Cerebral Blood Flow Autoregulation Assessment in Patients with Idiopathic Intracranial Hypertension

doi:10.3969/j.issn.1673-5765.2020.11.011

Abstract

Abstract:

Objective To investigate the capacity of cerebral blood flow autoregulation in patients with idiopathic intracranial hypertension (IIH). Methods This study consecutively enrolled patients with IIH from Beijing Tiantan Hospital, Capital Medical University and age-matched health volunteers as control from December 2018 to March 2019. The spontaneous fluctuation in arterial blood pressure and cerebral blood flow velocity were analyzed using transfer function analysis to assess cerebral blood flow autoregulation. Results A total of 10 patients with IIH and 13 control subjects were included. 46 middle cerebral arteries (MCAs) were detected, including 20 MCAs in cerebral hemisphere with high cranial pressure and 26 normal ones. Compared to control group, MCA blood flow in IIH group decreased significantly [(0.64±0.35)%/% vs (0.37±0.20)%/%, P =0.004], the phase of cerebral blood flow in IIH group also declined significantly (58.80±20.86º vs 39.16±23.79º, P =0.005). The rate of cerebral blood flow recovery per second in IIH group was lower than that in control group, but without statistical significance [(26.34±43.29)%/s vs (38.81±20.16)%/s, P =0.240]. Conclusions Cerebral blood flow autoregulation in patients with IIH was significantly impaired.

Key words: Idiopathic intracranial hypertension; Cerebral autoregulation; Transcranial Doppler

摘要：

目的分析特发性颅内压增高（idiopathic intracranial hypertension，IIH）患者脑血流自动调节机能。方法连续入组2018年12月-2019年3月在首都医科大学附属北京天坛医院就诊的IIH患者，并选取年龄匹配的健康志愿者作为对照组。应用传递函数的算法分析TCD显示的大脑中动脉血流速度及动脉血压的自然波动以评估脑血流自动调节机能。结果入组IIH组10例，对照组13例。所有入组者均完成了双侧大脑半球的脑血流自动调节检测，共检测了20个高颅压半球及26个正常对照半球。与对照组相比，IIH组大脑中动脉脑血流增益显著降低[（0.64±0.35）%/% vs（0.37%±0.20）%/%，P =0.004]；相位也显著降低（58.80±20.86°vs 39.16±23.79°，P =0.005），差异有统计学意义。IIH组每秒钟脑血流速度的恢复率较对照更低，但差异尚未达到统计学意义（[ 26.34±43.29）%/s vs（38.81±20.16）%/s，P=0.240]。结论 IIH患者脑血流自动调节机能显著受损。

关键词: 特发性高颅压; 脑血流自动调节; 经颅多普勒超声

CHEN Jie,LIU Jia, DONG Pei, DONG Ke-Hui, MO Da-Peng, WANG Yi-Long, ZHAO Xing-Quan, GONG Xi-Ping. Cerebral Blood Flow Autoregulation Assessment in Patients with Idiopathic Intracranial Hypertension[J]. Chinese Journal of Stroke, 2020, 15(11): 1218-1222.

陈洁，刘嘉，董培，董可辉，莫大鹏，王伊龙，赵性泉，龚浠平. 特发性高颅压患者脑血流自动调节研究[J]. 中国卒中杂志, 2020, 15(11): 1218-1222.

References

[1] MARKEY K A，MOLLAN S P，JENSEN R H，et al.

Understanding idiopathic intracranial hypertension：

mechanisms，management，and future directions[J].

Lancet Neurol，2016，15（1）：78-91.

[2] WAKERLEY B R，MOLLAN S P，SINCLAIR A

J，Idiopathic intracranial hypertension：update on

diagnosis and management[J]. Clin Med（Lond），

2020，20（4）：384-388.

[3] WALL M，GEORGE D. Idiopathic intracranial

hypertension. A prospective study of 50 patients[J].

Brain，1991，114（Pt 1A）：155-180.

[4] PANERAI R B. Cerebral autoregulation：from

models to clinical applications[J]. Cardiovasc Eng，

2008，8（1）：42-59.

[5] BUDOHOSKI K P，CZOSNYKA M，DE RIVA

N，et al. The relationship between cerebral

blood flow autoregulation and cerebrovascular

pressure reactivity after traumatic brain injury[J].

Neurosurgery，2012，71（3）：652-660.

[6] GAO L，SMIELEWSKI P，CZOSNYKA M，et

al. Cerebrovascular signal complexity six hours

after intensive care unit admission correlates with

outcome after severe traumatic brain injury[J]. J

Neurotrauma，2016，33（22）：2011-2018.

[7] JAEGER M，SOEHLE M，SCHUHMANN M U，et

al. Clinical significance of impaired cerebrovascular

autoregulation after severe aneurysmal subarachnoid

hemorrhage[J]. Stroke，2012，43（8）：2097-2101.

[8] LIMA-OLIVEIRA M，SALINET A S M，

NOGUEIRA R C，et al. Intracranial hypertension

and cerebral autoregulation：a systematic review

and meta-analysis[J/OL]. World Neurosurg，2018，

113：110-124[2020-06-25]. https：//doi.org/10.1016/

j.wneu.2018.01.194.

[9] NORDIC Idiopathic Intracranial Hypertension

Study Group Writing Committee，WALL M，

MCDERMOTT M P，et al. Effect of acetazolamide

on visual function in patients with idiopathic

intracranial hypertension and mild visual loss：the

idiopathic intracranial hypertension treatment

trial[J]. JAMA，2014，311（16）：1641-1651.

[10] REINHARD M，GERDS T A，GRABIAK D，et al.

Cerebral dysautoregulation and the risk of ischemic

events in occlusive carotid artery disease[J]. J Neurol，

2008，255（8）：1182-1189.

[11] CHEN J，LIU J，XU W H，et al. Impaired dynamic

cerebral autoregulation and cerebrovascular

reactivity in middle cerebral artery stenosis[J/OL].

PLoS One，2014，9（2）：e88232[2020-06-25]. https：

//doi.org/10. 1371/journal.pone.0088232.

[12] INTHARAKHAM K，BEISHON L，PANERAI R B，

et al. Assessment of cerebral autoregulation in stroke：

a systematic review and meta-analysis of studies at

rest[J]. J Cereb Blood Flow Metab，2019，39（11）：

2105-2116.

[13] PURKAYASTHA S，FADAR O，MEHREGAN A，

et al. Impaired cerebrovascular hemodynamics are

associated with cerebral white matter damage[J]. J

Cereb Blood Flow Metab，2014，34（2）：228-234.

[14] CLAASSEN J A，MEEL-VAN DEN ABEELEN A S，

SIMPSON D M，et al. Transfer function analysis of

dynamic cerebral autoregulation：a white paper from

the International Cerebral Autoregulation Research

Network[J]. J Cereb Blood Flow Metab，2016，36（4）：

665-680.

[15] LIU J，SIMPSON D M，ALLEN R. High

spontaneous fluctuation in arterial blood pressure

improves the assessment of cerebral autoregulation[J].

Physiol Meas，2005，26（5）：725-741.

[16] CHEN J，LIU J，DUAN L，et al. Impaired dynamic

cerebral autoregulation in moyamoya disease[J].

CNS Neurosci Ther，2013，19（8）：638-640.

[17] KRAMER A H，COUILLARD P L，ZYGUN D A，

et al. Continuous assessment of "optimal" cerebral

perfusion pressure in traumatic brain injury：a

cohort study of feasibility，reliability，and relation to

outcome[J]. Neurocrit Care，2019，30（1）：51-61.

[18] FARB R I，VANEK I，SCOTT J N，et al. Idiopathic

intracranial hypertension：the prevalence and

morphology of sinovenous stenosis[J]. Neurology，

2003，60（9）：1418-1424.

[19] LIU K C，STARKE R M，DURST C R，et al. Venous

sinus stenting for reduction of intracranial pressure

in IIH：a prospective pilot study[J]. J Neurosurg，

2017，127（5），1126-1133.

[20] KING J O，MITCHELL P J，THOMSON K R，et

al. Manometry combined with cervical puncture in

idiopathic intracranial hypertension[J]. Neurology，

2002，58（1）：26-30.

[21] SIMISTER R，BOWLER J V，WILSON P L，et al.

Transverse venous sinus stenosis and intracranial

hypertension：evidence for which comes first[J]. J

Neurol，2008，255（4）：601-603.