Acetazolamide Vasoreactivity in Vascular Dementia and Persistent Vegetative State Evaluated by Transcranial Harmonic Perfusion Imaging and Doppler Sonography

• Published in: Annals of the New York Academy of Sciences Vol. 977; no. 1; pp. 445 - 453
• Main Authors: SHIOGAI, T., UEBO, C., MAKINO, M., MIZUNO, T., NAKAJIMA, K., FURUHATA, H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2002
• Subjects: Acetazolamide; acetazolamide (ACZ); Adult; Aged; Aged, 80 and over; Carbonic Anhydrase Inhibitors; Dementia, Vascular - diagnosis; Dementia, Vascular - diagnostic imaging; Dementia, Vascular - psychology; Diagnosis, Differential; Humans; Magnetic Resonance Angiography; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - pathology; persistent vegetative state (PVS); Persistent Vegetative State - diagnosis; Persistent Vegetative State - diagnostic imaging; Psychiatric Status Rating Scales; Reference Values; transcranial Doppler sonography (TCD); transcranial harmonic perfusion imaging (HPI); Ultrasonography, Doppler; vascular dementia (VaD); vasoreactivity
• ISSN: 0077-8923; 1749-6632
• DOI: 10.1111/j.1749-6632.2002.tb04850.x

: To clarify the pathophysiological differences of the cerebrovascular reserve capacity in relation to cerebral cognitive impairments between vascular dementia (VaD) and persistent vegetative state (PVS), we evaluated acetazolamide (ACZ) vasoreactivity testing by transcranial harmonic perfusion imaging (HPI) and Doppler sonography (TCD). Sixteen patients (age: 29–85 years; mean: 62) were divided into three groups: 7 VaD, 4 PVS, and 5 nondementia patients. Mean velocity (Vm) in the middle and posterior cerebral artery (MCA, PCA) was measured, and time‐intensity curves of the HPI were evaluated at three regions of interest—the bilateral temporal lobe (TL), basal ganglia (BG), and thalamus (Th). TCD and HPI were evaluated before (resting state) and after ACZ administration, and vasoreactivity was compared among the three groups in terms of resting values and relative changes (%Δ) of Vm, peak intensity (PI), area under curve (AUC), and mean transit time (MTT). Results of the resting state: Decreased Vm, PI, and AUC of the VaD and PVS groups were more obvious in the right side. Results of vasoreactivity: In the PVS group, %ΔVm decreased in the left PCA and MCA; %ΔPI and %ΔAUC decreased in the left TL and bilateral BG. In the VaD group, %ΔPI and %ΔAUC decreased in the right TL; %ΔMTT tended to increase in the left side. ACZ vasoreactivity tests by transcranial HPI and TCD allowed bedside, noninvasive quantitative evaluation of the pathophysiology of cognitive function impairment in relation to cerebrovascular reserve capacity in VaD and PVS.