Cerebral Hemodynamic Effects of Cheyne-Stokes Respiration in a Patient with Stroke.
BACKGROUND
Cheyne-Stokes respiration (CSR) and central sleep apnea (CSA) are common in patients with heart failure and/or stroke. We aim to describe the cerebrovascular effects of CSR during the acute phase of stroke in a heart failure patient.


METHODS
A 74-year-old male with previous dilated cardiomyopathy had sudden onset of right hemiparesis and aphasia. A transcranial Doppler was performed with continuous measurement of blood pressure (BP) (Finometer) and end-tidal CO2(nasal capnography). Offline analysis of hemodynamic data disclosed relatively large periodic oscillations of both cerebral blood flow velocity and BP related to the CSR breathing pattern. Derivate variables from the cerebrovascular resistance were calculated (critical closing pressure and resistance-area product), demonstrating that there may be a myogenic impairment of cerebral blood flow (CBF) control in the affected hemisphere of this subgroup of patient.


CONCLUSIONS
There is an impairment of CBF regulation in the affected hemisphere of the patient with ischemic stroke and CSR, highlighting the role of cerebral hemodynamic monitoring in this scenario.
Department of Neurology, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: rcnogueira28@gmail.com.
R C
RC
Nogueira
Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; Biomedical Research Unit in Cardiovascular Science, Glenfield Hospital, Leicester LE3 9QP, UK.
R B
RB
Panerai
Department of Neurosurgery, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil.
M J
MJ
Teixeira
Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; Biomedical Research Unit in Cardiovascular Science, Glenfield Hospital, Leicester LE3 9QP, UK.
T G
TG
Robinson
Department of Neurosurgery, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil.
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E
Bor-Seng-Shu
D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002560:Cerebrovascular Circulation; D002639:Cheyne-Stokes Respiration / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006439:Hemodynamics; D006706:Homeostasis; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D015656:Respiratory Mechanics; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014655:Vascular Resistance
Cheyne–Stokes; Ischemic stroke; cerebral autoregulation; cerebral blood flow control; transcranial Doppler and ultrasound