Nogueira R C, Panerai R B, Teixeira M J, Robinson T G, Bor-Seng-Shu E
Department of Neurology, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; Biomedical Research Unit in Cardiovascular Science, Glenfield Hospital, Leicester LE3 9QP, UK.
J Stroke Cerebrovasc Dis. 2017 May;26(5):e80-e82. doi: 10.1016/j.jstrokecerebrovasdis.2017.02.026. Epub 2017 Mar 15.
Cheyne-Stokes respiration (CSR) and central sleep apnea (CSA) are common in patients with heart failure and/or stroke. We aim to describe the cerebrovascular effects of CSR during the acute phase of stroke in a heart failure patient.
A 74-year-old male with previous dilated cardiomyopathy had sudden onset of right hemiparesis and aphasia. A transcranial Doppler was performed with continuous measurement of blood pressure (BP) (Finometer) and end-tidal CO (nasal capnography). Offline analysis of hemodynamic data disclosed relatively large periodic oscillations of both cerebral blood flow velocity and BP related to the CSR breathing pattern. Derivate variables from the cerebrovascular resistance were calculated (critical closing pressure and resistance-area product), demonstrating that there may be a myogenic impairment of cerebral blood flow (CBF) control in the affected hemisphere of this subgroup of patient.
There is an impairment of CBF regulation in the affected hemisphere of the patient with ischemic stroke and CSR, highlighting the role of cerebral hemodynamic monitoring in this scenario.
潮式呼吸（CSR）和中枢性睡眠呼吸暂停（CSA）在心力衰竭和/或中风患者中很常见。我们旨在描述心力衰竭患者中风急性期CSR对脑血管的影响。
一名74岁男性，既往有扩张型心肌病，突然出现右侧偏瘫和失语。进行了经颅多普勒检查，并持续测量血压（BP）（Finometer）和呼气末二氧化碳（鼻罩式二氧化碳描记法）。对血流动力学数据的离线分析显示，脑血流速度和BP均与CSR呼吸模式相关的相对较大的周期性振荡。计算了脑血管阻力的衍生变量（临界关闭压和阻力-面积乘积），表明该亚组患者受影响半球的脑血流（CBF）控制可能存在肌源性损害。
缺血性中风和CSR患者受影响半球的CBF调节存在损害，突出了脑血流动力学监测在这种情况下的作用。
