1
|
Cordelli DM, Marra C, Ciampoli L, Barbon D, Toni F, Zama D, Giordano L, Milito G, Sartori S, Sainati L, Foiadelli T, Mina T, Fusco L, Santarone M, Iurato C, Orsini A, Farello G, Verrotti A, Aceti A, Masetti R. Posterior Reversible Encephalopathy Syndrome in infants and young children. Eur J Paediatr Neurol 2021; 30:128-133. [PMID: 33139147 DOI: 10.1016/j.ejpn.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to describe the characteristics of Posterior Reversible Encephalopathy Syndrome (PRES) in infants and young children (<6 years) and to compare them with the older pediatric population affected by PRES. METHODS we retrospectively reviewed records of 111 children (0-17 years) diagnosed with PRES from 2000 to 2018 in 6 referral pediatric hospitals in Italy. The clinical, radiological and EEG features, as well as intensive care unit (ICU) admission rate and outcome of children aged <6 years were compared to those of older children (6-17 years). Factors associated with ICU admission in the whole pediatric cohort with PRES were also evaluated. RESULTS Twenty-nine patients younger than 6 years (26%) were enrolled with a median age at onset of PRES of 4 years (range: 6 months-5 years). Epileptic seizures were the most frequent presentation at the disease onset (27/29 patients). Status epilepticus (SE) was observed in 21/29 patients: in detail, 11 developed convulsive SE and 10 presented nonconvulsive SE (NCSE). SE was more frequent in children <6 years compared with older children (72% vs 45%) as well as NCSE (35% vs 10%). Seventeen children aged <6 years required ICU admission. Prevalence of ICU admissions was higher within younger population compared to older (59% vs 37%). In the whole study population SE was significantly associated with ICU admission (p = 0.001). CONCLUSIONS PRES in children < 6 years differs from older children in clinical presentation suggesting a more severe presentation at younger age.
Collapse
Affiliation(s)
- Duccio Maria Cordelli
- Unit of Child Neurology and Psychiatry, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, Italy.
| | - Chiara Marra
- Unit of Child Neurology and Psychiatry, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, Italy.
| | - Lara Ciampoli
- Unit of Child Neurology and Psychiatry, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, Italy.
| | - Davide Barbon
- Unit of Child Neurology and Psychiatry, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, Italy.
| | - Francesco Toni
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy.
| | - Daniele Zama
- Unit of Pediatric Oncology and Haematology "Lalla Seràgnoli", Department of Pediatrics, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
| | - Lucio Giordano
- Child Neurology and Psychiatry Unit, Spedali Civili, Brescia, Italy.
| | - Giuseppe Milito
- Child Neurology and Psychiatry Unit, Spedali Civili, Brescia, Italy.
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Italy; Neuroimmunology Group, Pediatric Research Institute "Città Della Speranza", Padova, Italy.
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child Health, Azienda Ospedale Università di Padova, Padova, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Italy.
| | - Tommaso Mina
- Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Lucia Fusco
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Marta Santarone
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Chiara Iurato
- University of Pisa, Department of Clinical and Experimental Medicine, Paediatric Unit, Pisa, Italy.
| | - Alessandro Orsini
- Paediatric Neurology, Department of Paediatrics, University Hospital of Pisa, Pisa, Italy.
| | | | | | - Arianna Aceti
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, AOU Bologna, University of Bologna, Italy.
| | - Riccardo Masetti
- Unit of Pediatric Oncology and Haematology "Lalla Seràgnoli", Department of Pediatrics, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
| |
Collapse
|
2
|
Allen LA, Schmidt JR, Thompson CT, Carlson BE, Beard DA, Lombard JH. High salt diet impairs cerebral blood flow regulation via salt-induced angiotensin II suppression. Microcirculation 2019; 26:e12518. [PMID: 30481399 DOI: 10.1111/micc.12518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/03/2018] [Accepted: 11/22/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study sought to determine whether salt-induced ANG II suppression contributes to impaired CBF autoregulation. METHODS Cerebral autoregulation was evaluated with LDF during graded reductions of blood pressure. Autoregulatory responses in rats fed HS (4% NaCl) diet vs LS (0.4% NaCl) diet were analyzed using linear regression analysis, model-free analysis, and a mechanistic theoretical model of blood flow through cerebral arterioles. RESULTS Autoregulation was intact in LS-fed animals as MAP was reduced via graded hemorrhage to approximately 50 mm Hg. Short-term (3 days) and chronic (4 weeks) HS diet impaired CBF autoregulation, as evidenced by progressive reductions of laser Doppler flux with arterial pressure reduction. Chronic low dose ANG II infusion (5 mg/kg/min, i.v.) restored CBF autoregulation between the pre-hemorrhage MAP and 50 mm Hg in rats fed short-term HS diet. Mechanistic-based model analysis showed a reduced myogenic response and reduced baseline VSM tone with short-term HS diet, which was restored by ANG II infusion. CONCLUSIONS Short-term and chronic HS diet lead to impaired autoregulation in the cerebral circulation, with salt-induced ANG II suppression as a major factor in the initiation of impaired CBF regulation.
Collapse
Affiliation(s)
- Linda A Allen
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James R Schmidt
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher T Thompson
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Brian E Carlson
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Daniel A Beard
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Julian H Lombard
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
3
|
Lekic T, Krafft PR, Coats JS, Obenaus A, Tang J, Zhang JH. Infratentorial strokes for posterior circulation folks: clinical correlations for current translational therapeutics. Transl Stroke Res 2013; 2:144-51. [PMID: 23060944 DOI: 10.1007/s12975-011-0068-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Approximately 20 percent of all strokes will occur in the Infratentorial brain. This is within the vascular territory of the posterior vascular circulation. Very few clinical specifics are known about the therapeutic needs of this patient sub-population. Most evidence-based practices are founded from research about the treatment of anterior circulatory stroke. As a consequence, little is known about how stroke in the Infratentorial brain region would require a different approach. We characterized the neurovascular features of Infratentorial stroke, pathophysiological responses, and experimental models for further translational study.
Collapse
Affiliation(s)
- Tim Lekic
- Department of Physiology, School of Medicine, Loma Linda University, Loma Linda, Calif
| | | | | | | | | | | |
Collapse
|
4
|
Posterior circulation stroke: animal models and mechanism of disease. J Biomed Biotechnol 2012; 2012:587590. [PMID: 22665986 PMCID: PMC3361739 DOI: 10.1155/2012/587590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/06/2012] [Accepted: 03/12/2012] [Indexed: 02/08/2023] Open
Abstract
Posterior circulation stroke refers to the vascular occlusion or bleeding, arising from the vertebrobasilar vasculature of the brain. Clinical studies show that individuals who experience posterior circulation stroke will develop significant brain injury, neurologic dysfunction, or death. Yet the therapeutic needs of this patient subpopulation remain largely unknown. Thus understanding the causative factors and the pathogenesis of brain damage is important, if posterior circulation stroke is to be prevented or treated. Appropriate animal models are necessary to achieve this understanding. This paper critically integrates the neurovascular and pathophysiological features gleaned from posterior circulation stroke animal models into clinical correlations.
Collapse
|
6
|
Reinhard M, Waldkircher Z, Timmer J, Weiller C, Hetzel A. Cerebellar autoregulation dynamics in humans. J Cereb Blood Flow Metab 2008; 28:1605-12. [PMID: 18493256 DOI: 10.1038/jcbfm.2008.48] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Knowledge on autoregulation of cerebellar blood flow in humans is scarce. This study investigated whether cerebellar autoregulation dynamics and CO(2) reactivity differ from those of the supratentorial circulation. In 56 healthy young adults, transcranial Doppler (TCD) monitoring of the posterior inferior cerebellar artery (PICA) and, simultaneously, of the contralateral middle cerebral artery (MCA) was performed. Autoregulation dynamics were assessed by the correlation coefficient method (indices Dx and Mx) from spontaneous blood pressure fluctuations and by transfer function analysis (phase and gain) from respiratory-induced 0.1 Hz blood pressure oscillations. CO(2) reactivity was measured via inhalation of air mixed with 7% CO(2). The autoregulatory indices Dx and Mx did not differ between the cerebellar (PICA) and cerebral (MCA) vasculature. Phase and gain, which describe faster aspects of autoregulation, showed slightly better values in the PICA compared with the MCA (higher phase, P=0.005; lower gain, P=0.007). Correlation between absolute autoregulation values in the PICA and the MCA was significant (P<0.001). The TCD CO(2) reactivity was significantly lower in the PICA (P<0.001), which could be influenced by an assumed PICA dilation under hypercapnia. In conclusion, dynamic autoregulation in the human cerebellum is well operating and has slightly faster regulatory properties than the anterior cerebral circulation.
Collapse
Affiliation(s)
- Matthias Reinhard
- Department of Neurology, Neurocenter, University of Freiburg, Freiburg, Germany.
| | | | | | | | | |
Collapse
|
7
|
Abstract
BACKGROUND AND PURPOSE Dynamic autoregulation has been studied predominantly in the middle cerebral artery (MCA). Because certain clinical conditions, ie, presyncopal symptoms or hypertensive encephalopathy, suggest a higher vulnerability of autoregulation within posterior parts of the brain, we investigated whether the cerebral blood flow velocity (CBFV) is modulated differently within the posterior cerebral artery (PCA). METHODS Spontaneous oscillations of CBFV and arterial blood pressure (ABP) in the frequency range of 0.5 to 20 cycles per minute were studied in 30 volunteers (supine and tilted positions). Analysis was based on the "high-pass filter model," which predicts a specific frequency-dependent phase and amplitude relationship between oscillations in CBFV to ABP. These parameters, characterized as phase shift angles and transfer function gains, were calculated from simultaneously recorded beat-to-beat blood pressure and transcranial Doppler signals of the PCA and MCA by means of cross-spectrum analysis. RESULTS In the MCA and PCA, phase shift angles were decreased, and gains were elevated with increasing oscillation frequency. The PCA gain values in supine and tilted positions were significantly higher than in the MCA. CONCLUSIONS The phase and amplitude relationship between CBFV and ABP showed a frequency dependence in the PCA similar to that in the MCA. The study therefore suggests that the high-pass filter model of dynamic cerebral autoregulation can be applied to the PCA. In this model the generally higher gain values in the PCA indicate a lower damping of ABP oscillations, which are transmitted to the posterior part of cerebral circulation.
Collapse
Affiliation(s)
- C Haubrich
- Department of Neurology, University Hospital Aachen, Pauwelsstrasse 31, 52074 Aachen, Germany.
| | | | | | | |
Collapse
|