Calcitonin gene related peptide induced changes of internal homeostatic body model; translation from TCD studies

Intravenously introduced Calcitonin gene-related peptide (αCGRP) induces CGRP- induced headache (CGRP-IH) as well cerebral and systemic hemodynamic changes detectable with transcranial Dop- pler sonography (TCD). Therefore, elevation of CGRP in the systemic blood can evoked headache in predisposed subjects, especially in migrainours. Thus, increase of CGRP during migraine episode might be source of nociceptive sensation. Following predictive coding and interoception, this could induce painful prediction error and updates the internal homeostatic model, inducing headache, and turn subject into no fit to purpose mode which leads to disability during migraine episode. The CGRP provocation might be used for discrimination of CGRP sensitive from insensitive migraine using TCD and predict CGRP antagonism effect in migraine treatment

Calcitonin gene related peptide induced changes of internal homeostatic body model; translation from TCD studies

Intravenously introduced Calcitonin gene-related peptide (αCGRP) induces CGRP- induced headache (CGRP-IH) as well cerebral and systemic hemodynamic changes detectable with transcranial Dop- pler sonography (TCD). Therefore, elevation of CGRP in the systemic blood can evoked headache in predisposed subjects, especially in migrainours. Thus, increase of CGRP during migraine episode might be source of nociceptive sensation. Following predictive coding and interoception, this could induce painful prediction error and updates the internal homeostatic model, inducing headache, and turn subject into no fit to purpose mode which leads to disability during migraine episode. The CGRP provocation might be used for discrimination of CGRP sensitive from insensitive migraine using TCD and predict CGRP antagonism effect in migraine treatment

Lipidi u krvi i karotidni plak

Increased lipids in the blood could be associated with an increased lipid core of atherosclerotic plaque and plaque echolucency on the B-mode image. The hypothesis that plasma levels of blood lipids predict the echolucency of carotid atherosclerotic plaques on B-mode imaging was tested. A total of 237 outpatients, mean age 62.9±10.2 years, were enrolled in the study. There were 189 symptomatic and 48 asymptomatic patients. All of them underwent duplex sonography of carotid arteries and lipidogram in the last year, and had plaques in common or internal carotid arteries. Other risk factors, i.e. arterial hypertension, diabetes mellitus, aging and gender, were also evaluated. In the model of logistic regression, the type of plaque (hypoechogenic, echogenic) was introduced as a dependent variable, with LDL, HDL and triglycerides as independent variables. The model fitted the data moderately well (r2=0.19, p<0.001). LDL and HDL appeared to be significant predictors (p<0.01). The association of plaque type with arterial hypertension, diabetes mellitus, aging and gender was tested by logistic regression. The model fitted the data moderately well (r2=0.24, p<0.001). Arterial hypertension and age were significant (p<0.01) predictors for echogenic plaques, whereas cigarette smoking was indicative of hypoechogenic plaques (p=0.01). In conclusion, LDL and HDL appeared to be associated with hypoechogenic plaques. LDL showed positive, and HDL negative association. Among other risk factors, aging and arterial hypertension showed positive association with echogenic plaques, whereas cigarette smoking showed positive association with hypoechogenic plaques.Povišeni lipidi u krvi mogli bi biti udruženi s povećanom lipidnom jezgrom aterosklerotskog plaka i eholucencijom plaka na prikazu u B-modu. Ispitana je pretpostavka da plazmatske razine lipida u krvi predskazuju eholucenciju karotidnih aterosklerotskih plakova na prikazu u B-modu. U studiju je bilo uključeno ukupno 237 ambulantnih bolesnika srednje dobi od 62,9±10,2 godina, 189 od njih simptomatskih i 48 asimptomatskih. Svi su bolesnici u protekloj godini podvrgnuti pretrazikarotidnih arterija pomoću dupleks sonografije. Svi su bolesnici imali plakove u skupnoj ili unutarnjoj karotidnoj arteriji i u svih je učinjen lipidogram. Procjenjivani su i drugi rizični čimbenici kao to su arterijska hipertenzija, šećerna bolest, starenje i spol. U model logistične regresije uvedena je vrst plaka (hipoehogeni ili ehogeni) kao zavisna varijabla, uz LDL, HDL i trigliceride kao nezavisne varijable. Model je umjereno dobro odgovarao podacima (r2=0,19; p<0,001). LDL i HDL pokazali su se značajnim predskazateljima (p<0,01). Udruženost vrste plaka s arterijskom hipertenzijom, šećernom bolešću, starenjem i spolom ispitana je logističnom regresijom. Model je umjereno odgovarao podacima (r2=0,24; p<0,001). Arterijska hipertenzija i starosna dob bile su značajni (p<0,01) predskazatelji ehogenih plakova, dok je pušenje ukazivalo na hipoehogene plakove(p=0,01). zaključeno je kako su LDL and HDL udruženi s hipoehogenim plakovima. LDL je pokazao pozitivnu, a HDL negativnu udruženost. Među ostalim čimbenicima rizika starenje i arterijska hipertenzija pokazali su pozitivnu udruženost s ehogenim plakovima, a pušenje pozitivnu udruženost s hipoehogenim plakovima

Karotidna angioplastika s cerebralnom zaštitom

Carotid endarterectomy (CEA) is widely used in the management of high grade carotid stenosis. It is a surgical procedure requiring general anesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It has complications, including stroke, death, cranial nerve palsies, wound hematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in the presence of cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distal internal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anesthesia and carries a lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distal embolization of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intimal hyperplasia. CAS is a relatively new procedure and it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. In Slovenia, we have also started with carotid angioplasty by the study Slovenian Carotid Angioplasty Study (SCAS). According to our initial experience in 17 patients, CAS could gain more importance in stroke prevention with proper selection of patients with brain ischemia and improved cerebral protection during the procedure.Karotidna endarterektomija (CEA) u širokoj je uporabi pri liječenju karotidne stenoze visokog stupnja. Kirurški zahvat obavlja se u općoj anesteziji, a primjenjuje se samo pri oštećenjima na račvištu karotide ili u njegovoj neposrednoj blizini. Komplikacije koje se mogu pojaviti obuhvaćaju moždani udar, smrt, paralizu kranijskih živaca, hematom na mjestu rane i srčane komplikacije. Rizik komplikacija povećan je u bolesnika s recidivirajućom stenozom karotidne arterije nakon CEA, u bolesnika u kojih je primijenjena radioterapija u području vrata te u bolesnika s kardiopulmonalnom bolesti. Nedostatci CEA potaknuli su liječnike da potraže alternativne načine liječenja. Karotidna angioplastika uz postavljanje stenta (CAS) manje je invazivna metoda od CEA. Ona je poglavito prikladna za liječenje recidivirajućih stenoza nakon prethodne CEA te za liječenje stenoze distalnog dijela unutarnje karotidne arterije koja je nedostupna za CEA. CAS ne uzrokuje paralizu kranijskih živaca. Usto, nije nužna opća anestezija, a u bolesnika s teškom kardiopulmonalnom bolesti pobol i smrtnost su manji. U komplikacije CAS pripadaju moždani udar zbog distalne embolizacije plaka ili odvajanja tromba tijekom postupka, nagla okluzija krvne žile zbog tromboze, disekcija ili vazospazam te ponovna stenoza zbog hiperplazije intime. CAS je razmjerno nov postupak, pa je nužno utvrditi njegovu djelotvornost i sigurnost prije nego što se uvede u široku kliničku uporabu. U Sloveniji smo započeli s istraživanjem karotidne angioplastike u okviru projekta “Slovenian Carotid Angioplasty Study (SCAS)”. Prema našim prvim iskustvima u 17 bolesnika, CAS bi se mogao pokazati važnim u prevenciji moždanog udara, uz dobar odabir bolesnika s moždanom ishemijom i uz bolju cerebralnu zaštitu tijekom postupka

Moyamoya sindrom s arteriovenskom fistulom dure nakon ozljede glave

Moyamoya vascular pattern and dural arteriovenous fistula (dAVF) are rare vascular abnormalities and both can be secondary to head trauma. The role of dural angiogenesis in the pathophysiology of vascular malformation is rather unclear. We report a unique case of moyamoya vasculopathy simultaneously associated with dAVF after heavy head trauma. It seems that both moyamoya syndrome and dAVFs are associated with dural angiogenesis induced by head trauma. The interrelationship between vascular abnormalities is complex and unclear.Vaskularna struktura moyamoya i arteriovenska fistula dure (dAVF) su rijetke krvožilne nepravilnosti koje mogu nastati kao posljedica ozljede glave. Uloga duralne angiogeneze u patofiziologiji vaskularne malformacije prilično je nejasna. Opisujemo jedinstven slučaj moyamoya vaskulopatije istodobno udružene s dAVF nakon teške traume glave. Čini se da su i sindrom moyamoya i dAVF udruženi s duralnom angiogenezom izazvanom ozljedom glave. Međuodnos vaskularnih nepravilnosti je složen i nejasan

Associations between cerebral and systemic endothelial function in migraine patients: a post-hoc study

<p>Abstract</p> <p>Background</p> <p>There is a growing interest in the role of the endothelium in migraine. Recently, our group showed differences in endothelial function between the anterior and posterior cerebral circulation in healthy subjects, reduced vasodilatatory capacity of the posterior cerebral circulation and unimpaired systemic endothelial function in migraine patients without comorbidities. However, the relationship between cerebral and systemic endothelial function and the anterior and posterior cerebral endothelial function in migraine patients is still not clear.</p> <p>Methods</p> <p>We compared cerebral and systemic endothelial function through post-hoc linear regression analysis of cerebrovascular reactivity (CVR) to L-arginine between the middle cerebral artery (MCA) and flow-mediated vasodilatation (FMD) of the right brachial artery and the posterior cerebral artery (PCA) and FMD in migraine patients without comorbidities and in healthy subjects. The anterior and posterior cerebral endothelial function was also compared using post-hoc linear regression analysis between CVR to L-arginine in the MCA and the PCA.</p> <p>Results</p> <p>No significant correlation was found between CVR to L-arginine in the MCA and FMD and in the PCA and FMD in migraine patients with aura (p = 0.880 vs. p = 0.682), without aura (p = 0.153 vs. p = 0.179) and in healthy subjects (p = 0.869 vs. p = 0.662). On the other hand, we found a significant correlation between CVR to L-arginine in the MCA and PCA in migraine patients with aura (p = 0.004), without aura (p = 0.001) and in healthy subjects (p = 0.002). Detailed analysis of the linear regression between all migraine patients and healthy subjects did not show any difference in the regression coefficient (slope) (p = 0.382). However, a significant difference in curve elevation (intercept) was found (p = 0.002).</p> <p>Conclusions</p> <p>Our study suggests that the endothelial function in the cerebral and systemic circulation might be different in migraine patients without comorbidities, while that of the anterior and posterior cerebral circulation might be coupled. These results could improve understanding of endothelial function in migraine patients without comorbidities.</p

Enhanced Hemodynamic and Clinical Response to αCGRP in Migraine Patients—A TCD Study

Introduction: Sensitisation of the nervous system in a patient with migraine is supposed to be associated with calcitonin gene-related peptide (CGRP) activity. Therefore, the vascular response to human αCGRP (hαCGRP) could be a surrogate marker for the sensitization. We hypothesize that vascular response to hαCGRP is augmented in a patient with migraine.Methods: Twenty healthy subjects and 20 patients with migraine participated in our study. TCD was used to monitor mean arterial velocity in the middle cerebral artery (vm MCA). Simultaneously, end-tidal CO2 (Et-CO2), mean arterial pressure (MAP), and heart rate (HR) were measured. The reconstruction of the signals was made for basal conditions, during and after CGRP infusion which were compared using statistics.Results: In both groups, we found significant decrease between measurement points of vm MCA and Et-CO2 during and after hαCGRP infusion. MAP did not show significant trends during the infusion, but it was significantly increased after the infusion in migraine patients only. Responses to hαCGRP, defined as differences between two measurement points, were significantly higher for vm MCA and Et-CO2 in patients with migraine. A significant difference between groups was found in MAP response. Significant relationships were found between migraine and vm MCA, Et-CO2, and MAP.Conclusion: In patients with migraine, vm MCA responses to hαCGRP are significantly higher and are associated with CGRP-induced headache which indicates that patients with migraine are more prone to sensitization