Near Infrared Spectroscopy for the Detection of Desaturations in Vulnerable Ischemic Brain Tissue

Abstract

Background and Purpose-There is uncertainty whether bilateral near infrared spectroscopy (NIRS) can be used for monitoring of patients with acute stroke. Methods-The NIRS responsiveness to systemic and stroke-related changes was studied overnight by assessing the effects of brief peripheral arterial oxygenation and mean arterial pressure alterations in the affected versus nonaffected hemisphere in 9 patients with acute stroke. Results-Significantly more NIRS drops were registered in the affected compared with the nonaffected hemisphere (477 drops versus 184, PϽ0.001). In the affected hemispheres, nearly all peripheral arterial oxygenation drops (nϭ128; 96%) were detected by NIRS; in the nonaffected hemispheres only 23% (nϭ30; Pϭ0.17). Only a few mean arterial pressure drops were followed by a significant NIRS drop. This was however significantly different between both hemispheres (32% versus 13%, Pϭ0.01). Conclusions-This pilot study found good responsiveness of NIRS signal to systemic and stroke-related changes at the bedside but requires confirmation in a larger sample. (Stroke. 2012;43:1134-1136.)

Microvascular cerebral blood flow fluctuations in association with apneas and hypopneas in acute ischemic stroke

“…There was no interhemispheric difference between the maximum increases (p ¼ 0.189) or the maximum decreases (p ¼ 0.053). However, this result suggested a trend toward a potential difference between hemispheres, as it has been previously found by NIRS-DOS, 25,26 as mentioned in Sec. 1.…”

“…Fluctuations of cerebral hemodynamics have previously been observed in acute stroke patients. A study of nine patients with acute stroke 25 reported arterial desaturations from unknown origin that correlated with cerebral hemodynamics measured with near-infrared diffuse optical spectroscopy (NIRS-DOS), and showed an asymmetry of the changes in the two cerebral hemispheres. Pizza et al 26 observed in seven patients with acute/subacute middle cerebral artery stroke that obstructive and central apneas were linked to cerebral oxygenation changes by NIRS-DOS.…”

Prehospital stroke care, a narrative review

“…Current pilot studies are underway investigating this noninvasive method of monitoring patients in and around the early post-stroke period. [21] It may be potentially feasible for near-infrared technology to be used in the evaluation of large volume ischemic stroke and adapted for prehospital stroke evaluation. Small, mobile probes could 1 day be incorporated into all emergency medical vehicles and serve as a cost-effective screening tool without the need for CT scanners built into every ambulance.…”

Quantification of blood-brain barrier permeability by dynamic contrast-enhanced NIRS

“…Nevertheless, there is a continuing effort to develop optical methods that can more directly target key cerebral parameters such as CBF and cerebral oxidative metabolism 25, 26 . DCE NIRS is one such approach and has been previously used to detect CBF abnormalities in stroke patients 15, 27 and in animal models of cerebral ischemia 16 . The work presented in this study extends the potential clinical utility of NIRS by presenting a DCE method of assessing BBB integrity.…”