[Thought about an "expensive treatment"].
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Botulinum Toxins↗
Biomedical subjects
E Kerty
Publications and source records attributed to E Kerty.
Assessment of the ophthalmic artery as a collateral to the cerebral circulation. A comparison of transorbital Doppler ultrasonography and regional cerebral blood flow measurements.
The role of the ophthalmic artery (OA) as a collateral to the cerebral circulation in carotid occlusive disease is somewhat controversial. The aim of this study was to assess the importance of this collateral by comparing the results of transorbital Doppler ultrasonography and regional cerebral blood flow measurements using SPECT and Xenon-133 inhalation in 41 patients with unilateral high-grade internal carotid artery occlusive disease. Both measurements were performed under basal conditions and after the intravenous administration of 1 g acetazolamide to test cerebral vasoreactivity. Based on the direction of OA flow, the patients could be divided into three groups. In Group 1 (n = 16) with anterograde OA flow before and after acetazolamide, baseline rCBF values did not differ significantly between the two sides, or from those of the controls. The side-to-side asymmetry of the response to acetazolamide was also normal. In Group 2 (n = 11) where the OA flow was anterograde or "0 flow" before, but became retrograde after acetazolamide, rCBF was significantly reduced on the symptomatic compared to the non-symptomatic side under basal conditions. However, the increase in rCBF after acetazolamide was within normal limits. In Group 3 (n = 14) the OA flow was reversed both under basal conditions and after the vasodilatory stimulus. Baseline rCBF was significantly lower (p < 0.05) on the symptomatic side compared to the non-symptomatic, and the asymmetry became even greater (p < 0.001) after acetazolamide. Our findings demonstrate that the OA may be an important collateral pathway in patients with ICA occlusive disease, and contribute to the cerebral perfusion reserve in the case of compromised blood supply.
Acetazolamide↗
Cervicocranial artery dissection. Detection by Doppler ultrasound and MR angiography.
PURPOSE: To evaluate pulsed Doppler ultrasound and MR angiography (MRA) in the diagnosis of cervicocranial dissection. MATERIAL AND METHODS: Fourteen patients with cervicocranial artery dissection were examined over a 3-year period. Twelve patients had dissection of the extracranial part of the internal carotid artery, and 2 had vertebral artery dissection. All patients were examined with pulsed Doppler ultrasound. In addition, all patients had conventional angiography (n = 9) and/or MR imaging including MRA (n = 9). RESULTS: Doppler ultrasound disclosed unspecific abnormalities in 11 of 14 dissected vessels; 3 patients had false-negative Doppler findings. MRA showed vessel abnormalities in 9 of 9 patients; 2 vessels were occluded, and 7 vessels had changes typical of dissection (double lumen and/or string sign). Twelve patients had follow-up examinations with pulsed Doppler ultrasound (n = 12), conventional angiography (n = 3), and MRA/MR (n = 11). Follow-up Doppler showed complete or partial normalization in 6 of 9 patients, all confirmed by either angiography or MRA. CONCLUSION: Our findings suggest that Doppler ultrasound may be used in follow-up of pathologic Doppler findings in known dissections, and that MRA may replace angiography in the confirmative diagnosis of cervicocranial dissection.
Adult↗
[Hemifacial spasms. Causes, clinical findings and treatment].
Hemifacial spasm is a condition characterized by involuntary, episodic, synchronous contractions of muscles innervated by the facial nerve in one half of the face. The treatment can be medical or neurosurgical, but the most effective is injections of botulinum toxin. 13 patients who received this treatment for hemifacial spasm are described. The treatment of different forms of focal dystonias has been described before in this journal. The aetiology of hemifacial spasm is different from that of focal dystonia. It is probably due to compression of the facial nerve, causing ectopic generation of impulses. Treatment with botulinum toxin is shown to be effective also for this condition, but the dosage and the duration of effect differ from those reported for focal dystonias. This may be due to differences in the pathophysiological mechanisms of the two conditions.
Adult↗
Doppler study of the ophthalmic artery in patients with carotid occlusive disease.
Assessing the adequacy of collateral circulatory pathways has become increasingly important in the investigation of cerebral circulation. Using transorbital Doppler ultrasonography (TOD), we examined the ophthalmic artery (OA) in patients with hemodynamic significant internal carotid artery (ICA) occlusive disease. The velocity and the direction of flow in the OA were studied in 45 patients (occlusion n = 27, stenosis > 75% n = 18), and in 30 age matched controls, under baseline conditions and within 30 minutes after the i.v. administration of 1 g acetazolamide as a vasodilatory stimulus. Based on the direction of flow before and after acetazolamide, the 45 patients could be separated into four groups with increasing degree of ICA lesions. In group I the OA flow was anterograde, but the velocity decreased after acetazolamide. In group II the OA direction became retrograde after acetazolamide, indicating collateral flow to the brain. In patients with retrograde OA flow following acetazolamide injection (group II-IV), the vessel reacted similarly to an intracranial artery, with marked increase in velocity when vasoreactivity was tested. TOD and the acetazolamide test provide useful information about potential collateral OA flow to the brain in patients with ICA occlusive disease.
Adult↗
Ocular hemodynamic changes in patients with high-grade carotid occlusive disease and development of chronic ocular ischaemia. I. Doppler and dynamic tonometry findings.
Ophthalmic artery blood flow pattern and the pulsatile ocular blood volume changes in patients with hemodynamically significant carotid occlusive disease are described. Using transorbital Doppler ultrasonography and dynamic tonometry 45 patients with high-grade internal carotid artery stenosis or occlusion and 15 healthy controls were examined. The measurements were performed under baseline conditions and 30 min after 1 gi.v. acetazolamide administration. The velocity in the ophthalmic artery was significantly lower in patients compared with controls. Pulsatile ocular blood volume was also lower in patients than in controls under baseline conditions, and a further reduction was found after acetazolamide, despite the significant decrease of intraocular pressure. A different reaction was observed in eyes with chronic ocular ischaemia.
Acetazolamide↗
Ocular hemodynamic changes in patients with high-grade carotid occlusive disease and development of chronic ocular ischaemia. II. Clinical findings.
Ocular changes due to chronic ischaemia are described in 45 patients with hemodynamically significant carotid occlusive disease. Regarding the ophthalmic artery flow before and after vasodilatory stimulus, the patients were divided into four different groups. Eyes with permanent anterograde ophthalmic artery flow had evidence of embolic features, but no signs of chronic hypoperfusion. In the group where anterograde ophthalmic artery flow changed to retrograde after 1 g intravenous acetazolamide, the patients had symptoms of critical ocular perfusion, but only subtle structural changes could be demonstrated. Chronic ocular ischaemic syndromes were found in the cases with retrograde ophthalmic artery flow, especially where bilateral severe carotid obstruction was present.
Acetazolamide↗
Cerebral vasoreactivity assessed with transcranial Doppler and regional cerebral blood flow measurements. Dose, serum concentration, and time course of the response to acetazolamide.
BACKGROUND AND PURPOSE: To improve the assessment of cerebral vasoreactivity using acetazolamide (ACZ), we studied the time course of the response and the relationship between dose, response, and serum concentration. METHODS: Blood flow velocities were measured with the use of transcranial Doppler ultrasonography in one of the middle cerebral arteries of 48 healthy subjects after the intravenous administration of 1 to 1.6 g ACZ. In 34 subjects (group 1), velocities were measured every second minute to detect the maximum middle cerebral artery velocity increase. We also measured regional cerebral blood flow using single-photon emission computed tomography in 27 of the subjects in group 1 before and approximately 15 to 20 minutes after the ACZ injection. The serum concentration of ACZ was measured in 15 subjects. In the remaining 14 subjects (group 2), middle cerebral artery velocity measurements were made 10, 25, 30, and 45 minutes after ACZ administration to obtain information regarding the late time course of the response. RESULTS: In group 1 the plateau phase of the velocity response was reached 8 to 15 minutes after ACZ administration. A large range of velocity increase was observed, and a significant correlation was found between the maximum velocity increase and the dose and serum concentration of ACZ. In group 2 subjects, maximum velocities were maintained 30 minutes after the injection, but after 45 minutes velocities had decreased to 68% of their highest level. No significant relationship was found between dose or serum concentration of ACZ and the regional cerebral blood flow increase. The velocity increase after ACZ was similar in both older and younger subjects. CONCLUSIONS: This study shows that cerebral vasoreactivity is best assessed 10 to 30 minutes after ACZ administration and that the dose should probably exceed 15 mg/kg if a maximum vasodilatory response in the cerebral circulation is to be obtained.
Acetazolamide↗
Ocular and cerebral blood flow measurements in healthy subjects. A comparison of blood flow velocity and dynamic tonometry measurements before and after acetazolamide.
The ocular and cerebral blood flow was studied in 15 healthy subjects using transcranial Doppler ultrasonography (2 MHz). The blood flow velocity in the precerebral carotid arteries, in the ophthalmic artery and in the middle cerebral artery was measured under baseline conditions and after i.v. administration of 1 g acetazolamide. To measure the intraocular pressure and the corneal indentation pulse amplitude, a dynamic tonometer was used. Pulsatile ocular blood volume was calculated from these values. After one single dose of acetazolamide a significant decrease in ophthalmic artery flow velocity, and a significant increase both in internal carotid and in middle cerebral artery velocity was found. A significant decrease in intraocular pressure and in pulsatile ocular volume after acetazolamide was also demonstrated. These findings suggest that the acute effect of acetazolamide may be associated with a reduced ocular blood flow, explaining some of the reduction in IOP.
Acetazolamide↗
[Involvement of the visual system in multiple sclerosis].
Ocular symptoms commonly occur in multiple sclerosis patients. Clinically, optic neuritis is considered to be the classic visual manifestation. Little attention is paid to other forms of visual pathway affections, such as intrabulbar inflammation and various types of visual field defects. We describe some unusual forms of visual pathway affections in multiple sclerosis, in which combined neuroophthalmological examination and magnet tomography were very effective both in diagnosing and during follow-up of multiple sclerosis patients.
Adult↗
[Optic neuritis--to treat or not to treat?].
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Humans↗
[Botulinum toxin treatment of spastic torticollis].
Botulinum toxin A was administered to 19 patients with spasmodic torticollis. A significant decrease of abnormal head and neck movements was recorded, and all the patients who suffered pain reported relief. Side effects were minor and transient. The results of this study indicate that botulinum toxin is an effective means of treating torticollis.
Adult↗
[Autoimmune optic neuritis].
We describe two patients with autoimmune optic neuritis. The initial symptom was severe loss of vision without clinical signs or symptoms of systemic autoimmune disease. The patients had recurrent attacks of optic neuritis in both eyes, causing permanent visual impairment despite conventional doses of corticosteroid. The only laboratory sign of autoimmune disease was a positive antinuclear antibody (ANA). These patients must be differentiated from cases with idiopathic optic neuritis or multiple sclerosis. Early diagnosis and high-dose corticosteroid therapy may be necessary, and may be successful in restoring visual function. Continued therapy with cytotoxic agents may be required.
Adult↗
[Treatment of focal dystonia with botulinum toxin].
Focal dystonia and hemifacial spasms are difficult to treat. Medication and surgery may suppress the dystonic movements but the improvement is not satisfactory. The present article reviews use of Botulinum toxin in cases of focal dystonia. Injections of very small doses of Botulinum A toxin into the affected muscles is a new and efficient therapy for patients with focal dystonia. The toxin acts by inhibiting the release of acetylcholine from the nerve terminal, leading to a localized paralysis of the treated muscle. The effect is temporary and gradually diminishes, but the treatment can be repeated. The use of Botulinum toxin must be applied on the basis of a thorough knowledge of its effect and possible side effects.
Botulinum Toxins↗
[Spontaneous dissection of the internal carotid artery].
Spontaneous dissection of the internal carotid artery is supposed to be a rare condition, but seems to be increasingly diagnosed. The symptoms are protean from unilateral headache, Horners syndrome, tinnitus, to cerebral ischemia and hemipareses. The condition is of unknown incidence and usually affects previously healthy persons. It is nearly always unilateral. The diagnosis is ascertained by characteristic angiographical findings. The prognosis depends on the exhibited symptoms. Three patients seen during the last year at the Department of Neurology at the National Hospital (Rikshospitalet) are presented, together with a brief survey of symptomatology, diagnosis, prognosis and treatment.
Adult↗
Chiasmal optic neuritis.
We describe two cases of chiasmal optic neuritis. The presenting symptoms were reduced visual acuity and bitemporal visual field defects. The enlargement of the optic chiasm in the acute stage and normalization after recovery is demonstrated by magnetic resonance imaging (MRI).
Adrenal Cortex Hormones↗
Chronic ocular ischaemia.
Patients with carotid artery occlusive disease may develop ocular changes in both the anterior and posterior segments of the eye caused by chronic ischaemia. Four cases are reported with a wide variety of the characteristic ocular ischaemic symptoms and signs. Pulsed Doppler spectral analysis of the precerebral carotid arteries was used to detect the presence of relevant carotid occlusive disease. Diagnosis and therepy require an interdisciplinary approach, to prevent cerebral stroke and to preserve ocular function.
Aged↗