Volume 03 Issue 06-2023
70
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
06
P
AGES
:
70-78
SJIF
I
MPACT
FACTOR
(2021:
5.
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(2023:
6.
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OCLC
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1121105677
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ABSTRACT
This article discusses the characteristics of cerebral hemodynamics in patients with post-COVID syndrome. In a
comprehensive clinical examination of patients, the generally accepted clinical examination of the somatic status,
laboratory research methods, and instrumental research methods (USDG of the arteries and veins of the head and
neck) were used.
KEYWORDS
Characteristics of cerebral hemodynamics, post-COVID syndrome, clinical examination, somatic status, laboratory
research methods, instrumental research.
INTRODUCTION
Studies have shown that individuals after respiratory
distress syndrome experience deficits in memory,
attention, fluency, information processing speed and
control functions, while 30 to 80% of patients continue
to show cognitive impairment a year after atypical
acute respiratory distress syndrome ( 2,4,8).
To be sure, a large number of severe cases of COVID 19
are associated with pre-existing conditions that are
also associated with neuropsychological deficits,
Research Article
CHARACTERISTICS OF CEREBRAL HEMODYNAMICS IN PATIENTS WITH
POST-COVID SYNDROME
Submission Date:
June 14, 2023,
Accepted Date:
June 19, 2023,
Published Date:
June 24, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue06-15
J. A. Nazarova
Center For The Development Of Professional Qualifications Of Medical Workers, Uzbekistan
G.G. Urinova
Andijan State Medical Institute, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 06-2023
71
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
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P
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:
70-78
SJIF
I
MPACT
FACTOR
(2021:
5.
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(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
including hypertension, diabetes, cardiovascular
disease, cancer, and chronic respiratory disease (3,
6,7). Because of this, it is necessary to study the
complex factors and medical complications faced by
patients after COVID 19, as the exact nature and extent
of the neuro-psychological deficit experienced by
COVID 19 survivors has not yet been established, the
results are likely to vary widely in depending on a
number of clinical factors and individual differences.
Purpose of the study. To evaluate the features of
Doppler characteristics of cerebral hemodynamics in
patients with post-COVID syndrome.
Material and research methods. The study included 87
young patients aged 18 to 44 years (mean age 31.9±12.1
years) with post-covid syndrome (PCS) (Fig. 1). The
patients were divided into two groups: group I
consisted of 36 women (41.4%), group II - 51 men
(58.6%), gender index was 1.4:1.0.
Figure 1. Distribution of patients by sex.
The control group (CG) included healthy individuals
comparable with those of the main group in terms of
sex and age characteristics (n=20; mean age 32.4±7.3
years; gender index 1,0:1,2).
The diagnosis of post-COVID syndrome was included in
the International Classification of Diseases (ICD-10),
heading code U09.9 “Post
-COVID-19 condition,
unspecified”, which also includes post
-COVID state (5).
Patients were observed in the conditions of the
neurological and therapeutic departments in the
regional hospital of the city of Andijan.
Volume 03 Issue 06-2023
72
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
06
P
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:
70-78
SJIF
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(2021:
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5.
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(2023:
6.
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OCLC
–
1121105677
Publisher:
Oscar Publishing Services
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In a comprehensive clinical examination of patients,
the generally accepted clinical examination of the
somatic status, laboratory research methods, and
instrumental research methods (USDG of the arteries
and veins of the head and neck) were used.
Statistical significance of the results was assessed
using Student's test of significance (t) for parametric
distribution and Fisher's test (F) for nonparametric
data distribution. Differences were considered
significant at 95% confidence interval (P≤0.05
).
Research results. In the study of Doppler ultrasound of
patients with PCS, it was found that in women the
percentage of patients with vasodilation and a
combination of vasodilation with venous congestion is
significantly higher than in male patients (Fig. 2).
Figure 2. Ultrasound parameters in patients with PCS
So these figures were 22.2% and 13.9% versus 15.7% and
17.6% respectively. Vasospasm was significantly more
common in the group of male patients - 37.3% versus
30.6% of female patients. Vasospasm reserves were
found to be reduced in 57% of patients with PCS.
Structural features of the cerebrovascular system in
young patients with PCS and the state of extra- and
intracranial cerebral arteries in patients with PCS were
assessed by non-invasive methods, such as DS, TCD.
The course of the carotid arteries in patients of both
groups was physiological, which did not distinguish
them from patients in the control group.
Table 1
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Features of the course of the vertebral arteries in patients with PCS
Sign
I group
II group,
Control n=20
women, n=36
men, n=51
аbс
%
аbс
%
аbс
%
Bending in V1
pPa
5
13,9%
7
13,7%
2
10,0%
Bending in V1
lPa
1
2,8%
3
5,9%
1
5,0%
Total in V1
5
13,9%
8
15,7%
3
15,0%
Bending in V2
pPa
2
5,6%
3
5,9%
1
5,0%
Bending in V2
lPa
0
0,0%
0
0,0%
0
0,0%
Total in V1 and
V2
6
16,7%
9
17,6%
3
15,0%
High entry of
pPA
2
5,6%
3
5,9%
1
5,0%
High LPA entry
2
5,6%
3
5,9%
1
5,0%
Non-rectilinear
course of PA
7
19,4%
11
21,6%
3
15,0%
Note: * - significant differences.
The internal diameters of the ICA in patients with PCS
were smaller (p<0.001) than in CG patients. The course
of PA was more variable (tpb. 1). Patients with PCS
were significantly more likely to have non-straight VA
course, asymmetry of their internal diameters, and
hypoplasia of one of the vertebral arteries. Structural
changes were observed more often in males (Table 2).
Table 2
Hypoplasia of the PA and asymmetry of the internal diameters of the PA in patients with PCS
Volume 03 Issue 06-2023
74
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
03
ISSUE
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70-78
SJIF
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(2021:
5.
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(2022:
5.
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)
(2023:
6.
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)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
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Sign
I group
II group,
Control n=20
women, n=36 men, n=51
аbс
%
аbс
%
аbс
%
Hypoplasia pPA
4
11,1%
8
15,7%
2
10,0%
LPA hypoplasia
7
19,4%
11
21,6%
1
5,0%
Total
11
30,6%
19
37,3%
3
15,0%
Asymmetry of
internal diameters
of PA
9
25,0%
16
31,4%
3
15,0%
Note: * - significant differences.
Analysis of SCR in CCA in PCS showed a slight decrease
in the left OSA (26.5 cm/s; ) compared with the control
group (30.9 cm/s; p<0.05). Here and below, the data
are presented as the arithmetic mean (M) and standard
deviation (a) (Fig. 3).
Assessing the linear velocity of blood flow, it can be
stated that as the disease progresses, a decrease in
SCR occurs. Attention is drawn to the fact that a
significant decrease in SCR is more typical for men.
Figure 3. SCR on the left CCA in PCS.
In order to assess hemodynamic changes in PCS, the volumetric blood flow rate Q (in ml/min) in the CA and VA was
studied, as well as the total volumetric velocity Qsumm (Table 3).
Volume 03 Issue 06-2023
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(2023:
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Publisher:
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Table 3
Volumetric blood flow data (Q, ml/min) intracranial arteries in PCS
Q
I group, women,
n=36
II group, men,
n=51
CA
CCA
545,2 ± 71,5
495,8 ± 96,1 *
523,6 ± 89,3
ICA
274,1 ± 48,4
246,2 ± 39,4 *
292,6 ± 68,5
PA
92,5 ± 26,1
81,6 ± 29,3
96,3 ± 35,5
Qsumm
754,7 ± 15,1
634,4 ± 106,1
*
798,4 ± 84,7
The main method for assessing the functional
characteristics of the cerebrovascular system in
patients with PCS was TCDG with the determination of
cerebrovascular reactivity (CVR).
Hemodynamics in the carotid system in patients with
PCS was characterized by significantly higher linear
blood flow velocity (BFV) (p<0.001) and increased
circulatory indices RI and PI (p<0.001). In combination
with a significantly smaller diameter of the ICA in
patients with PCS, this is a compensatory reaction that
occurs under the influence of the system of
autoregulation of cerebral circulation and is aimed at
maintaining adequate blood flow in the carotid artery
system.
When comparing hemodynamic parameters in the
carotid pools in patients identified in accordance with
the type of initial autonomic tone of the subgroups,
only significantly significant differences were obtained
in the parameters of each of the subgroups with the
control group, and not between the subgroups.
The most pronounced differences with the control
group were noted in patients of subgroups 1 and 2
(sympathicotonic and mixed variant of autonomic
dysfunction), where the highest values of systolic and
mean SCR and PI were recorded, which can be
explained by the predominant influence of the
sympathetic nervous system. However, both in
vagotonics and even in patients with eutonia, higher
SCR values were revealed than in the control group.
This is evidence that the identified changes are
certainly associated with concomitant CTD autonomic
dysfunction, but they can probably be interpreted in
terms of pronounced dysplastic-dependent structural
and functional changes in the resistive vessels of the
cerebral circulatory system in the structure of the PCS
vascular syndrome. Thus, the intense work of the
autoregulatory system in patients with PCS is even
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more complicated in the presence of concomitant SVD,
especially its sympathicotonic variant.
Hemodynamic parameters in the vertebrobasilar
system also differed significantly in patients with PCS
and in the control group. However, such a significant
increase in systolic SCR was not observed here, as in
the carotid basins, with the exception of the left VA, in
which Vs was significantly higher. The increase in Vs in
the left VA may be compensatory and is due to the fact
that in this study, in patients with PCS, hypoplasia of
the left VA occurred 2 times more often than the right
one. When evaluating hemodynamic parameters in
patients with PCS, it should be noted that there were
no significant differences in SCR and PI between
groups.
CVR is the most significant parameter for the
functional assessment of cerebral blood flow. The
vasomotor reactivity index (VMI) in patients with PCS
is significantly higher (p<0.001), the values of the
coefficient of reactivity to hypercapnic load are also
higher (p<0.001) than in the control group, while the
values of the coefficient of reactivity to hypocapnic
load are lower than in the control group (p<0.05).
Autoregulation threshold shift index (ATSI) in patients
with PCS is significantly lower (p<0.01) than in the
control group.
All complaints presented by patients were associated
with PCS. In the case of complaints of discomfort in the
region of the heart, a moderate positive correlation
(r=0.45; p<0.001), with complaints of palpitations, a
positive weak correlation (r=0.26; p=0.003), with
complaints of interruptions in the region of the heart -
a moderate positive relationship (r=0.34; p<0.001).
In patients with PCS, a correlation was found between
complaints of headache and the values of the
diameters of the ICA (moderate negative; r=-0.43),
IVMR (moderate positive; r=0.63) and the value of the
coefficient of reactivity to hypercapnic load Vm Kp+
(moderate positive; r=0.38). Thus, headache in young
patients with PCS is a pain of a vascular nature, for
which
there
is
anatomical
and
functional
preconditioning.
Complaints of dizziness are associated with the non-
rectilinear course of the vertebral arteries (moderate
positive correlation; r=0.69), asymmetry of the internal
diameters of the vertebral arteries (moderate positive
correlation; r=0.38), high entry of the vertebral arteries
into the canal of the transverse processes of the
cervical vertebrae (weak positive relationship; r=0.30)
and hypoplasia of the vertebral arteries (weak positive
relationship; r=0.19). That is, dizziness in young
patients with PCS is also vascular in nature.
The study revealed that the internal diameters of the
ICA in patients with PCS are smaller. The dependence
of the ICA diameters on the diameters of the common
carotid arteries (CCA) is determined. The relationship is
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positive of medium strength (r=0.62). Significance level
is high: p<0.001. Regression analysis yielded the
following equation: y=0.16+0.49*x, where x is the
diameter of the common carotid arteries and y is the
diameter of the internal carotid arteries.
IVMR in patients with PCS is significantly higher than in
patients of the control group. A correlation is revealed
between the value of IMRI and the values of the
diameters of the CCA and ICA. In the case of OSA, this
relationship is negative and moderate (r=-0.36), with a
significance level of <0.001; with ICA - negative strong
relationship (r=-0.78), at a significance level of <0.001.
CONCLUSION
In young patients with post-covid syndrome, the ability
to vasoconstriction is reduced, because. under the
influence of the autoregulation system, the vessel is
initially narrowed, which, in turn, increases the ability
to vasodilate. The existing shift in autoregulation
indicates that the reserve has already been activated,
the remaining reserve possibilities for compensating
for anatomical and functional changes are limited.
Significantly significant differences in the above
indicators of reactivity between male and female
patients were not obtained.
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