OBJECTIVE: To evaluate cerebral hemodynamics and cerebral hyperperfusion syndrome (HPS) in patients
who develop focal neurological deficits after EC-IC bypass surgery.
METHODS: Patients with severe intracranial ICA or MCA stenosis and impaired buy GSK3326595 CVR on transcranial Doppler (TCD) derived breath-holding index (BHI) were evaluated with acetazolamide-challenged technetium-99m hexamethylpropyleneamineoxime-single-photon emission computed tomography (SPECT). EC-IC bypass surgery was offered to patients with impaired CVR on SPECT. Close monitoring was performed in patients developing focal neurological deficits within 7 days of surgery.
RESULTS: Of 112 patients with severe intracranial ICA/MCA stenosis, 77 (69%) showed impaired CVR and 46 (41%) underwent EC-IC bypass. Transient neurological deficits within 7 days of surgery developed in 8 (17%). HPS was confirmed by CT perfusion and/or SPECT in 7 cases. A strong correlation was observed between
HPS and preoperative TCD-BHI values (0%, 6.3%, and 41% in patients with BHI 0.3-0.69, 0-0.3 and,0, respectively; P = .012). HPS patients showed more than a 50% increase in MCA flow velocity on TCD (compared with preoperative values) on the operated side (63.3% vs 3.3% on control side, P < .001). Meticulous control of blood pressure and hydration led to rapid and complete resolution of neurological deficits in all cases.
CONCLUSION: Symptomatic cerebral HPS is common in the early postoperative Ro 61-8048 period after EC-IC bypass surgery. Early diagnosis and appropriate management might prevent the complications of this syndrome.”
“Background.
To estimate the spectrum of familial risk for psychopathology in first-degree relatives of children with unabridged DSM-IV bipolar-I disorder (BP-I).
Method. We conducted a blinded, controlled family study using structured diagnostic interviews of this website 157 children with BP-I probands (n = 487 first-degree relatives), 162 attention deficit hyperactivity disorder (ADHD) (without BP-I) probands (is = 511 first-degree relatives), and 136 healthy control (without ADHD or BP-I) probands (n = 411 first-degree relatives).
Results. The morbid risk (MR) of BP-I disorder in relatives of BP-I probands (MR = 0.18) was increased 4-fold [95% confidence interval (CI) 2.3-6.9, p<0.001] over the risk to relatives of control probands (MR = 0.05) and 3.5-fold (95% CI 2.1-5.8, p<0.001) over the risk to relatives of ADHD probands (MR = 0.06). In addition, relatives of children with BP-I disorder had high rates of psychosis, major depression, multiple anxiety disorders, substance use disorders, ADHD and antisocial disorders compared with relatives of control probands. Only the effect for antisocial disorders lost significance after accounted for by the corresponding diagnosis in the proband. Familial rates of ADHD did not differ between ADHD and BP-I probands.
Conclusions.