International Medical Journal, Vol. 23., Iss. 4, 2017, P. 83−86.
THE STATE OF VENOUS HEMODYNAMICS IN ACUTE HEMISPHERIC ISCHEMIC STROKE
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Cerebrovascular pathology is the most significant among neurological diseases. In its structure, the share of ischemic strokes accounts for up to 80 % of all cases of acute disorders of cerebral circulation. Qualitative and quantitative study of the cerebral blood flow can be done with transcranial duplex and triplex ultrasound scanning. In acute and chronic disorders of cerebral circulation, the venous system of the brain can be included in the pathological process primarily. Hemodynamics with early signs of cerebrovascular insufficiency is manifested by vasoconstrictive disorders, and in severe stages by decrease in pulsation and difficulty in venous outflow from the cranial cavity. If the outflow of blood is difficult, typical for venous stasis microcirculatory disturbances are noted. Long−term venous dyscirculation results in clinical symptoms, leading to a decline in performance and a deterioration in the quality of life of patients. The purpose of our research was to evaluate qualitative as well as quantitative data of venous hemodynamics in patients with acute hemispheric ischemic stroke according to the data of transcranial triplex scanning. The study of cerebral veins was performed with the help of energy and pulsed−wave Doppler modes. When using transcranial triplex scanning, both qualitative and quantitative analysis were performed. Speed parameters of venous blood flow were assessed as well as its phase. The following parameters of venous blood flow were studied: the frequency of visualization of deep cerebral veins as well as the peak of velocity of venous blood−flow. Venous blood flow parameters were compared: frequency of deep cerebral veins visualization, peak velocity in patients with acute hemispheric ischemic stroke, transient ischemic attack, and healthy people. The most frequently visualized veins were examined: vein of Galen, Rosenthal vein, deep medial cerebral and tentorial sinus. It was noted that the frequency of visualization of intracerebral veins on the side of the cerebral infarction increased significantly. There was a significant increase in the last maximum rate of blood flow in the cerebral veins. A direct relationship (r = 0,72) was established between the velocity indices of venous blood flow and severity of ischemic stroke. A significant increase was observed in the phase nature of the spectrum at triplex scanning. Since a significant increase in the peak velocity of venous blood flow in ischemic stroke is evident, a change in its systolic velocity in the main cerebral veins and venous sinuses may be an important criterion for early differential diagnosis of ischemic stroke and other acute disorders of cerebral circulation. Thus, it was found that in ischemic stroke, the frequency of visualization of cerebral veins increases, systolic blood flow velocity in the examined veins increases simultaneously with reduction in the peak systolic velocity in the middle cerebral artery on the side of the stroke.
Key words: transcranial triplex scanning, ischemic stroke, state of venous hemodynamics.