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Hypercapnia impact on vascular and neuronal reactivity in patients before and after carotid endarterectomy
Ostrý, Svatopluk ; Stejskal, Lubor (advisor) ; Šonka, Karel (referee) ; Zvěřina, Eduard (referee)
Indications for carotid endarterectomy (CEA) of symptomatic and asymptomatic internal carotid artery (ICA) stenosis were based on numerous randomised studies. The benefit was rated relative to the lowered risk of ipsilateral stroke relapse. There is evidence that rCBF correlates with brain electrical activity (EEG, SEPs). Somatosensory function is represented by evoked neuronal activity in central region. Can the neuronal activity in primary somatosensory cortex be influenced by hypercapnia-induced increased rCBF or CEA in patients with ICA stenosis or is a change such as that permanent? The aim of the present study was to determine whether CEA in unilateral symptomatic stenosis in the extracranial vascular system had a bearing on neuronal activity in the central region of the cerebral cortex. Material and methods The criteria for enrollment in the study were a history of ischaemic insult (TIA, RIND, minor stroke) less than six weeks before admission and unilateral stenosis of the ICA of 70-99 % measured on the DSA with the NASCET method. Patients were divided inti two groups: Group A (28 men and 13 women) with their initial NIHSS ≤ 2. Group B consisted of 12 men and 5 women, starting NIHSS was from 3 to 8. All patients were examined before CEA, on post-operative days 3-7 and 3 months after CEA. SEPs ans...
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Residual cognitive capacity in unconscious patients. Event related potentials and cerebral blood flow study
Holečková, Irena ; Choc, Milan (advisor) ; Polívka, Jiří (referee) ; Rektor, Ivan (referee) ; Stejskal, Lubor (referee)
UNIVERSITÉ CLAUDE BERNARD LYON 1 - LYON Ecole Doctorale Biologie Moléculaire Intégrée et Cognitive Année Universitaire 2007 - 2008 UNIVERZITA KARLOVA V PRAZE Lékařská fakulta v Plzni Vědní obor : chirurgické obory THESE EN COTTUTELLE FRANCO - TCHEQUE Irena HOLEČKOVÁ Neurochirurgické oddělení Fakultní nemocnice v Plzni Capacités cognitives chez les patients inconscients Étude des potentiels évoqués cognitifs et du débit sanguin cérébral Kognitivní kapacita u pacientů s poruchou vědomí Studie kognitivních evokovaných potenciálů a mozkového krevního průtoku Cognitive capacity in unconscious patients Event related potentials and cerebral blood flow study 2008 Ce travail de thèse a reçu le soutien financier de l'Ambassade de France en République Tchèque L'ensemble des travaux a été réalisé dans le Service de Neurophysiologie Clinique et Epileptologie de l'Hôpital Neurologique de Lyon, au sein de l'équipe de l' Unité INSERM 821 et au sein de CERMEP-imagerie du vivant de Lyon, France. Remerciements Le mot remerciement s'avère insuffisant pour exprimer ma reconnaissance envers Madame Catherine Fischer, Chargée de recherche, pour avoir diriger ce travail. Sa compétence, ses conseils ont été essentiels à la réalisation de cette thèse. Je vous remercie de m'avoir «ouvert les oreilles» au domaine passionnant des...
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Unruptured intracranial aneurysms : Does the risk of endovascular treatment outweigh natural history?
Beneš, Vladimír ; Stejskal, Lubor (advisor) ; Haninec, Pavel (referee) ; Janoušková, Ladislava (referee)
Summary: Background: The management of unruptured intracranial aneurysms (UIAs) remains controversial. The international study of UIAs (ISUIA) found low rates of rupture and appreciable treatment risks, which can be interpreted that many UIAs should not be treated. Results of endovascular coiling of 131 patients with UIAs are presented along with a risk-benefit analysis based on patient and aneurysm characteristics. Patients and methods: From December 1996 to September 2005, 131 patients (93 women and 38 men, mean age 51 years) with 151 UIAs were treated using detachable coil embolisation. Data on procedural complications, patient and aneurysm characteristics, clinical and radiological follow-up were entered into a prospectively collected database. A risk-benefit analysis was performed. Results: Endovascular treatment was successful in 145 (96%) aneurysms. One aneurysm ruptured intraoperatively with a fatal outcome. Ten thromboembolic events occurred, leaving one patient moderately disabled. The combined morbidity and mortality rate at 6 months per patient is 1,5% (95% confidence interval: 0,07 - 5,7%). Risk-benefit analysis comparing these data with published natural history suggests that treatment with low complication rates can be offered to most patients with UIAs. Conclusion: UIAs can be coiled with...
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Unruptured intracranial aneurysms : Does the risk of endovascular treatment outweigh natural history?
Beneš, Vladimír ; Stejskal, Lubor (advisor) ; Haninec, Pavel (referee) ; Janoušková, Ladislava (referee)
Summary: Background: The management of unruptured intracranial aneurysms (UIAs) remains controversial. The international study of UIAs (ISUIA) found low rates of rupture and appreciable treatment risks, which can be interpreted that many UIAs should not be treated. Results of endovascular coiling of 131 patients with UIAs are presented along with a risk-benefit analysis based on patient and aneurysm characteristics. Patients and methods: From December 1996 to September 2005, 131 patients (93 women and 38 men, mean age 51 years) with 151 UIAs were treated using detachable coil embolisation. Data on procedural complications, patient and aneurysm characteristics, clinical and radiological follow-up were entered into a prospectively collected database. A risk-benefit analysis was performed. Results: Endovascular treatment was successful in 145 (96%) aneurysms. One aneurysm ruptured intraoperatively with a fatal outcome. Ten thromboembolic events occurred, leaving one patient moderately disabled. The combined morbidity and mortality rate at 6 months per patient is 1,5% (95% confidence interval: 0,07 - 5,7%). Risk-benefit analysis comparing these data with published natural history suggests that treatment with low complication rates can be offered to most patients with UIAs. Conclusion: UIAs can be coiled with...
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Residual cognitive capacity in unconscious patients. Event related potentials and cerebral blood flow study
Holečková, Irena ; Choc, Milan (advisor) ; Polívka, Jiří (referee) ; Rektor, Ivan (referee) ; Stejskal, Lubor (referee)
UNIVERSITÉ CLAUDE BERNARD LYON 1 - LYON Ecole Doctorale Biologie Moléculaire Intégrée et Cognitive Année Universitaire 2007 - 2008 UNIVERZITA KARLOVA V PRAZE Lékařská fakulta v Plzni Vědní obor : chirurgické obory THESE EN COTTUTELLE FRANCO - TCHEQUE Irena HOLEČKOVÁ Neurochirurgické oddělení Fakultní nemocnice v Plzni Capacités cognitives chez les patients inconscients Étude des potentiels évoqués cognitifs et du débit sanguin cérébral Kognitivní kapacita u pacientů s poruchou vědomí Studie kognitivních evokovaných potenciálů a mozkového krevního průtoku Cognitive capacity in unconscious patients Event related potentials and cerebral blood flow study 2008 Ce travail de thèse a reçu le soutien financier de l'Ambassade de France en République Tchèque L'ensemble des travaux a été réalisé dans le Service de Neurophysiologie Clinique et Epileptologie de l'Hôpital Neurologique de Lyon, au sein de l'équipe de l' Unité INSERM 821 et au sein de CERMEP-imagerie du vivant de Lyon, France. Remerciements Le mot remerciement s'avère insuffisant pour exprimer ma reconnaissance envers Madame Catherine Fischer, Chargée de recherche, pour avoir diriger ce travail. Sa compétence, ses conseils ont été essentiels à la réalisation de cette thèse. Je vous remercie de m'avoir «ouvert les oreilles» au domaine passionnant des...
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Hypercapnia impact on vascular and neuronal reactivity in patients before and after carotid endarterectomy
Ostrý, Svatopluk ; Stejskal, Lubor (advisor) ; Šonka, Karel (referee) ; Zvěřina, Eduard (referee)
Indications for carotid endarterectomy (CEA) of symptomatic and asymptomatic internal carotid artery (ICA) stenosis were based on numerous randomised studies. The benefit was rated relative to the lowered risk of ipsilateral stroke relapse. There is evidence that rCBF correlates with brain electrical activity (EEG, SEPs). Somatosensory function is represented by evoked neuronal activity in central region. Can the neuronal activity in primary somatosensory cortex be influenced by hypercapnia-induced increased rCBF or CEA in patients with ICA stenosis or is a change such as that permanent? The aim of the present study was to determine whether CEA in unilateral symptomatic stenosis in the extracranial vascular system had a bearing on neuronal activity in the central region of the cerebral cortex. Material and methods The criteria for enrollment in the study were a history of ischaemic insult (TIA, RIND, minor stroke) less than six weeks before admission and unilateral stenosis of the ICA of 70-99 % measured on the DSA with the NASCET method. Patients were divided inti two groups: Group A (28 men and 13 women) with their initial NIHSS ≤ 2. Group B consisted of 12 men and 5 women, starting NIHSS was from 3 to 8. All patients were examined before CEA, on post-operative days 3-7 and 3 months after CEA. SEPs ans...
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