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PubMed2002

Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion: a xenon-133 single-photon emission computed tomography study.

BACKGROUND AND PURPOSE: The present study prospectively evaluated relationships among baseline characteristics, cerebral hemodynamics, and outcome of patients with symptomatic major cerebral artery occlusion, by quantitative measurement of cerebral blood flow using xenon-133 (133Xe) inhalation and single-photon emission computed tomography (SPECT). METHODS: Regional cerebrovascular reactivity (rCVR) to acetazolamide was calculated at entry to the study using 133Xe SPECT. Seventy consecutive patients aged less than 70 years with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion were divided into 2 groups: normal or reduced rCVR, and prospectively followed up for a period of 24 months. RESULTS: During the follow-up period, recurrent strokes occurred in 8 of the 23 patients with reduced rCVR at entry and in 3 of 47 patients with normal rCVR. Cumulative recurrence-free survival rates in all patients, and in each subgroup of patients with ICA or MCA occlusion and reduced rCVR on entry, were significantly lower than in those with normal rCVR (P=0.0030, P=0.0404, and P=0.0310, respectively; Kaplan-Meier analysis). Among the factors considered, only lower rCVR and resting regional cerebral blood flow values were significantly associated with the risk of stroke recurrence (P=0.0019 and P=0.0080, respectively; Cox regression multivariate analysis). CONCLUSIONS: The present study demonstrated that reduced rCVR to acetazolamide as determined by 133Xe SPECT is significantly associated with an increased risk of stroke recurrence in patients with symptomatic MCA or ICA occlusion.

Acetazolamide↗
PubMed1995

Magnetic resonance imaging of regional cerebral blood oxygenation changes under acetazolamide in carotid occlusive disease.

BACKGROUND: Gradient-echo magnetic resonance imaging can demonstrate changes in cerebral blood oxygenation with high spatiotemporal resolution. We have previously shown that this technique allows monitoring of autoregulatory responses under vasodilatory stress in the healthy human brain. Here the approach has been extended to assess impairment of the autoregulatory reserve capacity in patients with carotid occlusive disease. SUMMARY OF REPORT: We studied four patients with unilateral occlusion of the internal carotid artery on a 2.0-T clinical high-field magnetic resonance system. Oxygenation-sensitive imaging was based on long-echo-time, gradient-echo sequences (repetition time, 62.5 milliseconds; echo time, 30 milliseconds) with low flip angles (10 degrees) to emphasize changes in blood oxygenation rather than flow velocity. Dynamic recording monitored signal intensities before and after injecting 1 g of acetazolamide. In sections covering the hand area of the primary sensorimotor cortex, acetazolamide-induced magnetic resonance signal increases were attenuated in the vascular territories of occluded arteries. Lateralization of responses in the left and right hemispheric parts of the section corresponded to decreased hemodynamic reserve capacity as measured globally by transcranial Doppler ultrasonography. CONCLUSIONS: The present findings indicate that magnetic resonance imaging can demonstrate exhaustion of the autoregulatory reserve capacity when monitoring cerebral blood oxygenation changes during vasodilatory stress. We suggest that this method can help to evaluate regional cerebral hemodynamics in patients with carotid occlusive disease.

Acetazolamide↗
PubMed1995

Effect of acetazolamide on regional cerebral oxygen saturation and regional cerebral blood flow.

BACKGROUND AND PURPOSE: To verify whether the monitoring of regional cerebral oxygen saturation (rSO2) with transcranial near-infrared spectroscopy would successfully reflect changes in intracranial hemodynamics but not changes in extracranial compartment, we measured rSO2 and regional cerebral blood flow (rCBF) simultaneously in seven patients with cerebral ischemia and five normal volunteers before and after acetazolamide administration. SUMMARY OF REPORT: The baseline values of rSO2 and rCBF were 64.2 +/- 5.6% and 53.9 +/- 11.1 mL/100 g per minute, respectively. rCBF increased by 44.4 +/- 23.3% and rSO2 significantly increased to 69.6 +/- 5.6% after acetazolamide administration. Bilateral simultaneous measurement of rSO2 indicated a tendency that the larger the delta rSO2, the greater the delta%rCBF. The relationship between rSO2 level and rCBF value fit significantly on the theoretical curve calculated from Fick's equation. CONCLUSIONS: It is suggested that monitoring of rSO2 with INVOS-3100 could be a useful indicator in the evaluation of intracranial hemodynamic changes.

Acetazolamide↗
PubMed1996

Preoperative and postoperative evaluation of cerebral perfusion and vasodilatory capacity with 99mTc-HMPAO SPECT and acetazolamide in childhood Moyamoya disease.

BACKGROUND AND PURPOSE: The results of long-term follow-up studies of cerebral perfusion and vasodilatory capacity following administration of acetazolamide after serial vascular reconstructions in 25 patients with childhood moyamoya disease are reported. METHODS: Cerebral perfusion was measured with 99mTc-hexamethylpropyleneamine oxime single-photon emission CT before and after IV administration of 10 mg/kg acetazolamide, which was performed both before and after vascular reconstruction by superficial temporal artery-middle cerebral artery anastomosis and encephalomyosynangiosis (first and second operations) and/or omental transplantation to the brain (third operation). RESULTS: Follow-up periods ranged between 12 and 24 months (mean +/- SD, 18.5 +/- 3.2 months) after the first operation. Repetitive transient ischemic attacks disappeared completely after serial vascular reconstructions in all patients. Before the first operation, cerebral perfusion in the territory of the middle cerebral artery on the side of initial operation was 83.9 +/- 4.7% and was significantly lower than that in the contralateral side (88.3 +/- 4.9%, n = 25; P < .0001, paired t test). Vasodilatory capacity on the side of the first operation was -18.4 +/- 2.5% and that on the contralateral side -14.4 +/- 2.1%. The former value was significantly lower than the latter value (n = 25; P < .0001, paired t test). After the first operation, cerebral perfusion and vasodilatory capacity on the side of initial operation were markedly improved, to 87.8 +/- 4.5% and -14.7 +/- 2.7%, respectively (n = 25; P < .0001, both cases, paired t test). Before the second operation, cerebral perfusion and vasodilatory capacity on the side of the second operation were 76.6 +/- 4.1% and -20.1 +/- 1.9%, respectively, and significantly lower than those before the first operation (n = 25; P < .0001, both cases, paired t test). Eight patients subsequently required bifrontal omental transplantation for repetitive paraparetic transient ischemic attacks after the second operation; they had low cerebral perfusion and vasodilatory capacity bilaterally in the territories of the anterior cerebral arteries (72.4 +/- 2.7% and -18.6 +/- 1.7%, respectively). After omental transplantation, both were significantly increased, to 81.9 +/- 3.4% and -11.8 +/- 1.9%, respectively (n = 25; P < .0001, both cases, paired t test). CONCLUSIONS: Hemodynamic compromise existed in patients with childhood moyamoya disease and was a major cause of development of ischemic symptoms. Regions in which hemodynamic compromise was present could be determined by measuring regional cerebral perfusion and vasodilatory capacity.

Acetazolamide↗
PubMed1968

The phosphaturic effect of sodium bicarbonate and acetazolamide in dogs.

Urinary inorganic phosphate excretion was studied before and during the administration of sodium bicarbonate and acetazolamide in dogs that were not given infusions of phosphate. The excretion fraction of filtered phosphate increased after sodium bicarbonate or acetazolamide was given. This phosphaturia was attributed to decreased tubular reabsorption of phosphate consequent to alkalinization of either tubular urine or cells.

Acetazolamide↗
PubMed1989

Responses to hypercarbia induced by acetazolamide in panic disorder patients.

CO2 inhalation has been reported to induce panic attacks in panic disorder patients. State anxiety, somatic symptoms of anxiety, physiological changes, and cerebral blood flow (CBF) were monitored in panic disorder patients before and after intravenous injections of 1 g of acetazolamide (13 patients) and saline (10 patients), given under double-blind conditions. In spite of significant hypercarbia, as evidenced by increased CBF in the former group, only one subject reported panic and even that attack did not meet DSM-III-R criteria. There was only one significant difference between the drug and placebo groups; the acetazolamide group experienced significantly more dizziness.

Acetazolamide↗
PubMed2000

Effects of intralaryngeal carbon dioxide and acetazolamide on the laryngeal chemoreflex.

Sudden infant death syndrome is the leading cause of death in infants in the United States. The laryngeal chemoreflex (LCR) is thought to contribute to its pathogenesis. In adult animals, increasing levels of intralaryngeal CO2 result in a decrease in ventilatory activity. Intravenous acetazolamide (AZ) abolishes this response. The purpose of this study was to determine the effects of intralaryngeal CO2 and AZ on the LCR and respiratory physiology of piglets under normoxic and hypoxic conditions. We applied 0% or 10% CO2 in a randomized order to the larynx of 26 piglets. Intubation via tracheotomy prevented inhalation of the gas mixtures. Laryngeal stimulation was performed under normoxic conditions (PaO2 of >70 mm Hg) in 15 animals and under hypoxic conditions (PaO2 of 50 to 65 mm Hg) in 11 animals both with and without intravenous AZ (5 mg/kg). Respiratory and cardiovascular response data were recorded. Ten percent intralaryngeal CO2 has no significant effect on mean baseline respiratory rate, systemic PaCO2 or PaO2 levels, or apnea duration (p > .05). The use of AZ (versus no AZ) resulted in significantly higher baseline respiratory rates (64 versus 51 breaths per minute; p = .016), a decreased baseline systemic PaCO2 level (38.8 versus 45.9 mm Hg; p < .001), a higher baseline PaO2 level (97.9 versus 82.8 mm Hg; p < .001), shorter mean apnea durations (15.5 versus 24.8 seconds; p = .001), a higher lowest O2 saturation level after the stimulus (78.0% versus 68.4%; p = .003), and fewer profound apneas (10 of 90 versus 41 of 90 trials; p < .001). We conclude that 10% intralaryngeal CO2 does not decrease ventilatory activity in piglets and has no significant effect on the LCR. Acetazolamide, however, appears to have a protective effect against the LCR, resulting in shorter and less severe apneas. The protective effect of AZ against the LCR appears to be related to its ability to stimulate the respiratory drive and increase oxygenation at baseline.

Acetazolamide↗
PubMed2002

Combined treatment with acetazolamide and medroxyprogesterone in chronic obstructive pulmonary disease patients.

Medroxyprogesterone acetate (MPA) and acetazolamide (ACET) are two ventilatory stimulants which are used in hypoxic and hypercapnic patients with chronic obstructive pulmonary disease (COPD). In a double-blind randomised study, the effects of a 2-week treatment with MPA (30 mg b.i.d.) or ACET (250 mg b.i.d.), followed by a 2-week treatment with a combination of both drugs (MPA/ACET), on daytime and nocturnal ventilatory and blood gas parameters in 17 stable hypercapnic COPD patients were investigated. ACET, MPA and MPA/ACET treatment decreased mean daytime carbon dioxide tension in arterial blood by 0.4, 0.7 and 1.2 kPa, respectively. Minute ventilation was improved only with combined therapy, from 9.3 to 11.2 L x min(-1). With MPA/ACET therapy, the hypercapnic and hypoxic ventilatory responses significantly increased, from 3.7 to 5.8 L x min(-1) x kPa(-1) and from -0.13 to -0.40 L x min(-1) x %(-1), respectively. The mouth exclusion pressure response to hypoxia increased during combination therapy, from -0.01 to -0.03 kPa %(-1). Nocturnal end-tidal carbon dioxide tension decreased with MPA and MPA/ACET treatment, by 0.9 and 1.4 kPa, respectively. MPA/ACET significantly increased mean nocturnal arterial oxygen saturation values, from 85.5 to 90.2%. The authors conclude that short-term combined treatment with medroxyprogesterone acetate and acetazolamide has a more favourable effect on day and night-time blood gas values and chemical drive than single drug treatment.

Acetazolamide↗
PubMed1979

Severe acidosis from acetazolamide in a diabetic patient.

An insulin-dependent diabetic patient with nephropathy developed severe acidosis after treatment with acetazolamide for glaucoma. A renal tubular abnormality may have allowed the usually self-limiting acidosis of acetazolamide to progress. It is suggested that the plasma electrolytes of patients at risk should be monitored.

Acetazolamide↗
PubMed1983

Acetazolamide-responsive episodic ataxia syndrome.

We studied a kindred with an acetazolamide-responsive, episodic ataxia syndrome. Affected members experienced paroxysmal attacks of ataxia that were precipitated by exertion or stress. All but one young patient had additional neurologic symptoms that included paresthesia, weakness, headache, tinnitus, vertigo, and myotonia. All symptoms were prevented by acetazolamide. Between attacks, serum pyruvate and lactate levels and urinary amino acids were normal, but electroencephalograms showed paroxysmal, high-amplitude, slow and sharp activity. Serum K+ was normal during attacks. The metabolic abnormality seems to affect the cerebellum and brainstem and may involve peripheral nerve and muscle.

Acetazolamide↗
PubMed1992

Acetazolamide treatment of paroxysmal dystonia in central demyelinating disease.

We report successful treatment of paroxysmal dystonia (tonic seizures) in three patients with central demyelinating disease (CDD) using acetazolamide alone or in combination with carbamazepine. Acetazolamide is a useful alternative, or an adjunct, to carbamazepine in the treatment of paroxysmal dystonia in CDD.

Acetazolamide↗
PubMed1992

The effect of acetazolamide on essential tremor: an open-label trial.

We studied the effect of the carbonic anhydrase inhibitor acetazolamide on 24 patients with essential tremor by patient self-evaluation of functional disability, rating of motor task function, and clinical rating of tremor severity. Acetazolamide significantly reduced tremor severity, but there was no statistically significant change in patient self-assessment of function or motor task rating. Although side effects were common, over half the patients elected to remain on the drug.

Acetazolamide↗
PubMed1993

Acetazolamide-induced nephrolithiasis: implications for treatment of neuromuscular disorders.

Carbonic anhydrase inhibitors can cause nephrolithiasis. We studied 20 patients receiving long-term carbonic anhydrase inhibitor treatment for periodic paralysis and myotonia. Three patients on acetazolamide (15%) developed renal calculi. Extracorporeal lithotripsy successfully removed a renal calculus in one patient and surgery removed a staghorn calculus in another, permitting continued treatment. Renal function remained normal in all patients. Nephrolithiasis is a complication of acetazolamide but does not preclude its use.

Acetazolamide↗
PubMed1993

Acetazolamide test in detecting reduced cerebral perfusion reserve and predicting long-term prognosis in patients with internal carotid artery occlusion.

In a series of 32 patients with internal carotid artery occlusion, regional cerebral blood flow (rCBF) and regional cerebral vasoreactivity (rCVR) were measured by xenon-133 single photon emission computed tomography and the acetazolamide test. We evaluated its usefulness in detecting the reduced cerebral perfusion reserve and predicting long-term prognosis. All Type 1 patients (normal rCBF and rCVR) were medically treated and experienced no recurrent ischemic attack. Cerebral hemodynamics remained unchanged. Type 2, 3, and 4 patients underwent superficial temporal artery-middle cerebral artery double anastomosis, if they consented to surgery. All Type 2 (normal rCBF and reduced rCVR) and Type 3 (reduced rCBF and rCVR) patients, who underwent surgery, showed no further ischemic attacks, as well as long-term normalization of rCVR, although long-term rCBF normalization was obtained in only three of seven Type 3 patients. Cerebral hemodynamics remained unchanged in Type 4 patients after surgery. In follow-up periods, major completed stroke occurred in all 3 Type 2 and Type 3 patients who were medically treated. These results suggest that the acetazolamide test is valuable in assessing the cerebral perfusion reserve and predicting long-term prognosis in patients with internal carotid artery occlusion, although further long-term or randomized studies are needed.

Acetazolamide↗
PubMed1990

Hemodynamic evaluation in patients with superficial temporal artery-middle cerebral artery anastomosis--stable xenon CT-CBF study and acetazolamide.

Sixteen patients with minor completed stroke in the chronic stage underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The acetazolamide-activated regional cerebral blood flow (rCBF) was measured 20 minutes after the injection using inhalation of stable xenon and computed tomographic scanning (Xes CT-CBF study) pre- and postoperatively. Eleven patients (Group 1) showed immediate improvement in neurological state within a few days of the operation, while five (Group 2) showed no improvements. Preoperative rCBF in the ischemic areas without infarction was 30.8 +/- 3.0 ml/100 gm/min in Group 1 and 53.0 +/- 5.2 ml/100 gm/min in Group 2. Preoperative vasodilatory capacity with acetazolamide in Group 1 was 5.7 +/- 8.6 and significantly increased to 19.8 +/- 4.9 after surgery. In Group 2, pre- and postoperative vasodilatory capacity was 12.7 +/- 3.1 and 14.9 +/- 2.9, respectively, and there was no significant change. These results suggested that minor stroke patients with moderate decrease of affected side rCBF (less than 40 ml/100 gm/min) and with hemodynamic impairment may have the surgical indication for STA-MCA anastomosis.

Acetazolamide↗
PubMed1993

Effects of acetazolamide on acid-base balance in the endolymphatic sac of the guinea pig.

The effects of acetazolamide, a carbonic anhydrase inhibitor, on acid-base parameters in the endolymphatic sac of the guinea pig were investigated using ion-selective microelectrodes. Bicarbonate concentration was reduced and pH shifted to being acidic immediately after administration of acetazolamide. Chloride concentration in the endolymphatic sac increased after carbonic anhydrase inhibition. These findings provide evidence of an active function of carbonic anhydrase in the endolymphatic sac and suggest that carbonic anhydrase activity is involved in the formation of endolymphatic sac fluid.

Acetazolamide↗
PubMed1987

Urine composition and stone formation during treatment with acetazolamide.

Twelve patients who formed renal stones during acetazolamide treatment for glaucoma were studied. Calcium phosphate was the dominating component in the stones. Long term treatment with acetazolamide decreased urinary citrate markedly, which will result in an increased ion-activity product of calcium phosphate and a decreased inhibiting property of urine on calcium phosphate crystallization. The treatment also increased urinary oxalate which together with a low citrate might increase the risk of calcium oxalate crystallization. However, an estimate of the ion-activity product of calcium oxalate in urine (AP [CaOx]-index) was unaffected by the treatment and calcium oxalate was a minor component of the stones.

Acetazolamide↗
PubMed1994

Acetazolamide in bipolar affective disorders.

Acetazolamide is a carbonic anhydrase inhibitor used for a variety of purposes, including adjunctively in the management of various types of epilepsy. A previous study on its psychotropic effects suggested the possibility of efficacy in atypical psychotic states, especially those characterized by cyclicity. In the present investigation, 16 patients with refractory affective symptomatology were treated with acetazolamide in a prospective open trial after exhaustive trials with antidepressants, lithium, carbamazepine, divalproex, and other anticonvulsants. Seven of the 16 (44%) responded positively, in some cases dramatically, for as long as 2 years. Analysis revealed that all of the responders were either in a depressive phase or in a rapid-cycling phase of a bipolar illness and that all had experienced partial positive response to at least one other anticonvulsant and were being maintained on anti-convulsant therapy when the response occurred. Salient theoretical issues are explored.

Acetazolamide↗