[Cerebral hemodynamics in the vegetative state patients--relationship between patterns of dysautoregulation and prognosis (author's transl)]. 1978

R Hen, and Z Ito, and K Uemura, and H Kawakami

The pathophysiological analysis of cerebral hemodynamic mechanisms and its metabolism in the vegetative patients was not enough until now. It was reported in this paper that the correlation between cerebral hemodynamics, metabolism and neurological function was analysed in 14 patients with vegetative state caused by cerebrovascular disorders. The materials consist of 14 vegetative patients due to 7 hypertensive intracerebral hemorrhage, 6 subarachnoid hemorrhage and one cerebral infarction. In all of them, the cerebral hemodynamics such as cerebral blood flow (CBF), CO2 reactivity and autoregulation, and cerebral metabolism were measured sequencially by 133Xe clearance methods. In the majority of cases, both values of mean hemispheric CBF and cerebral oxygen consumption (CMRO2) were markedly decreased with severe impairments of autoregulation and CO2 reactivity on the bilateral hemispheres but much more significatly on the affected hemispheres. Futhermore, from view points of the pressureflow relationship in the CBF studies, the patterns of dysautoregulation could be classified into 2 types as follows; Type 1 is the complete loss type, which has no plateau formation in all ranging of systemic arterial blood pressure (SABP). Type 2 is the incomplete loss type with 2 subdivisions, in which the abnormal narrowing plateaus are recognized in relatively higher or lower range of SABP (called as the upper or the lower type of incomplete loss type respectively). And then, the phenomen, which we gave a term as "shift-off phenomenon", was recognized in 8 cases that the proper values of resting SABP was seated outside the plateau level of the auto-regulatory capacity. The correlation between CBF dynamics and the grade of vegetative state was analysed. In 2 cases with slight communications (vegetative grade1), mean hemispheric CBF value was 32.5 (ml/100 g/min.) and CMRO2 was 2.01 (ml/100 g/min.) with the normal or the upper type in incomplete loss of dysautoregulation. In 3 cases of vegetative grade 2, who could slightly response to vocal order, mean CBF and CMRO2 showed 27.0 +/- 2.0 and 1.7 +/- 0.08 respectively. In these cases, dysautoregulations with the upper type incomplete loss were recognized. In 3 cases of vegetative grade 3, who had only spontaneous movement of body and slight emotional expression but no response to vocal order, mean CBF was in 22.4 +/- 1.9 and CMRO2 in 1.28 +/- 0.21. The patterns of dysautoregulation showed the lower type of incomplete loss. We had experienced the shift-off phenomenon in all of 5 cases with the upper type of incomplete loss and in 3 of 7 cases with the lower type of incomplete loss dysautoregulation. As conclusion, in cases of vegetative grade 2 or 3 whose patterns of dysautoregulation are the upper or lower type of incomplete loss with the shift-off pnenomenon, it would be a useful therapeutic method to get away from vegetative state that SABP could be corrected and controlled within the proper plateau level of autoregulation by the suitable administration of some vasoactive agents.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010101 Oxygen Consumption The rate at which oxygen is used by a tissue; microliters of oxygen STPD used per milligram of tissue per hour; the rate at which oxygen enters the blood from alveolar gas, equal in the steady state to the consumption of oxygen by tissue metabolism throughout the body. (Stedman, 25th ed, p346) Consumption, Oxygen,Consumptions, Oxygen,Oxygen Consumptions
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D001794 Blood Pressure PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS. Systolic Pressure,Diastolic Pressure,Pulse Pressure,Pressure, Blood,Pressure, Diastolic,Pressure, Pulse,Pressure, Systolic,Pressures, Systolic
D001810 Blood Volume Volume of circulating BLOOD. It is the sum of the PLASMA VOLUME and ERYTHROCYTE VOLUME. Blood Volumes,Volume, Blood,Volumes, Blood
D002543 Cerebral Hemorrhage Bleeding into one or both CEREBRAL HEMISPHERES including the BASAL GANGLIA and the CEREBRAL CORTEX. It is often associated with HYPERTENSION and CRANIOCEREBRAL TRAUMA. Brain Hemorrhage, Cerebral,Cerebral Parenchymal Hemorrhage,Hemorrhage, Cerebral,Intracerebral Hemorrhage,Hemorrhage, Cerebrum,Brain Hemorrhages, Cerebral,Cerebral Brain Hemorrhage,Cerebral Brain Hemorrhages,Cerebral Hemorrhages,Cerebral Parenchymal Hemorrhages,Cerebrum Hemorrhage,Cerebrum Hemorrhages,Hemorrhage, Cerebral Brain,Hemorrhage, Cerebral Parenchymal,Hemorrhage, Intracerebral,Hemorrhages, Cerebral,Hemorrhages, Cerebral Brain,Hemorrhages, Cerebral Parenchymal,Hemorrhages, Cerebrum,Hemorrhages, Intracerebral,Intracerebral Hemorrhages,Parenchymal Hemorrhage, Cerebral,Parenchymal Hemorrhages, Cerebral
D002560 Cerebrovascular Circulation The circulation of blood through the BLOOD VESSELS of the BRAIN. Brain Blood Flow,Regional Cerebral Blood Flow,Cerebral Blood Flow,Cerebral Circulation,Cerebral Perfusion Pressure,Circulation, Cerebrovascular,Blood Flow, Brain,Blood Flow, Cerebral,Brain Blood Flows,Cerebral Blood Flows,Cerebral Circulations,Cerebral Perfusion Pressures,Circulation, Cerebral,Flow, Brain Blood,Flow, Cerebral Blood,Perfusion Pressure, Cerebral,Pressure, Cerebral Perfusion
D005260 Female Females
D006439 Hemodynamics The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM. Hemodynamic

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