies is the expectation that spatially coincident temporal variations in both the absorption and scattering properties of tissue can occur in vivo. We have also chosen to model dc illumination techniques, in recognition of their favorable performance and cost for practical systems. This choice was made with full knowledge of theoretical findings arguing that separation of the optical absorption and scattering coefficients under these conditions is not possible. Results obtained show that the NDM algorithm provides for good spatial resolution and excellent characterization of the temporal behavior of optical properties but is subject to interparameter crosstalk. The NCM algorithm, while also providing excellent characterization of temporal behavior, provides for improved spatial resolution, as well as for improved separation of absorption and scattering coefficients. A discussion is provided to reconcile these findings with theoretical expectations.

Sympathetic modulation of muscle spindle afferent sensitivity to stretch in rabbit jaw closing muscles

Previous reports showed that sympathetic stimulation affects the activity of muscle spindle afferents (MSAs). The aim of the present work is to study the characteristics of sympathetic modulation of MSA response to stretch: (i) on the dynamic and static components of the stretch response, and (ii) on group Ia and II MSAs to evaluate potentially different effects. In anaesthetised rabbits, the peripheral stump of the cervical sympathetic nerve (CSN) was stimulated at 10 impulses s(-1) for 45-90 s. The responses of single MSAs to trapezoidal displacement of the mandible were recorded from the mesencephalic trigeminal nucleus. The following characteristic parameters were determined from averaged trapezoidal responses: initial frequency (IF), peak frequency at the end of the ramp (PF), and static index (SI). From these, other parameters were derived: dynamic index (DI = PF - SI), dynamic difference (DD = PF - IF) and static difference (SD = SI - IF). The effects of CSN stimulation were also evaluated during changes in the state of intrafusal muscle fibre contraction induced by succinylcholine and curare. In a population of 124 MSAs, 106 units (85.4 %) were affected by sympathetic stimulation. In general, while changes in resting discharge varied among different units (Ia vs. II) and experimental conditions (curarised vs. non-curarised), ranging from enhancement to strong depression of firing, the amplitude of the response to muscle stretches consistently decreased. This was confirmed and detailed in a quantitative analysis performed on 49 muscle spindle afferents. In both the non-curarised (23 units) and curarised (26 units) condition, stimulation of the CSN reduced the response amplitude in terms of DD and SD, but hardly affected DI. The effects were equally present in both Ia and II units; they were shown to be independent from gamma drive and intrafusal muscle tone and not secondary to muscle hypoxia. Sympathetic action on the resting discharge (IF) was less consistent. In the non-curarised condition, IF decreased in most Ia units, while in II units decreases and increases occurred equally often. In the curarised condition, IF in group II units mostly increased. The results have important functional implications on the control of motor function in a state of 'high' sympathetic activity, like excessive stress, as well as in certain pathological conditions such as sympathetically maintained pain.

Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: a prospective case study and discussion

OBJECTIVE

To discuss the case of a patient with severely reduced visual fields arising from terminal glaucomatous retinal damage and the treatment of this condition by spinal manipulation.

CLINICAL FEATURES

A 25-year-old uniocular female patient with congenital glaucoma sought chiropractic treatment for spinal pain, headache, and classic migraine. Advanced optic disk cupping was present, and loss of vision was near complete. A 3-degree island of central vision and a small area of peripheral light sensitivity had remained relatively stable for 3 years after a trabeculectomy procedure that had resulted in intraocular hypotony.

INTERVENTION AND OUTCOME

It was considered possible that chiropractic spinal manipulative therapy may have a positive outcome in visual performance. Before commencing chiropractic spinal manipulative therapy, an ophthalmologic examination was performed, and visual performance was monitored through a course of treatment. Immediately after the first treatment, significant visual field improvement was recorded in the remaining eye. Maximal improvement of vision was achieved after 1 week (4 treatment sessions). Total monocular visual field had increased from approximately 2% to approximately 20% of normal. Corrected central acuity had improved from 6/12 to 6/9. Independent reexamination by the patient's regular ophthalmic surgeon confirmed the results.

CONCLUSION

Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.

Effect of generalised sympathetic activation by cold pressor test on cerebral haemodynamics in healthy humans

There is no general agreement regarding several aspects of the role of the sympathetic system on cerebral haemodynamics such as extent of effectiveness, operational range and site of action. This study was planned to identify the effect of a generalised sympathetic activation on the cerebral haemodynamics in healthy humans before it is masked by secondary corrections, metabolic or myogenic in nature. A total of 35 healthy volunteers aged 20-35 underwent a 5 min lasting cold pressor test (CPT) performed on their left hand. The cerebral blood flow (CBF) velocity in the middle cerebral arteries and arterial blood pressure were recorded with transcranial Doppler sonography and with a non-invasive finger-cuff method, respectively. The ratio of arterial blood pressure to mean blood velocity (ABP/Vm) and Pulsatility Index (PI) were calculated throughout each trial. CPT induced an increase in mean ABP (range 2-54 mmHg depending on the subject) and only a slight, though significant, increase in blood velocity in the middle cerebral artery (+2.4 and +4.4% on ipsi- and contralateral side, respectively). During CPT, the ratio ABP/Vm increased and PI decreased in all subjects on both sides. These changes began simultaneously with the increase in blood pressure. The increase in ABP/Vm ratio is attributed to an increase in the cerebrovascular resistance, while the concomitant reduction in PI is interpreted as due to the reduction in the compliance of the middle cerebral artery. The results suggest that generalised increases in the sympathetic discharge, causing increases in ABP, can prevent concomitant increases in CBF by acting on both small resistance and large compliant vessels. This effect is also present when a slight increase in blood pressure occurs, which suggests a moderate increase in the sympathetic discharge, i.e. when ABP remains far below the upper limit of CBF autoregulation.