phenylephrine-hydrochloride and Brain-Ischemia

Oro-pharyngeal dysphagia is frequently present during the acute phase of stroke. The aim of the present study was to evaluate whether the recording of surface EMG using a nasopharyngeal (NP) electrode could be applied to evaluation of pharyngeal muscle activity in acute stroke patients and if this neurophysiological measure is related with clinical assessment of swallowing. Patients were examined and clinical severity was assessed with the National Institute of Health Stroke Scale (NIHSS) score; dysphagia was evaluated through bedside screening test using the Gugging Swallowing Scale (GUSS). Extension of the ischaemic lesion was measured by quantitative score, based on CT scan [Alberta Stroke Programme Early CT Score (ASPECTS)]. We analysed 70 patients; 50 were classified as dysphagic (Dys+), and 20 as non-dysphagic (Dys-). Each participant underwent a surface NP EMG recording performed with a NP electrode, made of a Teflon isolated steel catheter, with a length of 16 cm and a tip diameter of 1.5 mm. The electrode was inserted through the nasal cavity, rotated and positioned approximately 3 mm anteroinferior to the salpingo-palatine fold. At least four consecutive swallowing-induced EMG bursts were recorded and analysed for each participant. Swallowing always induced a repetitive, polyphasic burst of activation of the EMG, lasting around 0.25 to 1 sec, with an amplitude of around 100-600mV. Two parameters of the EMG potentials recorded with the NP electrode were analyzed: duration and amplitude. The duration of the EMG burst was increased in Dys+ patients with a statistically significant difference compared to Dys- patients (p < 0.001). The amplitude was slightly reduced in the Dys+ group, but statistically significant differences were not observed (p = 0,775). Nevertheless, the burst amplitude showed a significant inverse correlation with NIHSS [r(48) = -0.31; p < 0.05] and ASPECTS scores [r(48) = -0.27; p < 0.05], meaning that the burst amplitude progressively reduced with an increase of clinical severity (NIHSS) and topographic extension of brain lesions in CT (ASPECTS). These results suggest that NP recordings can give a semi-quantitative measure of swallowing difficulties originating from pharyngeal dysfunction, in fact, electromyographic findings suggest reduced pharyngeal motility.. La disfagia orofaringea è spesso presente durante la fase acuta di un ictus. Lo scopo di questo lavoro è stato quello di valutare se la registrazione elettromiografica di superficie tramite un elettrodo nasofaringeo può essere impiegata per testare l’attività muscolare del faringe nei pazienti con ictus acuto e se queste misurazioni elettrofisiologiche possono essere correlate con la valutazione clinica della deglutizione. Dal punto di vista clinico la severità del quadro è stata valutata mediante l’utilizzo della scala del National Institute of Health Stroke (NIHSS); la disfagia è stata valutata mediante il test di screening Gugging Swallowing Scale (GUSS); l’estensione della lesione ischemica alla TAC è stata misurata attraverso l’Alberta Stroke Programme Early CT Score (ASPECTS). Abbiamo valutato 70 pazienti di cui 50 disfagici (Dys+), e 20 non disfagici (Dys–). Ciascun partecipante è stato sottoposto a un’elettromiografia di superficie registrata mediante un elettrodo NP costituito da un catetere di Teflon isolato in acciaio (lungo 16 cm e con un diametro in punta di 1,5 mm). L’elettrodo è stato inserito attraverso la cavità nasale, ruotato e posizionato approssimativamente 3 mm antero-inferiormente rispetto alla volta salpingo-palatina. Per ogni partecipante sono state registrate ed analizzate le risposte elettromiografiche di almeno quattro deglutizioni volontarie ripetute. La deglutizione induce sempre all’elettromiografia burst ripetitivi e polifasici di durata compresa fra 0,25 e 1 secondo, con un’ampiezza intorno ai 100-600mV. I disfagici hanno mostrano una maggiore durata del burst rilevato all’elettromiografia rispetto ai non disfagici, con una differenza statisticamente significativa (p < 0,001), ma non hanno mostrano differenze in termini di ampiezza del burst stesso (p = 0,775); quest’ultima invece era inversamente correlata con lo NIHSS score [r(48) = –0,31; p < 0,05)] e con lo ASPECTS score [r(48) = –0,27; p < 0,05]. Questi risultati suggeriscono che le registrazioni nasofaringee possono rappresentare un indice semi-quantitativo delle difficoltà deglutitorie secondarie a disfunzione faringea ed in particolare, i risultati dell’elettromiografia sarebbero indicativi di una ridotta motilità faringea durante la fase acuta di un ictus.

Topics: Aged; Brain Ischemia; Deglutition Disorders; Electromyography; Female; Humans; Male; Middle Aged; Nose; Pharyngeal Muscles; Pharynx; Prospective Studies; Stroke

We studied effects of a temporary bilateral ligation of the internal carotid arteries on the subcortical and cortical structures of the somatosensory system by examining the thalamic input and postsynaptic cortical responses contained in the somatic evoked potentials (SEPs) recorded from the primary somatosensory cortex (SI) of the juvenile piglets in vivo. We predicted that the ligation should differentially affect these structures due to differences in blood supply.. The SEPs between 1 and 3000 Hz were measured in the SI cortex with a multichannel electrode array before, during and after a 20 min bilateral ligation of the internal carotid arteries in the swine under a barbiturate anesthesia.. The ligation differentially affected the thalamic input and the cortical responses contained in the high-frequency signals (HFSs) between 400 and 2000 Hz. The amplitude of the thalamic input did not change, but the amplitudes of the cortical HFS postsynaptic to the thalamic inputs decreased immediately after start of ligation, recovering over the next 30-90 min. The latency showed a small, but significant increase for several minutes after the start of ligation for both the thalamic input and cortical responses. The ligation increased the latency and reduced the amplitude of the peak of the first cortical response in the wideband SEP corresponding to human N20.. The HFS is useful for distinguishing selective effects of the temporary ligation on the subcortical and cortical structures of the somatosensory system. Since the porcine N20 starts after the presynaptic HFS, it was not useful in differentiating thalamic and cortical effects.. The HFS may open a new window in studying the cortical physiology in humans.

Topics: Animals; Brain Ischemia; Carotid Artery, Internal; Cerebrovascular Circulation; Electric Stimulation; Electroencephalography; Evoked Potentials, Somatosensory; Female; Functional Laterality; Ligation; Male; Nose; Receptors, Presynaptic; Somatosensory Cortex; Swine; Thalamus

Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5-year period. The immediate success rate was 93%, with long-term success achieved in 88% of patients. The overall complication rate was 17%, with the long-term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Brain Ischemia; Catheterization, Peripheral; Embolization, Therapeutic; Epistaxis; Female; Follow-Up Studies; Hemiplegia; Humans; Length of Stay; Longitudinal Studies; Male; Maxillary Artery; Middle Aged; Nose; Palate; Polyvinyl Alcohol; Recurrence; Retreatment; Risk Factors; Safety; Sphenoid Bone; Treatment Outcome