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TCD Diastolic Velocity Decay and Pulsatility Index Increment in PVS Cases

Published online by Cambridge University Press:  23 September 2016

Jesús Perez-Nellar ,
Calixto Machado ,
Claudio E. Scherle  and
Mauricio Chinchilla
Jesús Perez-Nellar
Affiliation:
Hermanos Ameijeiras Hospital, Service of Neurology
Calixto Machado*
Affiliation:
Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, Havana, Cuba
Claudio E. Scherle
Affiliation:
Hermanos Ameijeiras Hospital, Service of Neurology
Mauricio Chinchilla
Affiliation:
Hermanos Ameijeiras Hospital, Service of Neurology
*
Institute of Neurology and Neurosurgery, Apartado Postal 4268, Ciudad de La Habana, 10400, Cuba
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Abstract

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Background:

Functional neuroimaging has provided new insights for assessing cerebral function in persistent vegetative state patients (PVS). Compared to controls, positron emission tomography and single photon emission tomography have shown a substantial reduction of global brain cerebral glucose metabolism and perfusion in PVS. Doppler ultrasonography (TCD) assesses local blood flow velocity and direction in the proximal portions of large intracranial arteries; it is a noninvasive technique, and it can be carried out at the bedside. To date, few studies have applied TCD to study PVS.

Methods:

We assessed intracranial circulation by TCD in five PVS patients. The cause of brain insult was hypoxic encephalopathy in four cases, and the other suffered an embolic cerebral infarct causing a top of the basilar artery syndrome. The sample volume was set at 12 mm; power output and gain settings were maximized as needed. The temporal bone acoustic window was not suitable for intracranial vessel insonation in all patients. As an alternative, the internal carotid artery siphon was assessed by orbital insonation between 55-70 mm.

Results:

Systolic velocity was within a normal range, between 44 and 62 cm/second in all cases. However, the diastolic amplitude was reduced, as well as the end diastolic velocity, and the pulsatility index was increased in all patients.

Conclusions:

We conclude that TCD diastolic velocity decrement and PI augmentation in our cases might be related to uncoupling of cerebral blood flow and cerebral metabolic rate, arising from reduced cerebral glucose consumption and oxygen uptake, after extensive brain injury.

Résumé

RésuméContexte:

La neuroimagerie fonctionnelle a fourni de nouvelles avenues pour l'évaluation de la fonction cérébrale chez les patients en état végétatif persistant (EVP). La tomographie par émission de positons et la tomographie par émission d'un seul photon ont démontré une diminution substantielle du métabolisme et de la perfusion cérébrale du glucose dans tout le cerveau chez les patients en EVP par rapport aux sujets témoins. L'échographie Doppler (ED) évalue la vélocité du flux sanguin local et sa direction dans les portions proximales des grosses artères intracrâniennes. C'est une technique non effractive et elle peut être effectuée au chevet du patient. Cependant peu d'études ont utilisé l'ED pour étudier l'EVP.

Méthodologie:

Nous avons évalué la circulation intracrânienne par ED chez 5 patients en EVP. Une encéphalopathie hypoxique était la cause du dommage cérébral chez 4 patients et l'autre avait subi un infarctus cérébral par embolie à la bifurcation du tronc cérébral (top of the basilar artery syndrome). Le volume de l'échantillon était fixé à 12 mm et le réglage de la puissance de sortie et du gain étaient maximisés au besoin. La fenêtre acoustique de l'os temporal n'était pas propice à l'échographie des vaisseaux intracrâniens chez tous nos patients. Le siphon de la carotide interne a été évalué par échographie orbitaire entre 55-70 mm chez ces patients.

Résultats:

La vélocité systolique était dans l'écart normal, entre 44 et 62 cm par seconde, chez tous les patients. Cependant, l'amplitude diastolique était réduite de même que la vélocité en fin de diastole et l'indice de pulsatilité (IP) était diminué chez tous les patients.

Conclusions:

Nous concluons que la diminution de la vélocité diastolique à l'ED et l'augmentation de l'IP chez nos patients pourraient être reliées à un découplage du flux sanguin cérébral et du taux de métabolisme cérébral suite à une consommation réduite de glucose et d'oxygène au niveau du cerveau après un dommage cérébral important.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 6 , November 2010 , pp. 831 - 836
Copyright
Copyright © The Canadian Journal of Neurological 2010

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