Search

Blood flow in the common carotid artery as measured by means of the QFM system of Furuhata in 100 patients with angiographically proven obstructive or occlusive lesions of the internal carotid or middle cerebral artery, was compared with the normal blood flow range in healthy persons of 41 to 70 years of age. Findings were considered to be pathological in 72% of the patient pool. This figure was based on one or more of the standard-value criteria, namely, unilateral flow, bilateral flow, and percentage of the difference between both sides. Pathological findings were thus obtained in 100 per cent of the bilateral and in 90 per cent of the unilateral occlusions, in 53 per cent of the bilateral and in 52 per cent of the unilateral stenoses of the internal carotid artery. In occlusions of the internal carotid artery, no significant correlation between blood flow in the common carotid artery and the presence of an ophthalmic collateral extending beyond the carotid siphon could be established. However, there was a correlation with the diameter of the external carotid artery as well as to the sum total of the cross-sectional areas of its main branches. There was no significant correlation between common carotid blood flow and linear luminar narrowing in stenoses of the internal carotid artery if contralateral pathology was disregarded. Compared with normal flow (7,6 +/- 1,4 ml/sec), the mean flow was reduced in all unilateral stenoses of more than 30 per cent, whereas it was increased in stenoses of less than 30 per cent associated with a contralateral stenosis, and in stenoses of less than 70 per cent associated with a contralateral occlusion of the internal carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of aspirin as a risk factor in the occurrence of intracranial bleeding following head injury was investigated. Chronic subdural hematoma appears to be a suitable model for the evaluation of risk factors in the development of hemorrhage. The most common risk factors found in our study were, apart from age, chronic alcohol abuse (28%), consumption of cumarin-derivates (21%), aspirin (13%), and heparin (5%). A patient undergoing aspirin treatment must be considered at risk of development of chronic subdural hematoma. Aspirin should not be prescribed to patients with post-traumatic headaches.

Using the 16-detector 133Xe-NaCl technique (Novo Cerebrograph) quantitative measurements of regional cerebral blood flow (rCBF) were performed in 13 patients with unilateral carotid obstruction before and after stimulation with 1 g acetazolamide. In all patients resting studies showed no significant difference in hemispheric perfusion and a 47% flow increase after acetazolamide on the side with normal carotid artery. On the obstructed side in 8 patients the hemispheric flow increased equally indicating a sufficient and adequate intracerebral collateral circulation and capacity. In 5 patients a significant redistribution of brain flow occurred with diminished increase on the occluded side. This flow pattern indicates an inadequate vasodilator response and insufficient collateral capacity. The rCBF stimulation test identifies patients with a restricted collateral capacity and these patients could benefit from a surgical treatment.

Bei 14 Patienten mit einer einseitigen Obstruktion der Arteria carotis wurde der regionale CBF vor und nach Stimulation mit 3%iger C02-Einatmung quantitativ erfast. Die Messung der Hirndurchblutung erfolgte mit einem 16-Detektoren-System (Novo Cerebrograph). Unter Ruhebedingungen und Raumluftatmung war bei allen 14 Patienten die Hemispharendurchblutung seitengleich. Unter dem C02-Stimulus erfolgte bei 11 Patienten auf der Seite mit der intakten Blutzufuhr ein deutlicher (uber 6%iger) CBF-Anstieg. Die Analyse der Daten fur die Hemisphare distal der Karotisobstruktion ergab 3 unterschiedliche Verhaltensmuster: 1) Bei 6 Patienten kam es zu einem konkordanten Anstieg der Hirnperfusion in beiden Hemispharen als Ausdruck fur eine intakte Perfusionsreserve; 2) das Auftreten einer Seitendifferenz zuungunsten der befallenen Seite im Stimulationstest (n = 4) deutete auf eine eingeschrankte bis aufgebrauchte Perfusionsreserve und auf einen schlechten Kollateralkreislauf hin; 3) in der dritten Gruppe (beidseitig fehlender Anstieg, n = 4) war eine Kompensation durch den Kollateralkreislauf nicht mehr moglich. Fur die Patienten mit eingeschrankter oder aufgebrauchter Perfusionsreserve sehen wir die Indikation zum operativen Eingriff als gegeben.