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Fauss GNK, Strain MM, Huang YJ, Reynolds JA, Davis JA, Henwood MK, West CR, Grau JW. Contribution of Brain Processes to Tissue Loss After Spinal Cord Injury: Does a Pain-Induced Rise in Blood Pressure Fuel Hemorrhage? Front Syst Neurosci 2022; 15:733056. [PMID: 34975424 PMCID: PMC8714654 DOI: 10.3389/fnsys.2021.733056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Pain (nociceptive) input soon after spinal cord injury (SCI) expands the area of tissue loss (secondary injury) and impairs long-term recovery. Evidence suggests that nociceptive stimulation has this effect because it promotes acute hemorrhage. Disrupting communication with the brain blocks this effect. The current study examined whether rostral systems exacerbate tissue loss because pain input drives an increase in systolic blood pressure (BP) and flow that fuels blood infiltration. Rats received a moderate contusion injury to the lower thoracic (T12) spinal cord. Communication with rostral processes was disrupted by cutting the spinal cord 18 h later at T2. Noxious electrical stimulation (shock) applied to the tail (Experiment 1), or application of the irritant capsaicin to one hind paw (Experiment 2), increased hemorrhage at the site of injury. Shock, but not capsaicin, increased systolic BP and tail blood flow in sham-operated rats. Cutting communication with the brain blocked the shock-induced increase in systolic BP and tail blood flow. Experiment 3 examined the effect of artificially driving a rise in BP with norepinephrine (NE) in animals that received shock. Spinal transection attenuated hemorrhage in vehicle-treated rats. Treatment with NE drove a robust increase in BP and tail blood flow but did not increase the extent of hemorrhage. The results suggest pain input after SCI can engage rostral processes that fuel hemorrhage and drive sustained cardiovascular output. An increase in BP was not, however, necessary or sufficient to drive hemorrhage, implicating other brain-dependent processes.
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Affiliation(s)
- Gizelle N K Fauss
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Misty M Strain
- Department of Cellular and Integrative Physiology, University of Texas Health Science San Antonio, San Antonio, TX, United States
| | | | - Joshua A Reynolds
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Jacob A Davis
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Melissa K Henwood
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Christopher R West
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| | - James W Grau
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
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Belpomme D, Carlo GL, Irigaray P, Carpenter DO, Hardell L, Kundi M, Belyaev I, Havas M, Adlkofer F, Heuser G, Miller AB, Caccamo D, De Luca C, von Klitzing L, Pall ML, Bandara P, Stein Y, Sage C, Soffritti M, Davis D, Moskowitz JM, Mortazavi SMJ, Herbert MR, Moshammer H, Ledoigt G, Turner R, Tweedale A, Muñoz-Calero P, Udasin I, Koppel T, Burgio E, Vorst AV. The Critical Importance of Molecular Biomarkers and Imaging in the Study of Electrohypersensitivity. A Scientific Consensus International Report. Int J Mol Sci 2021; 22:7321. [PMID: 34298941 PMCID: PMC8304862 DOI: 10.3390/ijms22147321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 02/07/2023] Open
Abstract
Clinical research aiming at objectively identifying and characterizing diseases via clinical observations and biological and radiological findings is a critical initial research step when establishing objective diagnostic criteria and treatments. Failure to first define such diagnostic criteria may lead research on pathogenesis and etiology to serious confounding biases and erroneous medical interpretations. This is particularly the case for electrohypersensitivity (EHS) and more particularly for the so-called "provocation tests", which do not investigate the causal origin of EHS but rather the EHS-associated particular environmental intolerance state with hypersensitivity to man-made electromagnetic fields (EMF). However, because those tests depend on multiple EMF-associated physical and biological parameters and have been conducted in patients without having first defined EHS objectively and/or endpoints adequately, they cannot presently be considered to be valid pathogenesis research methodologies. Consequently, the negative results obtained by these tests do not preclude a role of EMF exposure as a symptomatic trigger in EHS patients. Moreover, there is no proof that EHS symptoms or EHS itself are caused by psychosomatic or nocebo effects. This international consensus report pleads for the acknowledgement of EHS as a distinct neuropathological disorder and for its inclusion in the WHO International Classification of Diseases.
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Affiliation(s)
- Dominique Belpomme
- Association for Research Against Cancer (ARTAC), 57/59 rue de la Convention, 75015 Paris, France;
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
| | - George L. Carlo
- The Science and Public Policy Institute, Washington, DC 20006, USA;
| | - Philippe Irigaray
- Association for Research Against Cancer (ARTAC), 57/59 rue de la Convention, 75015 Paris, France;
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
| | - David O. Carpenter
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
- Institute for Health and the Environment, University at Albany, Albany, NY 12222, USA
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Lennart Hardell
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
- The Environment and Cancer Research Foundation, SE-702 17 Örebro, Sweden
| | - Michael Kundi
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (M.K.); (H.M.)
| | - Igor Belyaev
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
- Biomedical Research Center, Slovak Academy of Science, 845 05 Bratislava, Slovakia
| | - Magda Havas
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
- Trent School of the Environment, Trent University, 1600 West Bank Drive, Peterborough, ON K9J 0G2, Canada
| | - Franz Adlkofer
- Verum-Foundation for Behaviour and Environment c/o Regus Center Josephspitalstrasse 15/IV, 80331 München, Germany;
| | - Gunnar Heuser
- Formerly UCLA Medical Center, Department of Medicine, P.O. Box 5066, El Dorado Hills, Los Angeles, CA 95762, USA;
| | - Anthony B. Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S, Canada;
| | - Daniela Caccamo
- Department of Biomedical Sciences, Dental Sciences and Morpho Functional Imaging, Polyclinic Hospital University, 98122 Messina, Italy;
| | - Chiara De Luca
- Department of Registration & Quality Management, Medical & Regulatory Affairs Manager, MEDENA AG, 8910 Affoltern am Albis, Switzerland;
| | - Lebrecht von Klitzing
- Medical Physicist, Institute of Environmental and Medical Physic, D-36466 Wiesenthal, Germany;
| | - Martin L. Pall
- School of Molecular Biosciences, Washington State University, Pullman, WA 99164, USA;
| | - Priyanka Bandara
- Oceania Radiofrequency Scientific Advisory Association (ORSAA), P.O. Box 152, Scarborough, QLD 4020, Australia;
| | - Yael Stein
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, Israel;
- Hadassah Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Jerusalem 91905, Israel
| | - Cindy Sage
- Sage Associates, Montecito, Santa Barbara, CA 93108, USA;
| | - Morando Soffritti
- Istituto Ramazzini, via Libia 13/A, 40138 Bologna, Italy;
- Collegium Ramazzini, Castello di Bentivoglio, via Saliceto, 3, 40010 Bentivoglio, Italy
| | - Devra Davis
- Environmental Health Trust, P.O. Box 58, Teton Village, WY 83025, USA;
| | - Joel M. Moskowitz
- School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - S. M. J. Mortazavi
- Medical Physics and Medical Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz P.O. Box 71348-14336, Iran;
- Ionizing and Non-ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz P.O. Box 71348-14336, Iran
| | - Martha R. Herbert
- A.A. Martinos Centre for Biomedical Imaging, Department of Neurology, MGH, Harvard Medical School, MGH/MIT/Harvard 149 Thirteenth Street, Charlestown, MA 02129, USA;
| | - Hanns Moshammer
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria; (M.K.); (H.M.)
- Department of Hygiene, Karakalpak Medical University, Nukus 230100, Uzbekistan
| | - Gerard Ledoigt
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
| | - Robert Turner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA;
- Clinical Pediatrics and Neurology, School of Medicine, University of South Carolina, Columbia, SC 29209, USA
| | - Anthony Tweedale
- Rebutting Industry Science with Knowledge (R.I.S.K.) Consultancy, Blv. Edmond Machtens 101/34, B-1080 Brussels, Belgium;
| | - Pilar Muñoz-Calero
- Foundation Alborada, Finca el Olivar, Carretera M-600, Km. 32,400, 28690 Brunete, Spain;
| | - Iris Udasin
- EOHSI Clinical Center, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA;
| | - Tarmo Koppel
- AI Institute, University of South Carolina, Columbia, SC 29208, USA;
| | - Ernesto Burgio
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
| | - André Vander Vorst
- European Cancer and Environment Research Institute (ECERI), 1000 Brussels, Belgium; (D.O.C.); (L.H.); (I.B.); (M.H.); (G.L.); (E.B.); (A.V.V.)
- European Microwave Association, Rue Louis de Geer 6, B-1348 Louvain-la-Neuve, Belgium
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3
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Anadani M, Arthur AS, Tsivgoulis G, Simpson KN, Alawieh A, Orabi Y, Goyal N, Alexandrov AV, Maier IL, Psychogios M, Liman J, Brinton D, Swisher CB, Shah S, Inamullah O, Keyrouz S, Kansagra AP, Allen M, Giles JA, Wolfe SQ, Fargen KM, Gory B, De Marini P, Kan P, Nascimento FA, Almallouhi E, Petersen N, Kodali S, Rahman S, Richard S, Spiotta AM. Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study. Ann Neurol 2020; 87:830-839. [DOI: 10.1002/ana.25716] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mohammad Anadani
- Department of NeurosurgeryMedical University of South Carolina Charleston SC USA
- Department of NeurologyMedical University of South Carolina Charleston SC USA
| | - Adam S. Arthur
- Department of NeurologyMedical University of South Carolina Charleston SC USA
| | - Georgios Tsivgoulis
- Department of NeurosurgeryUniversity of Tennessee Health Science Center Memphis TN USA
| | - Kit N. Simpson
- Department of NeurologyAttikon University Hospital, School of Medicine, National and Kapodistrian University of Athens Athens Greece
| | - Ali Alawieh
- Department of NeurosurgeryMedical University of South Carolina Charleston SC USA
| | - Yser Orabi
- Department of NeurologyMedical University of South Carolina Charleston SC USA
| | - Nitin Goyal
- Department of NeurologyUniversity Medical Center Göttingen Göttingen Germany
| | - Andrei V. Alexandrov
- Department of NeurologyUniversity of Tennessee Health Science Center Memphis TN USA
| | - Ilko L. Maier
- Department of NeurologyUniversity Medical Center Göttingen Göttingen Germany
| | | | - Jan Liman
- Department of NeurologyUniversity Medical Center Göttingen Göttingen Germany
| | - Daniel Brinton
- Department of Healthcare Leadership and ManagementMedical University of South Carolina Charleston SC USA
| | | | - Shreyash Shah
- Department of NeurologyDuke University Hospital Durham NC USA
| | - Ovais Inamullah
- Department of NeurologyDuke University Hospital Durham NC USA
| | - Salah Keyrouz
- Department of NeurologyWashington University School of Medicine St Louis MO USA
| | - Akash P. Kansagra
- Department of NeurologyWashington University School of Medicine St Louis MO USA
| | - Michelle Allen
- Department of NeurologyWashington University School of Medicine St Louis MO USA
| | - James A. Giles
- Department of NeurologyWashington University School of Medicine St Louis MO USA
| | - Stacey Q. Wolfe
- Department of NeurosurgeryWake Forest University Winston‐Salem NC USA
| | - Kyle M. Fargen
- Department of NeurosurgeryWake Forest University Winston‐Salem NC USA
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic NeuroradiologyUniversity Hospital of Nancy Nancy France
| | - Pierre De Marini
- Department of Diagnostic and Therapeutic NeuroradiologyUniversity Hospital of Nancy Nancy France
| | - Peter Kan
- Department of NeurosurgeryBaylor College of Medicine Houston TX USA
| | | | - Eyad Almallouhi
- Department of NeurologyMedical University of South Carolina Charleston SC USA
| | - Nils Petersen
- Department of NeurologyYale New Haven Hospital New Haven CT USA
| | - Sreeja Kodali
- Department of NeurologyYale New Haven Hospital New Haven CT USA
| | - Shareena Rahman
- Department of NeurologyDuke University Hospital Durham NC USA
| | - Sébastien Richard
- Department of NeurologyStroke Unit, University Hospital of Nancy Nancy France
| | - Alejandro M. Spiotta
- Department of NeurosurgeryMedical University of South Carolina Charleston SC USA
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4
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McCourt R, Gould B, Kate M, Asdaghi N, Kosior JC, Coutts S, Hill MD, Demchuk A, Jeerakathil T, Emery D, Butcher KS. Blood-brain barrier compromise does not predict perihematoma edema growth in intracerebral hemorrhage. Stroke 2015; 46:954-60. [PMID: 25700288 DOI: 10.1161/strokeaha.114.007544] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There are limited data on the extent of blood-brain barrier (BBB) compromise in acute intracerebral hemorrhage patients. We tested the hypotheses that BBB compromise measured with permeability-surface area product (PS) is increased in the perihematoma region and predicts perihematoma edema growth in acute intracerebral hemorrhage patients. METHODS Patients were randomized within 24 hours of symptom onset to a systolic blood pressure (SBP) treatment of <150 (n=26) or <180 mm Hg (n=27). Permeability maps were generated using computed tomographic perfusion source data acquired 2 hours after randomization, and mean PS was measured in the hematoma, perihematoma, and hemispheric regions. Hematoma and edema volumes were measured on noncontrast computed tomographic scans obtained at baseline, 2 hours and 24 hours after randomization. RESULTS Patients were randomized at a median (interquartile range) time of 9.3 hours (14.1) from symptom onset. Treatment groups were balanced with respect to baseline SBP and hematoma volume. Perihematoma PS (5.1±2.4 mL/100 mL per minute) was higher than PS in contralateral regions (3.6±1.7 mL/100 mL per minute; P<0.001). Relative edema growth (0-24 hours) was not predicted by perihematoma PS (β=-0.192 [-0.06 to 0.01]) or SBP change (β=-0.092 [-0.002 to 0.001]). SBP was lower in the <150 target group (139.2±22.1 mm Hg) than in the <180 group (159.7±12.3 mm Hg; P<0.0001). Perihematoma PS was not different between groups (4.9±2.4 mL/100 mL per minute for the <150 group, 5.3±2.4 mL/100 mL per minute for the <180 group; P=0.51). CONCLUSIONS BBB permeability is focally increased in the hematoma and perihematoma regions of acute intracerebral hemorrhage patients. BBB compromise does not predict acute perihematoma edema volume or edema growth. SBP reduction does not affect BBB permeability. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00963976.
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Affiliation(s)
- Rebecca McCourt
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Bronwen Gould
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Mahesh Kate
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Negar Asdaghi
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Jayme C Kosior
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Shelagh Coutts
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Michael D Hill
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Andrew Demchuk
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Thomas Jeerakathil
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Derek Emery
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.)
| | - Kenneth S Butcher
- From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.).
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5
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Ionov ID. Self-Amplification of Nigral Degeneration in Parkinson's Disease: A Hypothesis. Int J Neurosci 2009; 118:1763-80. [DOI: 10.1080/00207450802330561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Caceres MJ, Schleien CL, Kuluz JW, Gelman B, Dietrich WD. Early endothelial damage and leukocyte accumulation in piglet brains following cardiac arrest. Acta Neuropathol 1995; 90:582-91. [PMID: 8615078 DOI: 10.1007/bf00318570] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study examined the early microvascular and neuronal consequences of cardiac arrest and resuscitation in piglets. We hypothesized that early morphological changes occur after cardiac arrest and reperfusion, and that these findings are partly caused by post-resuscitation hypertension. Three groups of normothermic piglets (37.5 degrees - 38.5 degrees C) were investigated: group 1, non-ischemic time controls; group 2, piglets undergoing 8 min of cardiac arrest by ventricular fibrillation, 6 min of cardiopulmonary resuscitation (CPR) and 4 h of reperfusion; and group 3, non-ischemic hypertensive controls, receiving 6 min of CPR after only 10 s of cardiac arrest followed by 4-h survival. Immediately following resuscitation, acute hypertension occurred with peak systolic pressure equal to 197 +/- 15 mm Hg usually lasting less than 10 min. In reacted vibratome sections, isolated foci of extravasated horseradish peroxidase were noted throughout the brain within surface cortical layers and around penetrating vessels in group 2. Stained plastic sections of leaky sites demonstrated variable degrees of tissue injury. While many sections were unremarkable except for luminal red blood cells and leukocytes, other specimens contained abnormal neurons, some appearing irreversibly injured. The number of vessels containing leukocytes was higher in group 2 than in controls (3.8 +/- 0.6% vs 1.4 +/- 0.4% of vessels, P < 0.05). Evidence for irreversible neuronal injury was only seen in group 2. Endothelial vacuolization was higher in groups 2 and 3 than in group 1 (P < 0.05). Ultrastructural examination of leaky sites identified mononuclear and polymorphonuclear leukocytes adhering to the endothelium of venules and capillaries only in group 2. The early appearance of luminal leukocytes in ischemic animals indicates that these cells may contribute to the genesis of ischemia reperfusion injury in this model. In both groups 2 and 3 endothelial cells demonstrated vacuolation and luminal discontinuities with evidence of perivascular astrocytic swelling. Widespread microvascular and neuronal damage is present as early as 4 h after cardiac arrest in infant piglets. Hypertension appears to play a role in the production of some of the endothelial changes.
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Affiliation(s)
- M J Caceres
- Department of Pediatrics (R-131), University of Miami School of Medicine FL 33101, USA
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7
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Felding M, Cold GE, Jacobsen CJ, Stjernholm P, Voss K. The effect of ketanserin upon postoperative blood pressure, cerebral blood flow and oxygen metabolism in patients subjected to craniotomy for cerebral tumours. Acta Anaesthesiol Scand 1995; 39:582-5. [PMID: 7572004 DOI: 10.1111/j.1399-6576.1995.tb04131.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hypertension and cerebral hyperperfusion are often seen in the immediate postoperative period after craniotomy for supratentorial tumours. This study was performed to evaluate the effect of ketanserin, given at the end of the peroperative period, upon cerebral blood flow (CBF), and cerebral metabolic rate of oxygen (CMRO2) before extubation. Mean arterial blood pressure (MABP), cerebral arterio-venous oxygen content difference (AVDO2), PaO2, and PaCO2 were repeatedly measured during the operation, and 180 minutes after extubation. Ten patients were included in this study. The results were compared to those from a recent study in which ten patients served as control. All patients were anaesthetized with thiopentone, fentanyl, nitrous oxide 67%, halothane 0.5% anesthesia. Ten patients were given ketanserin 10-20 mg (mean 18.5 mg) before extubation. There was no significant difference in CBF- and CMRO2 values between the two groups. During the period between closure of the dura and 5 minutes after extubation, an increase in MABP was observed in the control group (P < 0.05) but not in the ketanserin group. During the same period, a decrease in AVDO2 was observed in both groups (P < 0.05) and during the next 10 minutes an increase was observed. However, no difference in AVDO2 values between the two groups was found. These findings suggest that peroperative treatment with ketanserin reduces postoperative hypertension without influencing the cerebral blood flow or metabolism.
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Affiliation(s)
- M Felding
- Department of Neuroanesthesia, Arhus Kommunehospital, Denmark
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8
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Felding M, Jakobsen CJ, Cold GE, Davidsen B, Jensen K. The effect of metoprolol upon blood pressure, cerebral blood flow and oxygen consumption in patients subjected to craniotomy for cerebral tumours. Acta Anaesthesiol Scand 1994; 38:271-5. [PMID: 8023668 DOI: 10.1111/j.1399-6576.1994.tb03888.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hypertension and cerebral hyperperfusion are often seen in the immediate postoperative period after craniotomy for supratentorial tumours. Metoprolol is known to attenuate the postoperative hypertensive response after hypotensive anaesthesia and this study was carried out to evaluate the effect of metoprolol on cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) before extubation and cerebral arteriovenous oxygen content difference (AVDO2), mean arterial blood pressure (MABP), PaO2 and PaCO2 in a 180-min period after extubation. Twenty patients anaesthetized with thiopentone, fentanyl, nitrous oxide 67%, and halothane 0.5% were randomized to receive intravenous metoprolol or placebo at the end of the peroperative period. There were no significant differences in CBF- and CMRO2 values between the two groups. In the period between closure of the dura and 5 min after extubation, an increase in MABP was observed in the control group (P < 0.05), but not in the metoprolol group. During the same period a decrease in AVDO2 was observed in both groups (P < 0.05); during the next 10 min an increase was observed, but with no difference in AVDO2 values between the groups. A higher level of PaO2 in the metoprolol group was observed in the postoperative period. These findings suggest that peroperative treatment with metoprolol reduces postoperative MABP but does not influence the cerebral blood flow and metabolism.
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Affiliation(s)
- M Felding
- Department of Neuroanaesthesia, Arhus University Hospital, Denmark
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9
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Abstract
The relationship between systemic arterial pressure (SAP) and neocortical microcirculatory blood-flow (CBF) in areas of focal cerebral ischemia was studied in 15 spontaneously hypertensive rats (SHRs) anesthetized with halothane (0.5%). Ischemia was induced by ipsilateral middle cerebral artery/common carotid artery occlusion and CBF was monitored continuously in the ischemic territory using laser-Doppler flowmetry during manipulation of SAP with I-norepinephrine (hypertension) or nitroprusside (hypotension). In eight SHRs not subjected to focal ischemia, we demonstrated that 0.5% halothane and the surgical manipulations did not impair autoregulation. Autoregulation was partly preserved in ischemic brain tissue with a CBF of greater than 30% of preocclusion values. In areas where ischemic CBF was less than 30% of preocclusion values, autoregulation was completely lost. Changes in SAP had a greater influence on CBF in tissue areas where CBF ranged from 15 to 30% of baseline (9% change in CBF with each 10% change in SAP) than in areas where CBF was less than 15% of baseline (6% change in CBF with each 10% change in SAP). These findings demonstrate that the relationship between CBF and SAP in areas of focal ischemia is highly dependent on the severity of ischemia. Autoregulation is lost in a gradual manner until CBF falls below 30% of normal. In areas without autoregulation, the slope of the CBF/SAP relationship is inversely related to the degree of ischemia.
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Affiliation(s)
- U Dirnagl
- Department of Neurology and Neuroscience, Cornell University Medical College, New York, New York
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10
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Asmussen J, Elkjaer S, Cold G, Herlevsen P, Melsen NC, Engberg M, Hove B, Astrup J. Per- and postoperative changes in the arterio-venous oxygen content difference (AVDO2) in patients subjected to craniotomy for cerebral tumours. Acta Neurochir (Wien) 1989; 101:9-17. [PMID: 2603775 DOI: 10.1007/bf01410062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sixteen patients with supratentorial cerebral tumours were subjected to craniotomy under thiopentone, fentanyl, nitrous oxide, halothane anaesthesia during moderate hypocapnia (PaCO2 level 4.0 kPa). The arterio-venous oxygen content difference (AVDO2) was measured peroperatively, and repeatedly during the first three hours after extubation. Peroperatively the level of AVDO2 averaged 8.0 vol% during opening of the dura, and decreased to 7.0 vol% during closure of the dura (P less than 0.05). Immediately after extubation the AVDO2 decreased to 4.3 vol% (P less than 0.05), and during the next 3 hours a gradual increase to 5.8 vol% (P less than 0.05) was disclosed. In individual cases the postoperative changes in AVDO2 correlated fairly well with changes in mean arterial blood pressure (MABP), but other factors including duration of the operation, age of the patients, size of the tumour, level of PaCO2 and adaptation to prolonged hyperventilation during operation are supposed to be responsible for the low levels of AVDO2 observed in the postoperative period.
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Affiliation(s)
- J Asmussen
- Department of Neuroanaesthesia, Neuroradiology and Neurosurgery, Arhus Kommenehospital, Denmark
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11
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Dutka AJ, Hallenbeck JM, Kochanek P. A brief episode of severe arterial hypertension induces delayed deterioration of brain function and worsens blood flow after transient multifocal cerebral ischemia. Stroke 1987; 18:386-95. [PMID: 3564094 DOI: 10.1161/01.str.18.2.386] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Transient arterial hypertension occurs sporadically following cerebral air embolism and may occur during the acute phase of stroke. This study used an animal model of multifocal cerebral ischemia induced by air embolism and reversed by recompression to assess the effect of induced hypertension on the evoked response recovery, local cerebral blood flow, intracranial pressure, and brain water in 19 anesthetized dogs (Canis familiaris). Six received 0.4 ml of air via the internal carotid artery, 8 received intracarotid air and 10 micrograms/kg norepinephrine to produce transient hypertension, and 5 received intracarotid saline and norepinephrine. The average evoked response recovery in the air-only group was 58.3 +/- 7.7% (mean +/- SEM) of control after 4 hours of recompression; the air plus hypertension group recovery was 15.4 +/- 2.7% (p less than 0.01). The final evoked response in the dogs receiving hypertension alone did not differ from control values. Seven of 8 dogs in the air plus hypertension group had very low blood flows; only 1 of 4 in the air-only group had very low flows. The amount of brain water and the intracranial pressure were not detectably different at the end of treatment among all 3 groups. These results support a role for endothelial damage produced by air and hypertension in potentiating the process of postischemic hypoperfusion.
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