Detection of hemodynamic transient ischemic attack during hemodialysis with near-infrared monitoring in a patient with internal carotid artery occlusion.
BACKGROUND
It is still difficult to directly prove the involvement of hemodynamic ischemia in ischemic attacks in patients with occlusive carotid artery diseases.


METHODS
In this report, we describe the case of a 52-year-old woman with right ICA occlusion who experienced repeated transient weakness of the left extremities during HD for chronic renal failure. Single-photon emission computed tomography showed reductions in CBF and CVR to acetazolamide in the right hemisphere. Real-time NIRS monitoring clearly showed a deterioration in the cerebral oxygenation state in the right hemisphere in response to a BP decrease during HD. Superficial temporal artery-MCA anastomosis improved SPECT as well as NIRS findings and resolved ischemic attacks during HD.


CONCLUSIONS
This is the first study to show that NIRS can be a useful tool in detecting hemodynamic ischemia in patients with impaired cerebral perfusion reserves noninvasively and in real time.
Kashiwazaki
Daina
D
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
Kuroda
Satoshi
S
Terasaka
Shunsuke
S
Iwasaki
Yoshinobu
Y
D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D006435:Renal Dialysis / Q000009:adverse effects*; D019265:Spectroscopy, Near-Infrared