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Cerebrovascular Reactivity and Subcortical Infarctions
Letizia M. Cupini, MD;
Marina Diomedi, MD;
Fabio Placidi, MD;
Mauro Silvestrini, MD;
Patrizia Giacomini, MD
Arch Neurol. 2001;58:577-581.
Objectives To investigate the association between different kinds of ischemic lesions
and cerebrovascular reactivity (CR) and to evaluate their relationships with
the major risk factors for stroke.
Subjects and Methods We evaluated CR using the breath-holding index technique during bilateral
transcranial Doppler monitoring of flow velocity in the middle cerebral arteries
of 41 consecutive patients attending our clinic for a recent, first-ever,
ischemic stroke and in 15 control subjects. Based on the location of the lesion
determined by computed tomography, the following 3 types of infarctions were
identified: cortical (or territorial), single subcortical, and subcortical
with multiple silent subcortical infarctions. Patients with a condition of
severe carotid artery stenosis or occlusion, which in itself could account
for altered CR, were excluded from this study. All physiological and pathologic
conditions that could possibly cause an impairment in CR were recorded.
Results The breath-holding index was significantly lower in the multiple subcortical
infarctions group than in the control subjects (P<.001),
single subcortical infarctions group (P<.01),
and cortical infarctions group (P<.01). In all
of the groups male sex (P<.05) and a history of
hypertension (P<.05), regardless of whether hypertension
was treated, correlated with low CR. The multiple regression analysis indicated
that the only significant factor able to influence the breath-holding index
was the type of lesion.
Conclusions Nonstenotic patients with first-ever stroke who had a recent symptomatic
subcortical infarction associated with multiple silent infarctions seem to
have an impaired cerebrovascular reserve capacity. The strong association
of subcortical infarctions with multiple silent infarctions with low CR indicates
the role of small vessel vasculopathy and hypoperfusion as possible pathogenetic
mechanisms of subcortical infarctions with multiple silent infarctions.
From Clinica Neurologica, Ospedale S Eugenio, Universita' di Roma "Tor
Vergata" (Drs Cupini, Diomedi, Placidi, and Silvestrini), Istituto di Ricovero
e Cura a Carattere Scientifico "S Lucia" (Drs Silvestrini and Placidi), and
Clinica delle Malattie Nervose e Mentali, Universita' di Roma La Sapienza
(Dr Giacomini), Rome, Italy.
Corresponding author: Letizia M. Cupini, MD, Clinica Neurologica,
Universita' di Roma "Tor Vergata," Ospedale S Eugenio, P. le Umanesimo 10,
00144 Rome, Italy (e-mail lecupini{at}tin.it).
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