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Age, intracranial pressure, autoregulation, and outcome after brain trauma

Marek Czosnyka, Marcella Balestreri, Luzius Steiner, Piotr Smielewski, Peter J. Hutchinson, Basil Matta, and John D. Pickard

generally, multiple markers that have been shown to be associated with worse outcome after head injury 6, 24, 28 may have a specific age dependency. We sought to investigate a selected subset of brain monitoring variables, focusing on the relationship between brain pressures and blood flow, which possibly contribute to the high incidence of unfavorable outcomes in elderly patients after head trauma. The age dependence of ICP, CPP, blood FV through basal cerebral arteries, and various indices used to describe pressure autoregulation and cerebrovascular reactivity were

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Cerebrovascular moyamoya disease in a 5-year-old girl who underwent interruption of the right common carotid artery in the neonatal period

Case report

Yoshihiko Maeda, Sadahiro Nomura, Tetsu Kurokawa, Hideyuki Ishihara, Kei Harada, Hiroshi Yoneda, Shoichi Kato, Hirosuke Fujisawa, and Michiyasu Suzuki

impaired cerebrovascular reactivity improves spontaneously with time, 30 with the establishment of collateral circulation. 13 After unilateral CCA interruption, collateral circulation develops in 3 ways: 16 via the anterior communicating artery, the posterior communicating artery, and extracranial anastomosis. The existence of extracranial anastomosis in our patient suggests that the anterior communicating artery and posterior communicating artery were insufficient to preserve right hemispheric CBF. The patient had decreased CBF in 2 phases: in infancy and then

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Effect of experimental subarachnoid hemorrhage on the adrenergic innervation of cerebral arteries

Ramiro D. Lobato, Jesús Marín, Mercedes Salaices, Javier Burgos, Fernando Rivilla, and Antonio G. García

, Salaices M , et al : Cerebrovascular reactivity to noradrenaline and serotonin following experimental subarachnoid hemorrhage. J Neurosurg 53 : 480 – 485 , 1980 Lobato RD, Marín J, Salaices M, et al: Cerebrovascular reactivity to noradrenaline and serotonin following experimental subarachnoid hemorrhage. J Neurosurg 53: 480–485, 1980 10.3171/jns.1980.53.4.0480 7. Molinoff PB , Weinshilboum R , Axelrod J : A sensitive enzymatic assay for dopamine-β-hydroxylase. J Pharmacol Exp Ther 178 : 425 – 431

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Abnormal cerebral vasodilation in aneurysmal subarachnoid hemorrhage: use of serial 133Xe cerebral blood flow measurement plus acetazolamide to assess cerebral vasospasm

Yves Roger Tran Dinh, Guillaume Lot, Rabah Benrabah, Oussama Baroudy, Jean Cophignon, and Jacques Seylaz

G , et al : Cerebrovascular reactivity in vivo after experimental subarachnoid hemorrhage. J Cereb Blood Flow Metab Suppl 2 : S235 , 1991 (Abstract) Alborch E, Alabadi A, Torregrosa G, et al: Cerebrovascular reactivity in vivo after experimental subarachnoid hemorrhage. J Cereb Blood Flow Metab Suppl 2: S235, 1991 (Abstract) 2. Debdi M , Seylaz J , Sercombe R : Early changes in rabbit cerebral artery reactivity after subarachnoid hemorrhage. Stroke 23 : 1154 – 1162 , 1992 Debdi M

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Cerebral hemodynamic impairment after aneurysmal subarachnoid hemorrhage as evaluated using transcranial Doppler ultrasonography: relationship to delayed cerebral ischemia and clinical outcome

Tõnu Rätsep and Toomas Asser

aneurysmal subarachnoid haemorrhage using acetazolamide-activated 123I-IMP SPECT. Acta Neurochir 123 : 125 – 128 , 1993 Kimura T, Shinoda J, Funakoshi T: Prediction of cerebral infarction due to vasospasm following aneurysmal subarachnoid haemorrhage using acetazolamide-activated 123I-IMP SPECT. Acta Neurochir 123: 125–128, 1993 10.1007/BF01401867 26. Kleiser B , Widder B : Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke 23 : 171 – 174 , 1992 Kleiser B, Widder B: Course of

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Cerebral hemodynamics as a predictor of stroke in adult patients with moyamoya disease: a prospective observational study

Gregory J. Zipfel, James Sagar, J. Phillip Miller, Tom O. Videen, Robert L. Grubb Jr., Ralph G. Dacey Jr., and Colin P. Derdeyn

typical moyamoya disease? . Cerebrovasc Dis 26 : 244 – 249 , 2008 10.1159/000147451 22 Silvestrini M , Troisi E , Matteis M , Cupini LM , Caltagirone C : Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis . Stroke 27 : 1970 – 1973 , 1996 10.1161/01.STR.27.11.1970 23 Smoker WR , Biller J , Hingtgen WL , Adams HP Jr , Toffol GJ : Angiography of nonhemorrhagic cerebral infarction in young adults . Stroke 18 : 708 – 711 , 1987 10.1161/01.STR.18.4.708 24

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The Extracranial–Intracranial Bypass Trial: implications for future investigations

Matthew C. Garrett, Ricardo J. Komotar, Maxwell B. Merkow, Robert M. Starke, Marc L. Otten, and E. Sander Connolly

response) instead of stroke and mortality rates. Improved postoperative stroke rates were reported in only 4 of these case series, and each used the preoperative stroke rate as a control. The second objection was the lack of an appropriate control group. Using pre- and postoperative data is unreliable because the natural course of cerebrovascular reactivity is highly variable, and numerous investigators have reported spontaneous improvement in many patients with impaired cerebrovascular reactivity. 16 , 46 , 50 Third, case studies carry a strong publication bias with

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Clinical factors influencing the development of extracranial-intracranial bypass graft for steno-occlusive cerebrovascular disease

Shunsuke Nomura, Koji Yamaguchi, Tatsuya Ishikawa, Akitsugu Kawashima, Yoshikazu Okada, and Takakazu Kawamata

and were scheduled for postoperative follow-ups at other clinics. Surgical Indication for ECIC Bypass The indications for ECIC bypass were based on the overall evaluation including symptoms, hemodynamic instability, and resistance to medication, basically referring to the JET criteria. Cerebral blood flow (CBF) was measured using cold xenon-CT, and cerebrovascular reactivity (CVR) was measured via the acetazolamide loading test with an increase in CBF defined as the percentage increase in CBF over resting CBF, as previously described. 12 Surgical Procedures and

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Asymmetry of pressure autoregulation after traumatic brain injury

Eric A. Schmidt, Marek Czosnyka, Luzius A. Steiner, Marcella Balestreri, Piotr Smielewski, Stefan K. Piechnik, Basil F. Matta, and John D. Pickard

and poor outcome. Interestingly, outcome seems to correlate more strongly with asymmetry of autoregulation than with global autoregulation. As shown in Fig. 2 , impairment and asymmetry of autoregulation are two overlapping and probably interdependent phenomena. Both represent an inadequate cerebrovascular reactivity. Whether a patient suffering from asymmetrical autoregulation improves in response to our current clinical management is an important issue that should be further investigated. Asymmetry of Autoregulation and Clinical Management The current CPP

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Oral Presentations 2016 AANS Annual Scientific Meeting Chicago, IL • April 30–May 4, 2016

Published online April 1, 2016; DOI: 10.3171/2016.4.JNS.AANS2016abstracts

for the Assessment of Neuropsychological Status (RBANS) was employed to assess cognitive function before, one week and three months after CEA/CAS. Using [123]I-IMP-SPECT, cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were quantitatively measured before CEA/CAS. Multivariate analysis was performed to evaluate the predictors to affect cognitive function in them. Results: Before CEA/CAS, total RBANS score in 62 patients was significant lower than the age-matched controls. Total RBANS scores significantly improved in 17 patients