Stroke, Vol 19, 963-969, Copyright © 1988 by American Heart Association
EB Ringelstein, C Sievers, S Ecker, PA Schneider and SM Otis
To evaluate the CO2-induced vasomotor reactivity of the cerebral
vasculature, relative changes of blood flow velocity within the middle
cerebral artery were measured by transcranial Doppler ultrasonography
during normocapnia and various degrees of hypercapnia and hypocapnia. We
studied 40 normal individuals and 40 patients with unilateral and 15
patients with bilateral internal carotid artery occlusions. When blood flow
velocity changes as percent of normocapnic values were plotted against
end-tidal CO2 volume percent, a biasymptotic curve (a tangent- hyperbolic
function) gave the best fit of the scattergram. The distance between the
upper and lower asymptotes was defined as cerebral vasomotor reactivity. In
the normal individuals, mean +/- SD vasomotor reactivity was 85.63 +/-
15.96%. In patients with internal carotid artery occlusions, vasomotor
reactivity was significantly lower than normal on both the occluded (mean
45.2%, median 50.4%; p less than 0.0001) and the nonoccluded (mean +/- SD
67.7 + 13.3%, p less than 0.01) sides in the unilateral group and on both
sides (mean +/- SD 36.6 +/- 15.9% and 44.9 +/- 24.6%, p less than 0.0001)
in the bilateral group. The difference between vasomotor reactivity for
symptomatic and asymptomatic unilateral occlusions was also highly
significant (mean 37.6% and 62.9%, p less than 0.006). Vasomotor reactivity
was also significantly lower in patients with low-flow infarctions on
computed tomography than in patients with normal scans (mean +/- SD 36.7
+/- 25% and 60.2 +/- 16.9%, p less than 0.008). A striking association of
low- flow infarctions, ischemic ophthalmopathy, and hypostatic transient
ischemic attacks was found with vasomotor reactivities of less than 34% or
even paradoxical reactions.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions
Department of Neurology, Klinikum RWTH, University Hospital, Aachen, Federal Republic of Germany.
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