Document Detail

Adaptive changes of autoregulation in chronic cerebral hypotension with arteriovenous malformations: an acetazolamide-enhanced single-photon emission CT study.
MedLine Citation:
PMID:  8693988     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To evaluate the relationship among feeding arterial pressure, lesion size, and perfusion in cerebral cortex adjacent to cerebral arteriovenous malformations (AVMs). METHODS: Eleven patients with hemispheric AVMs underwent 99mTc hexamethyl-propyleneamine oxime single-photon emission CT before and after 1 g of acetazolamide was administered intravenously. AVM volume was estimated from MR dimensions and measured according to the method described by Pasqualin. Pressure measurements were obtained in arteries feeding the cortex adjacent to AVMs. Single-photon emission CT regions of interest were defined in cortex adjacent to the AVM and compared with contralateral regions using the Mountz method to estimate a baseline and dynamic (acetazolamide-challenged) perfusion defect volume. RESULTS: Eight of 11 patients had baseline perfusion defects, but these defects were unrelated to feeding artery pressures (y = -.06x + 9.92, r2 = .04) or the dynamic change in defect volume after acetazolamide administration (y = .01x + .02, r2 = .002). However, there was a correlation between AVM volume and the baseline defect volume (y = .75x - 1.9, r2 = .76). Five patients had increased defect volume after acetazolamide administration; 5 patients had either no change in or improvement of perfusion. Dynamic changes in defect volume were related to feeding artery pressures. CONCLUSION: Perilesional baseline perfusion defects appear to be related to lesion size and not to local arterial pressure. Cerebrovascular reserve generally was preserved, and perfusion defects appeared to be more pronounced with lower arterial pressures in feeding vessels. Although vasodilatory testing can unmask hemodynamic failure with severe local hypotension, baseline perfusion defects near the lesion and distant perfusion changes are more likely attributable to other causes such as mass-related or neurogenic changes.
L Hacein-Bey; R Nour; J Pile-Spellman; R Van Heertum; P D Esser; W L Young
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  16     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  1995 Oct 
Date Detail:
Created Date:  1996-08-23     Completed Date:  1996-08-23     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1865-74     Citation Subset:  IM    
Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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MeSH Terms
Acetazolamide / pharmacology*
Adaptation, Physiological*
Blood Pressure*
Carbonic Anhydrase Inhibitors / pharmacology*
Cerebrovascular Circulation* / drug effects
Chronic Disease
Intracranial Arteriovenous Malformations / physiopathology*,  radionuclide imaging*
Middle Aged
Organotechnetium Compounds / diagnostic use
Oximes / diagnostic use
Technetium Tc 99m Exametazime
Tomography, Emission-Computed, Single-Photon*
Vasodilation / drug effects
Grant Support
Reg. No./Substance:
0/Carbonic Anhydrase Inhibitors; 0/Organotechnetium Compounds; 0/Oximes; 100504-35-6/Technetium Tc 99m Exametazime; 59-66-5/Acetazolamide

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