Karakteristike akustičnih evociranih potencijala kod bolesnika sa hipoplazijom vertebralne arterije i moždanim udarom u vertebrobazilarnom slivu
Sažetak
Uvod/Cilj. Akustični evocirani potencijali (AEP) predstavljaju elektrofiziološku metodu koja se koristi u dijagnostici patoloških promena moždanog stabla, akustičnog nerva (njegovog perifernog i centralnog dela), kod bolesnika u komi, kod potvrđivanja moždane smrti itd. Odgovor uključuje sedam negativnih talasa koji se generišu u strukturama moždanog stabla vaskularizovanih arterijama zadnjeg sliva. Ipak, u svakodnevnoj praksi se zbog svoje konstantnosti prati prvih pet talasa. Pretpostavlja se da hipoplazija vertebrlne arterije (HVA) utiče na nalaz AEP. Važeća definicija HVA obuhvata kriterijum da je dijametar krvnog suda ≤ 2 mm i da je odnos dijametara leve i desne vertebralne arterije ≥ 1 : 1,7. HVA se sreće u 5,3% slučajeva ukupne populacije i njeno prisustvo povećava rizik od infarkta mozga u zadnjem slivu (posterior circulation stroke – PCS). Cilj istraživanja bio je da ukaže na veću učestalost patoloških nalaza AEP kod bolesnika sa HVA i PCS i da pokaže karakteristike AEP u toj grupi bolesnika. Metode.
Sprovedena je prospektivna studija koja je obuhvatila 163 bolesnika sa PCS, u periodu od dve godine. Metodama kompjuterizovane tomografije (KT) i magnetne rezonance (MR) ustanovljena je dijagnoza PCS. Sumnja na postojanje HVA nakon Color Doppler ultrasonografije potvrđivana je KT i MR angiografijom. Svim bolesnicima urađeno je AEP ispitivanje. Praćene su promene talasnih amplituda i intertalasne latence (ITL). Rezultati. Nije postojala statistički značajna razlika između polova (χ2 = 1,823; p = 0,176) i godina starosti bolesnika u odnosu na prisustvo HVA (p = 0,815). Statistički značajno veći broj bolesnika sa višestrukim PCS imalo je pozitivan nalaz HVA (grupa HVA – 42,3%) u odnosu na bolesnike koji nisu imali HVA (grupa bezHVA – 26,6%) (χ2 = 4,278; p = 0,038). Statistički značajno veći broj patoloških AEP nalaza ustanovljen je kod bolesnika u grupi koja je imala PCS i HVA (χ2 = 4,899; p = 0,026). Utvrđeno je postojanje statistički značajne promene ITL praćene talasima niske amplitude u grupi HVA (χ2 = 4,465; p = 0,034). Zaključak. Distribucija HVA ne zavisi od pola ni starosti. Statistički značajno je veća učestalost patološkog AEP nalaza (prisustvo udruženih promena amplituda talasa i produženih ITL) kod bolesnika sa HVA i PCS.
Reference
Berger JR, Blum AS. Brainstem Auditory Evoked Potentials. In: Blum AS, Rutkove SB, editors. The Clinical Neurophysiolo-gy Primer. New Jersey: Humana Press; 2007. pp. 475–84.
Baran G, Gultekin TO, Baran O, Deniz C, Katar S, Yildiz GB, et al. Association between etiology and lesion site in ischaemic brainstem infarcts: a retrospective observational study. Neu-ropsychiatr Dis Treat 2018; 14: 757–66.
Thai-Van H, Cozma S, Boutitie F, Disant F, Truy E, Collet L. The pattern of auditory brainstem response wave V matura-tion in cochlear-implanted children. Clin Neurophysiol 2007; 118(3): 676–89.
Passero S, Nuti D. Auditory and vestibular system findings in patients with vertebrobasilar dolichoectasia. Acta Neurol Scand 1996; 93(1): 50–5.
Henry-Le Bras F, Fischer C, Nighoghossian N, Salord F, Trouillas P, Mauguière F. Early and middle latency auditory evoked po-tentials in vertebrobasilar strokes. Neurophysiol Clin 1994; 24(6): 399–412. (French)
De Biase S, Gigli GL, Lorenzut S, Bianconi C, Sfreddo P, Rossato G, et al. The importance of polysomnography in the evalua-tion of prolonged disorders of consciousness: sleep recordings more adequately correlate than stimulus-related evoked po-tentials with patients' clinical status. Sleep Med 2014; 15(4): 393–400.
Rogowski M, Michalska BI. The importance of brain stem evoked potentials in the diagnosis of neurosurgical patients. Neurol Neurochir Pol 2001; 35(4): 667–79. (Polish)
Iakupov EZ, Kuznetsova EA. Evoked potentials in patients with secondary headaches. Zh Nevrol Psikhiatr Im S S Korsakova 2010; 110(1): 73–7. (Russian)
Jiang ZD, Zhou Y, Yin R, Wilkinson AR. Amplitude reduction in brainstem auditory response in term infants under neonatal intensive care. Clin Neurophysiol 2013; 124(7): 1470–6.
Živadinovic B, Stamenović J, Ljubisavljevic S. The comparative analyses of the auditory evoked potentials and color Doppler sonography findings in patients diagnosed with vertebrobasilar insufficiency. Neurol Res 2014; 36(11): 939–44.
Živadinović B, Đurić S, Jolić M, Stamenović J. Diagnostic im-portance of auditory brainstem potentials of patients with ver-tebrobasilar insufficiency. Mak Med Pregl 2004; 58(supp1.61): 55.
Wang H, Zhou H, Guo Y, Wang H. Value of high-frequency stimulation ABR in the diagnosis and treatment of posterior circulation ischemia. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 26(16): 724–6.
Stone JL, Fino J, Patel K, Calderon-Arnulphi M, Suss N, Hughes JR. Modified brain stem auditory evoked potentials in patients with intracranial mass lesions. Clin EEG Neurosci 2012; 43(4): 291–302.
Chuang YM, Chan L, Wu HM, Lee SP, Chu YT. The clinical relevance of vertebral artery hypoplasia. Acta Neurol Taiwan 2012; 21(1): 1–7.
Katsanos A, Kosmidou M, Kyritsis AP, Giannopoulos S. Is verte-bral artery hypoplasia a predisposing factor for posterior circu-lation cerebral ischemic events? A comprehensive review. Eur Neurol 2013; 70(1–2): 78–83.
Antić S. Vascularization of the central nervous system. In: Pav-lović S, Stefanović N, Vučetić R, Antić S, Čukuranović R, Arsić S, editors. Anatomy of the central nervous system and senses. Niš: Sven; 2006. p. 48–157. (Serbian)
Mitsumura H, Miyagawa S, Komatsu T, Hirai T, Kono Y, Iguchi Y. Relationship between Vertebral Artery Hypoplasia and Poste-rior Circulation Ischemia. J Stroke Cerebrovascular Dis 2016; 25(2): 266–9.
Iqbal S. Vertebrobasilar variants and their basic clinical impli-cations. Int J Med Res Health Sci 2013; 2(4): 799–808.
Szárazová AS, Bartles E, Turčáni P. Vertebral artery hypoplasia and the posterior circulation stroke. Perspect Med 2012; 1(1–12): 198–202.
Vilimas A, Barkauskas E, Vilionskis A, Rudzinskaitë J, Morkûnaitë R. Vertebral artery hypoplasia: importance for stroke development, the role of posterior communicating ar-tery, possibility for surgical and conservative treatment. Acta medica Lituanica 2003; 10(2): 110–4.
Demarin V, Škarić-Jurić T, Lovrencić-Huzjan A, Puretić MB, Vuković V. Vertebral artery hypoplasia-sex-specific frequen-cies in 36 parent-offspring pairs. Coll Antropol 2001; 25(2): 501–9.
Chen YY, Chao AC, Hsu HY, Chung CP, Hu HH. Vertebral ar-tery hypoplasia is associated with a decrease in net vertebral flow volume. Ultrasound Med Biol 2010; 36(1): 38–43.
Hendrikse J, van Raamt AF, van der Graaf Y, Mali WP, van der Grond J. Distribution of cerebral blood flow in the circle of Willis. Radiology 2005; 235(1): 184–9.
Zhu W, Wang YF, Dong XF, Feng HX, Zhao HQ, Liu CF. Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction. Acta Neurol Belg 2016; 116(3): 287–93.
Hong JM, Chung CS, Bang OY, Yong SW, Joo IS, Huh K. Verte-bral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neuro-surg Psychiatry 2009; 80(10): 1087–92.
Lin Y, Zhang L, Bao J, Zhang B, Li H, Chen S, et al. Risk fac-tors and etiological subtype analysis of brainstem infarctions. J Neurol Sci 2014; 338(1–2): 118–21.
Gaigalaite V, Vilimas A, Ozeraitiene V, Dementaviciene J, Janilio-nis R, Kalibatiene D, et al. Association between vertebral artery hypoplasia and posterior circulation stroke. BMC Neurol 2016; 16: 118.
Thorwirth V, Volles E, Lossi C, Grunwald F. Auditory evoked brain stem potentials, visual pattern evoked and somatosenso-ry evoked potentials in transient ischemic attacks (TIA). Schweiz Arch Neurol Neurochir Psychiatr 1983; 132(1): 41–54. (German)
Drake ME Jr, Pakalnis A, Padamadan H, Hietter SA. Auditory evoked potentials in vertebrobasilar transient ischemic at-tacks. Clin Electroencephalogr 1990; 21(2): 96–100
Moncho D, Poca MA, Minoves T, Ferré A, Rahnama K, Sahuquillo J. Brainstem auditory evoked potentials and somatosensory evoked potentials in Chiari malformation. Rev Neurol 2013; 56(12): 623–34. (Spanish)
Pandey P, Kansara A, Thirumala P, Tamkus AA, Xavier AR. Neurophysiological monitoring with brainstem evoked poten-tials can be a valuable tool for patients undergoing vertebro-basilar stenting and angioplasty-initial experience. J Clin Neu-rophysiol 2013; 30(1): 55–8.
Yoshikatsu S, Masahiro S, Makoto H, Syuichi M. Topographical Relationships Between the Brainstem Auditory and Soma-tosensory Evoked Potentials and the Location of Lesions in Posterior Fossa Stroke. Neurol Med Chir 2003; 43(6): 282–92.