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2019, vol. 76, br. 3, str. 307-312
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Hipoplazija ipsilateralne unutrašnje jugularne vene je udružena sa lošijim ishodom akutnog moždanog udara u prednjoj cirkulaciji
Hypoplasia of the ipsilateral internal jugular vein is associated with worse outcome in acute anterior circulation stroke
aSpecial Hospital for Cerebrovascular Diseases 'Sveti Sava', Belgrade bVojnomedicinska akademija, Klinika za neurologiju, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
e-adresa: mirjanavuk@yahoo.com
Sažetak
Uvod/Cilj. Poremećaj odvođenja venske krvi iz mozga dovodi do cerebralne venske kongestije, povećanja intrakranijalnog pritiska i pada cerebralnog perfuzionog pritiska. Tačna uloga cerebralnog venskog sistema u akutnom moždanom udaru još uvek nije dovoljo poznata. Glavni izvodni put krvi iz mozga, gornjeg dela lica i vrata su unutrašnje jugularne vene (VJI). Urođene anomalije VJI remete odvođenje venske krvi iz mozga, što dovodi do kongestije u venskom sistemu mozga. Cilj ove studije je bio da utvrdi povezanost između hipolazije istostrane VJI i kliničkog ishoda akutnog ishemijskog moždanog udara (AIMU) u prednjoj cirkulaciji. Metode. Ova prospektivna studija slučaja obuhvatila je bolesnike sa AIMU u prednjoj cirkulaciji i jednostranom hipoplazijom istostrane VJI prema ultrasonografskim kriterijumima. U studiju su slučajnim izborom bila uključena 74 bolesnika sa AIMU u prednjoj cirkulaciji koji su hospitalizovani u Specijalnoj bolnici za cerebrovaskularne bolesti 'Sveti Sava' u Beogradu, od septembra 2015 do kraja januara 2016. Kod svih bolesnika je ultrazvučnim pregledom određivan dijametar VJI. Težina neurološkog deficita na prijemu procenjivana je pomoću National Institutes of Health Stroke Scale (NIHSS). Klinički ishod bolesti procenjivan je preko modifikovanog Rankin Skora (mRS) od 0 do 6, na dan otpusta. Dobar i loš ishod su definisani preko mRS skora. Skor 0-2 je smatran dobrim, dok je 3-6 smatran lošim. Rezultati. Istostrana hipoplastična VJI dijagnostikovana je kod 13 (17,6%) bolesnika sa AIMU u prednjoj cirkulaciji. U ovoj grupi devet (69,2%) bolesnika imalo je mRS ≥ 3. Od preostala četiri bolesnika sa mRS ≤ 2, tri su imala obostranu hipoplaziju VJI, dok je četvrti bolesnik imao užu VJI koja nije ispunjavala ultrazvučne kriterijume za hipoplaziju VJI. Zaključak. Bolesnici sa akutnim infarktom mozga u prednjoj cirkulaciji sa jednostranom hipoplazijom istostrane VJI (na strani infarkta mozga) imaju lošiji ishod u odnosu na bolesnike sa obostranom hipoplazijom VJI.
Abstract
Background/Aim. Disruption of cerebral venous blood drainage leads to cerebral venous congestion, an increase in intracranial pressure and decrease of the cerebral perfusion pressure. The exact role of the cerebral venous circulation in acute stroke is not yet known. The main blood drainage from the brain and the superficial parts of the face and neck is drained by a paired internal jugular vein (IJV). Congenital anomalies of IJV may disrupt the blood collection from the brain, which leads to congestion of the cerebral venous circulation. The aim of our study was to determine the association between the hypoplastic ipsilateral IJV and clinical outcome of patients with acute ischemic anterior circulation stroke. Methods. This prospective case series study involved the patients with the anterior circulation stroke and ultrasonographic criteria for unilateral hypoplasia of the ipsilateral IJV. Data from the 74 consecutive patients with acute anterior circulation stroke admitted to the Special Hospital for Cerebrovascular Diseases 'Sveti Sava', Belgrade, from September 2015 to January 2016 were included. Ultrasonography of IJV diameter and the collection of the hemodynamic data were performed in all patients. Neurological deficits on admission were evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. The clinical outcome was assessed using the modified Rankin Scale (mRS) score (from 0 to 6) at 30 days or at discharge, whichever occurred sooner. Good and poor outcomes were defined as an mRS score of 0-2 and 3-6, respectively. Results. Ipsilateral hypoplastic IJV was diagnosed in 13 (17.6%) patients with anterior circulation stroke. In this group, 9 stroke patients (69.2%) had mRS ≥ 3. Of the remaining 4 patients with mRS ≤ 2, three had bilateral hypoplasia of IJV and one patient had smaller diameter of the IJV, but did not fulfill the ultrasonographic criteria for hypoplastic venous anomaly. Conclusions. In our case, a series of the patients with anterior circulation stroke with ultrasonographic criteria for unilateral hypoplasia of the ipsilateral IJV (on stroke side) have worse clinical outcome compared with the patients with bilateral hypoplasia.
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Reference
|
|
  
|
Banks, J.L., Marotta, C.A. (2007) Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials. Stroke, 38(3): 1091-1096
|
|
|
Baron, J.-C. (2010) Perfusion Thresholds in Human Cerebral Ischemia: Historical Perspective and Therapeutic Implications. Cerebrovascular Diseases, 11(1): 2-8
|
|
|
Bateman, G. (2002) Pulse-wave encephalopathy: a comparative study of the hydrodynamics of leukoaraiosis and normal-pressure hydrocephalus. Neuroradiology, 44(9): 740-748
|
|
|
Bateman, G.A. (2000) Vascular compliance in normal pressure hydrocephalus. AJNR Am J Neuroradiol, 21(9): 1574-85
|
|
|
Bower, S., Vyas, S., Campbell, S., Nicolaides, K. H. (2003) Color Doppler imaging of the uterine artery in pregnancy: normal ranges of impedance to blood flow, mean velocity and volume of flow. Ultrasound in Obstetrics and Gynecology, 2(4): 261-265
|
|
|
Chung, C., Lin, Y., Chao, A., Lin, S., Chen, Y., Wang, Y., Hu, H. (2010) Jugular Venous Hemodynamic Changes with Aging. Ultrasound in Medicine & Biology, 36(11): 1776-1782
|
|
|
Doepp, F., Schreiber, S.J., von Münster, T., Rademacher, J., Klingebiel, R., Valdueza, J.M. (2004) How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns. Neuroradiology, 46(7): 565-570
|
|
|
Gotoh, M., Ohmoto, T., Kuyama, H. (1993) Experimental study of venous circulatory disturbance by dural sinus occlusion. Acta Neurochirurgica, 124(2-4): 120-126
|
|
|
Kasner, S.E. (2006) Clinical interpretation and use of stroke scales. Lancet Neurology, 5(7): 603-612
|
|
|
Krsmanović, Ž., Živković, M., Lepić, T., Stanković, A., Raičević, R., Dinčić, E. (2013) Small internal jugular veins with restricted outflow are associated with severe multiple sclerosis: a sonographer-blinded, case-control ultrasound study. BMC Neurology, 13(1):
|
|
|
Lichtenstein, D., Saïfi, R., Augarde, R., Prin, S., Schmitt, J.M., Page, B., Pipien, I., Jardin, F. (2001) The internal jugular veins are asymmetric. Usefulness of ultrasound before catheterization. Intensive Care Medicine, 27(1): 301-305
|
|
1 
|
Lin, B.S., Kong, C.W., Tarng, D.C., Huang, T.P., Tang, G.J. (1998) Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasonographic survey in uraemic patients. Nephrol Dial Transplant, 13(1): 134-8
|
|
|
Malferrari, G., Zedde, M., Prati, P. (2014) Neurosonological Evaluation of Cerebral Venous Outflow. Milano: Springer Science and Business Media LLC
|
|
|
Mucke, J., Möhlenbruch, M., Kickingereder, P., Kieslich, P.J., Bäumer, P., Gumbinger, C., Purrucker, J., Mundiyanapurath, S., Schlemmer, H., Bendszus, M., Radbruch, A. (2015) Asymmetry of Deep Medullary Veins on Susceptibility Weighted MRI in Patients with Acute MCA Stroke Is Associated with Poor Outcome. PLoS One, 10(4): e0120801
|
|
1
|
Paulson, O.B., Strandgaard, S., Edvinsson, L. (1990) Cerebral autoregulation. Cerebrovasc Brain Metab Rev, 2(2): 161-92
|
|
|
Pittock, S.J., Meldrum, D., Hardiman, O., Thornton, J., Brennan, P., Moroney, J.T. (2003) The Oxfordshire Community Stroke Project classification: Correlation with imaging, associated complications, and prediction of outcome in acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases, 12(1): 1-7
|
|
|
Samy Modeliar, S., Sevestre, M., de Cagny, B., Slama, M. (2008) Ultrasound evaluation of central veinsin the intensive care unit:effects of dynamic manoeuvres. Intensive Care Medicine, 34(2): 333-338
|
|
|
Seoane, E., Rhoton, A.L. (1999) Compression of the internal jugular vein by the transverse process of the atlas as the cause of cerebellar hemorrhage after supratentorial craniotomy. Surgical Neurology, 51(5): 500-505
|
|
|
Yan, S., Wan, J., Zhang, X., Tong, L., Zhao, S., Sun, J., Lin, Y., Shen, C., Lou, M. (2014) Increased Visibility of Deep Medullary Veins in Leukoaraiosis: A 3-T MRI Study. Frontiers in Aging Neuroscience, 6: 144
|
|
|
Yu, W., Rives, J., Welch, B., White, J., Stehel, E., Samson, D. (2009) Hypoplasia or Occlusion of the Ipsilateral Cranial Venous Drainage Is Associated With Early Fatal Edema of Middle Cerebral Artery Infarction. Stroke, 40(12): 3736-3739
|
|
|
Zamboni, P., Menegatti, E., Conforti, P., Shepherd, S., Tessari, M., Beggs, C. (2012) Assessment of cerebral venous return by a novel plethysmography method. Journal of Vascular Surgery, 56(3): 677-685.e1
|
|
|
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