Transient monocular visual loss due to multiple CNS vascular pathology: report of two cases

BACKGROUND: The frequency of the transient monocular visual loss (TMVL), lasting minutes or longer, varies from a single to many episodes, which are usually followed by complete recovery of vision. TMVL is related most commonly o occlusive carotid disease. The therapy of patients with TMCL is divided into surgical and medical.CASE1: A55-year-old female was admitted to the clinic, with 4 months history of TMVL of the right eye, lasting 2-3 minutes, followed by complete recovery. Neuro-ophthalmological examination was normal. Neuro imaging investigations revealed proximal part right internal carotid artery (ICA) stenosis of 70%, left ICA stenosis of 40%, King-King in the middle segment of ICA, causing stenosis of 14%, and incidental aneurysms of the intracranial part of right ICA andin M2 segment of right middle cerebral artery.CASE2: A 74-year-old female was admitted to the clinic, with 1 year history of TMVL of the right eye, lasting 4-5 minutes, followed by complete recovery. Neuro-ophthalmological examination was normal. Duplex scaning showed hemodynamically significant stenosis of the right ICA, with King-Kingintheleft. MRI reveale diffuse vascular pathology.CONCLUSION: These cases demonstrated a co-occurrence of hemodynamically significant carotid artery occlusion with multiple or diffuse vascular pathology in patients with TMVL. We suggest that the detailed history, neuro-ophthalmological, and neuroimaging examinations might be useful to determine the correct etiologic diagnosis and discuss the most effective therapeutic strategy in TMVL patients.Scripta Scientifica Medica 2011;43(2):83-8

CLINICAL AND NEUROPHYSIOLOGICAL CORRELATION IN PATIENTS WITH ISCHAEMIC CEREBROVASCULAR DISEASE

The aim of this study is to objectify the functional state of the brain in Ctnegative cases with clinical diagnosis of acute cerebrovascular disease (CVD). The CT scan, cerebral SPECT, brainstem auditory evoked potential (BAEP) and EEG with quantitative analysis (qEEG) were performed in 20 patients with ischaemic CVD. Of them, 6 were with transitory ischaemic attack (TIA), 8 with ischaemic stroke (IS) in the territory of the middle cerebral artery and 6 with brainstem infarction (BI). The zones with increased slow-wave activity described by the brain maps showed a good correlation (r=0,47) with the revealed decreased radiotracer uptake. The investigation of brain perfusion by SPECT alone cannot objectify the brainstem stroke. In these cases, the data from BAEP can help the topical diagnosis. Our results confirm the clinical importance of the qEEG for diagnosis of acute CVD, especially in relation with other electrophysiological and neuroimaging methods

The continuum of spreading depolarizations in acute cortical lesion development: Examining Leao's legacy.

A modern understanding of how cerebral cortical lesions develop after acute brain injury is based on Aristides Leao's historic discoveries of spreading depression and asphyxial/anoxic depolarization. Treated as separate entities for decades, we now appreciate that these events define a continuum of spreading mass depolarizations, a concept that is central to understanding their pathologic effects. Within minutes of acute severe ischemia, the onset of persistent depolarization triggers the breakdown of ion homeostasis and development of cytotoxic edema. These persistent changes are diagnosed as diffusion restriction in magnetic resonance imaging and define the ischemic core. In delayed lesion growth, transient spreading depolarizations arise spontaneously in the ischemic penumbra and induce further persistent depolarization and excitotoxic damage, progressively expanding the ischemic core. The causal role of these waves in lesion development has been proven by real-time monitoring of electrophysiology, blood flow, and cytotoxic edema. The spreading depolarization continuum further applies to other models of acute cortical lesions, suggesting that it is a universal principle of cortical lesion development. These pathophysiologic concepts establish a working hypothesis for translation to human disease, where complex patterns of depolarizations are observed in acute brain injury and appear to mediate and signal ongoing secondary damage

Search for excess showers from Crab Nebula

The arrival directions of muon poor showers registrated in the Tien Shan experiment during an effective running time about I,8.IO(4)h were analyzed. It is shown that there is a significant excess of these showers coming the direction of Crab Nebula

Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome

Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a continuous positive airway pressure of 40 cm H2O for 40 sec. The efficacy of the RM was assessed 5 min later. Patients were identified as responders if PaO2/FiO2 increased by >20% above the baseline. EVLWI was assessed by transpulmonary thermodilution before the RM, and patients were divided into groups of low EVLWI (<10 mL/kg) and high EVLWI (≥10 mL/kg). Results. EVLWI was increased in 12 patients. Following RM, PaO2/FiO2 increased by 33 (4–65) % in the patients with low EVLWI, whereas those in the high EVLWI group experienced a change by only −1((−13)–(+5)) % (P = 0.035). Conclusion. In ARDS, the response to a recruitment maneuver might be related to the severity of pulmonary edema. In patients with incresed EVLWI, the recruitment maneuver is less effective