Which is better, rheoencephalography or Doppler ultrasound?

Rheoencephalography of cerebral vessels is a simple but effective diagnostic method. As a result of this procedure, pathological processes such as circulatory disorders, as well as other deviations from the normal functioning of this important organ are identified. The method is popular with patients and doctors. This is explained not so much by the affordability of the examination, but by its high information content and the ability to quickly obtain accurate results. A big advantage over other methods of examining cerebral vessels is its minimal invasiveness, which becomes a factor favoring the use of this diagnostic even for pediatric patients.

General information about the method

Rheoencephalography (REG) makes it possible to identify circulatory disorders in the brain even in the early stages of pathology and thereby prevent the development of complications that pose a danger to the health and life of patients. Its invaluable advantage over MRI and CT is the ability to be examined without waiting in line, which in other places is about six months. Without detracting from the effectiveness of magnetic resonance and computed tomography, it should be noted that timely treatment is the key to victory over the disease, and in some cases, the ability to save the patient’s life.

What kind of procedure is this, who needs it, how to prepare for the examination - these are the questions that will be discussed in the article.

For what purpose is it carried out?

In addition to procedures related to the need to study pathological changes in the arteries and vessels of the brain, it is advisable to conduct REG for preventive purposes.

Pathologies. REG examination of cerebral vessels. Part 15. Lecture for doctors

Lecture for doctors “Pathologies. REG examination of cerebral vessels" Part 15

Content

REG examination of cerebral vessels. Part 1

Ultrasound or REG. Aspects of the use of rheoencephalography to assess cerebral circulation. Part 2

Analysis of rheographic (REG) curve. Part 3

Methodology for rheoencephalography (REG). Study of cerebral blood flow. Part 4

Changes in REG in arterial hypertension. Part 5

Vascular dystonia. REG examination of cerebral vessels. Part 6

Changes in REG in atherosclerosis. REG examination of cerebral vessels. Part 7

Changes in the venous blood supply to the brain and intracranial hypertension. REG examination of cerebral vessels. Part 8

Intracranial hypertension. REG examination of cerebral vessels. Part 9

Cerebral circulation disorders. REG examination of cerebral vessels. Part 10

Changes in REG in case of impaired patency of the cerebral arteries. REG examination of cerebral vessels. Part 11

Closed craniocerebral injury. REG examination of cerebral vessels. Part 12

Functional tests in REG. REG examination of cerebral vessels. Part 13

Artifacts during registration of rheograms. REG examination of cerebral vessels. Part 14

Hemispheric (F - M) and occipital (O - M) REGs of patient O., with pronounced atherosclerosis of the cerebral vessels and great vessels of the head, verified in sections

Rheograms of the cerebral hemispheres (FM), the skin and muscle of the temple (TT1 on the right) and the forearm (on the right) of patient B. with severe cerebral atherosclerosis

1 - initial data: a sharp decrease and flattening of rheographic waves in the frontomastoid lead, especially on the right, as well as in the temporal lead. Almost complete disappearance of the dicrotic wave on hemispheric REGs

2 — REG after 6 minutes

3 - 14 minutes after intravenous administration of papaverine.

B studies show that the decrease and loss of elasticity of the vascular wall in cerebral atherosclerosis is manifested on REG by the following indicators: 1) an increase in the duration of the anacrotic phase of the curve and a decrease in the steepness of its slope 2) varying degrees of flattening of the apex of the curve 3) smoothing of the dicrotic tooth until its disappearance 4) decrease the magnitude of the amplitude of the curve. All this leads to a significant change in the shape of the rheographic wave

Rheoencephalograms of patient K (hypertension in the transient stage)

The group studied (38 people) was the initial or transient stage of hypertension. Patients in this group (the majority are under the age of 40) are characterized by more or less long (weeks, months) periods of unstable increases in blood pressure, which can range from very high numbers to normal.

Rheoencephalographic studies revealed that the patient had; This group has a mild and unstable change in the top of the rheographic wave. The upward displacement of the dicrotic tooth led to a slight flattening of the apex, often to its bifurcation with the formation of a weakly defined plateau (Fig. 40). The angle of inclination and duration of the anacrotic phase of the REG did not change. The amplitude of the curve remained within normal limits and averaged 0.13 ± 0.04 ohms for hemispheric and 0.095 ± 0.031 ohms for occipital REGs. Under the influence of small doses of vasodilating drugs, the rheographic wave quickly returned to normal.

Rheograms (hemispheric and temporal) of patient B. (hypertension in the transitional stage).

1 — initial data: significant flattening of pulse waves, a smoothed dicrotic wave is shifted to the apex, and on hemispheric REGs exceeds it; 2 - 2 minutes after intravenous administration of 20 mg of papaverine: the apex of the curves becomes sharp, the dicrota shifts to the middle of the catacrota; 3 - after 5 minutes, REG waves acquire a normal shape.

REG in patients in the transitional stage of hypertension revealed a significant change in the shape of the pulse wave. There was a pronounced slowdown in the rise of the ascending part of the curve to an average of 0.16 ± 0.05 sec. The ratio of this time to the duration of the entire wave increased to 21.8% ± 5.4, which indicates a significant increase in cerebral vascular tone. However, the slope of the anacrotic phase remained unchanged. The dicrotic tooth shifted toward the top of the rheographic wave; the top was significantly rounded and formed a pronounced plateau. Often the dicrotic tooth even exceeded the top of the main wave, protruding above it in the form of a scallop. The REG amplitude decreased moderately to an average of 0.09 ± 0.028 ohms for hemispheric and 0.061 ± 0.018 ohms for occipital REGs, indicating a noticeable decrease in blood supply to the cerebral hemispheres. After the use of vasodilators, the curve quickly acquired a normal shape.

Consequently, according to REG data, the transitional stage of hypertension is characterized by a noticeable decrease in cerebral venous filling against the background of a significant increase in cerebral vascular tone. It is important to note that these changes in the cerebral arteries are still reversible, since after treatment and even after a single administration of vasodilators, the rheographic wave approaches the normal curve.

Rheograms of the cerebral hemispheres (FM), the musculoskeletal layer of the temple and forearm of patient M. (hypertension in the sclerotic stage).

a — initial data: significant reduction and flattening of the rheographic waves of the hemispheres and temple, the dicrotic tooth is sharply reduced and exceeds the top of the REG; b — after intravenous administration of 30 mg of papaverine, a slight increase in the amplitude of hemispheric and temporal rheograms against the background of a noticeable decrease in pulse waves of the forearm

248 people were studied - the sclerotic stage of hypertension. Patients in this group (the majority aged from 41 to 60 years) are characterized by a constantly high level of blood pressure and a gradual increase in general cerebral symptoms and symptoms of organic brain damage. Patients in this group experience microstrokes—small spots of softening in the stern and subcortical formations.

Sclerotic changes in the vessels are revealed in the fundus; ECG data indicate a significant deterioration in the blood supply to the myocardium. On radiographs, sclerotic changes in the aorta and main arteries of the head can often be noted.

Rheoencephalographic studies often reveal a sharp change in the shape of the pulse wave in these patients. The average duration of the anacrotic phase of the REG increased to 0.2 ± 0.05 sec, and its ratio to the duration of the entire wave increased to 27.8% ± 6.8, which indicates a sharp increase in tone and sclerotic changes in the cerebral vessels. An increase in tonic tension and loss of elasticity of the cerebral arteries is evidenced by a significant decrease in the angle of inclination of the anacrotic phase of the rheographic wave to an average of 72° ± 22.5° instead of 81° normally. The dicrotic tooth decreases significantly and moves towards the apex, usually exceeding it. The amplitude of the rheographic wave decreases significantly - to 0.068 ± 0.021 for hemispheric REGs and to 0.51 ± 0.009 ohms for occipital REGs. As a result of such pronounced changes in the main rheographic parameters, the shape of the pulse wave changes significantly, often acquiring an arched shape. Under the influence of vasodilators, the REG amplitude only slightly increases, and often it even decreases without changing its shape and individual details.

The most characteristic and variable REG indicators in connection with the severity of the clinical manifestations of hypertension, as follows from the above, are the dicrotic wave and the duration of the anacrotic phase of the curve. The transient phase is characterized by a noticeable, albeit unstable, displacement of the dicrotic tooth towards the apex of the REG with its slight flattening and the formation of sometimes a weakly expressed plateau. Subsequently, as the disease deepens, i.e., as the tone increases and the elasticity of the arteries changes, a more significant flattening of the apex of the REG occurs with the formation of a pronounced plateau as a result of the displacement of the dicrotic tooth to the very apex against the background of a noticeable decrease in the amplitude of the curve. Finally, in the sclerotic phase of the disease, a sharp flattening and rounding of the apex of the REG occurs with a significant decrease in its amplitude; the curve takes on an arched shape.

However, REG changes in the sclerotic phase of hypertension differ from those in general and cerebral atherosclerosis in that in hypertension the highest point of the REG wave is formed by a dicrotic wave, surpassing the top of the systolic wave, whereas in atherosclerosis additional waves are often absent, and if they are pronounced, then never exceed the top of the REG. Although the dicrotic wave is often weakly expressed, its high location above the very top of the REG in the later stages, as well as its good expression and shift to the top of the curve in the earlier phases of hypertension, is a very characteristic, distinctive sign of a change in the rheographic wave of the hypertensive type.

Hemispheric REG (FM) and rheograms of the musculocutaneous integument of the temple (TT) of patient B.

1 - during a hypertensive crisis; 2 — hemispheric and occipital REG after 10 minutes. after intramuscular injection of magnesium sulfate

Rheograms of patient L. (hypertension with a tendency to local cerebral vascular crises).

1 - hemispheric REG (d - right, s - left); 2 — rheograms of the musculocutaneous layer of the temple and 3 — forearm

Hemispheric (F—M), occipital (O—M) REG and reegrams of the musculocutaneous REG of patient S. with bilateral blockage of the internal carotid artery. A sharp decrease and flattening of the rheographic waves of the hemispheres (a). b — orbital, c — temporal plethysmograms of the same patient.

Diagram reflecting the dynamics of hemispheric and regional REG in different groups of patients during compression of the common carotid arteries. In the “Background REG” column, the first row indicates the frequency of absence of asymmetry in the initial curves, the second - the frequency of interhemispheric asymmetry due to a decrease in rheotraphic waves on the side of the affected vessel, and the third - the frequency of interhemispheric asymmetry due to the greater amplitude of the REG on the side of the affected vessel.

1 — no changes in REG during compression of the carotid; 2 - unilateral decrease in REG amplitude with compression of the affected vessel and 3 - uninjured vessel; 4 - bilateral decrease and 5 - bilateral increase in rheographic volition during compression of the carotid

Hemispheric (FM) and temporal (TT1) rheograms of patient T. with bilateral blockage of the internal carotid artery and stenosis of the left vertebral artery

Interhemispheric asymmetry of the REG in patient X., 50 years old, with stenosis of the left internal carotid artery and symptoms of arteritis due to a decrease in the curves on the left. 1 — compression of the left common carotid artery causes a significant decrease in the amplitude of hemispheric REG only on the left; 2—right: sharp bilateral decrease in hemispheric rheograms and unilateral decrease in temporal ones

Compression of the stenotic carotid artery in 43 of 56 patients (76.8%) caused a significant decrease in the REG amplitude, on average by 61.3 ± 10.8%, only on the same artery; in 7 patients (12.5%) there was a bilateral increase in rheographic waves, and in 6 people (10.7%) there were no changes in the curves. When the opposite (intact) carotid artery was compressed, 30 patients (53.6%) had a bilateral decrease in the REG amplitude by an average of 54.3 ± 12.7%; in 18 (37.4%) there was only a unilateral decrease in the magnitude of rheographic waves by side of compression and in 5 patients (9%) - their bilateral increase. A particularly pronounced decrease in blood flow in the affected hemisphere with compression of the “healthy” carotid artery was observed in 13 patients with a pronounced narrowing of the main vessel. Such a sharply positive test indicates a significant compensating role of the pressed carotid artery and insufficient compensation through the vertebrobasilar system. In 18 patients in whom the “healthy carotid test” turned out to be negative (did not cause a deterioration in the blood supply to the affected hemisphere), the narrowing of the internal carotid artery was small (segmental) or the collateral circulation was sufficiently developed not only through the anterior connecting artery, but through the posterior connecting arteries.

Thus, in cases of complete blockage of the carotid artery, a sharp decrease in the REG amplitude of the hemisphere of the same name occurs when blood flow in the main compensatory system is obstructed; with stenosis, depending on its severity and the degree of reduction in blood flow, a decrease in the REG amplitude in the hemisphere of the same name occurred in some cases with compression of the stenotic artery itself, and in others with compression of the intact carotid artery, which provides compensatory collateral circulation. The main difference in the dynamics of REG during compression of the carotid arteries during stenosis was that in the majority of patients (30 people), a significant decrease in blood supply to the hemisphere of the same name occurred with compression of both the stenotic and “healthy” arteries. An interesting fact is that when a stenotic artery is compressed, REG changes often do not occur immediately, as when a “healthy” carotid is pressed (after 1.5-3 seconds), but much more slowly (after 15-26 seconds).

An equally valuable distinguishing feature of incomplete occlusion of the internal carotid artery from its complete occlusion is the dynamics of the REG when turning the head to the sides. In patients with complete blockage, turning the head to both sides does not cause any changes in cerebral hemodynamics. With stenosis, turning the head in the opposite direction also did not cause changes in the REG, while turning the head towards the stenotic artery was accompanied in 37 of 56 patients (66%) by a significant decrease in the REG amplitude of the same hemisphere - by 52.8 ± 7.6% ( fluctuations 34.8-68.3%). Let us note once again that before and after functional tests it is necessary to strictly monitor the balancing of the rheographic channels.

Dynamics of REG in patient K., with hypoplasia of the right vertebral artery

1 — initial hemispheric (FM) and occipital (OM) REGs; 2 — a sharp decrease in the amplitude of the occipital REG on the right when the right vertebral artery is clamped during surgery at its mouth; 3 - gradual increase in rheographic waves to the initial curve at the 4th minute after clamping of the right vertebral artery, d - right, s - left. The arrow indicates the compression of the artery.

Dynamics of occipital REG in patient D. with a transient circulatory disorder in the left middle cerebral artery system during compression of the occipital arteries.

A slight decrease in REG waves during compression of the occipital arteries (by 10%).

Leads: occipito-parenteral (OP) and occipito-mastoid (OM); d1 and s1 are the first derivatives of REG. Arrows mark the beginning and end of arterial compression

Dynamics of REG in patient A. with stenosis of the right vertebral artery at the level of the osteophyte during compression of the occipital arteries. Decrease in the amplitude of the occipital REG: on the right - sharp in the occipitomastoid (OM) lead, significant - in the occipitomastoid (OM) lead

Occipital REG of patient S. with occlusion of the left vertebral artery. Leads: occipto-mastoid (OM) and occipto-pariental (OP)

A sharp bilateral decrease in the amplitude of the occipital REG (0.02 ohm) with a fairly high amplitude of the hemispheric REG (0.13 ohm) in patient Sh., 68 years old, with complete blockage of the basilar artery.

Leads: octinal-masgoidal (OM) and frontomastoidal (FM), d1 and s2 - the first derivatives of the REG

Dynamics of occipital (OM) and hemispheric (FM) REGs of patient A. with complete blockage of the right vertebral artery under the influence of functional loads.

1- pronounced interhemispheric asymmetry of the initial occipital REG due to a decrease in pulse volition on the right; 2 - disappearance of this asymmetry after sublingual application of nitroglycerin (0.00013). The arrow marks the beginning of functional tests, and - a decrease in the amplitude of the occipital REG; sharp on the right and significant on the left when turning the head to the right; b — no changes in REG when turning the head to the left; c - when extending the neck

Occipital REG of patient Sh. with vertebrobasilar insufficiency caused by displacement of the right vertebral artery by an osteophyte. 1 - sharp decrease in REG amplitude in the occipitomastoid lead on the right when turning the head to the right; 2 - significant decrease in rheographic waves in the same lead on the left when turning the head to the left; 3 - the same on the right, with neck extension; d1 and s1 are the first derivatives of REG

Decrease in occipital (OM) REG in patient L. with subluxation of the articular processes of the cervical vertebrae.

I - decrease is sharp on the right and significant on the left when turning the head to the right; 2— when extending the neck

Decrease in the amplitude of the occipital REG in patient B. with hypertension and osteophytes in the area of ​​the uncovertebral joints of the IV-VI cervical vertebrae (more on the left).

I - on the left, a sharp decrease in the amplitude of the REG when turning the head to the right; 2 - significant decrease in REG amplitude when turning to the left.

Pronounced interhemispheric asymmetry of the hemispheric (FM), frontotemporal (FT) and occipital (OM, OR) REG due to the reduction and flattening of rheographic waves on the left in patient A. with complete blockage of the left internal carotid and vertebral arteries

Dynamics of REG of patient 3. with hypoplasia and anomalous origin of the left vertebral artery

Regional REG of a healthy study subject K., 22 years old. Leads: parieto-occipital (PC), fronto-central (FC), occipito-parietal (OP) and fronto-frontal (FF1); d1 and S1 are the first derivatives of REG

Regional and hemispheric REG of patient K. with complete blockage of the trunk of the left middle cerebral artery.

Pronounced interhemispheric asymmetry of hemispheric (FM) and, especially, regional REG to the rolandotemporal lead due to a significant decrease in the amplitude of the curves on the left. Frontal REGs (FF1 are symmetrical both in size and shape

Regional and hemispheric REG of patient K. with complete blockage of the trunk of the left middle cerebral artery.

Pronounced interhemispheric asymmetry of hemispheric (FM) and, especially, regional REG to the rolandotemporal lead due to a significant decrease in the amplitude of the curves on the left. Frontal REG (FF1) are symmetrical both in size and shape

Interhemispheric asymmetry in only regional REGs of patient C, with blockage of the trunk of the left middle cerebral artery.

Sharp asymmetry in the rolandotemporal lead (RT) and slight asymmetry in the parieto-neutral lead (PC). The amplitude of the hemispheric (FM) and frontal (FF1) leads is quite high and symmetrical

Hemispheric and regional REG of patient K. with damage to the left anterior cerebral artery, interhemispheric asymmetry of regional REG in the fronto-central lead (FC) due to a decrease in pulse waves on the left and in the occipital-mastoid lead (OM) due to an increase in pulse waves on the left. Hemispheric (FM) and regional REGs in the narieto-central lead (PC) are symmetrical

Hemispheric and regional REG of patient K. with subarachnoid hemorrhage in the anterior parts of the brain on the left. Noticeable asymmetry of hemispheric (FM) and sharp asymmetry of regional frontal (FT) REG. Occipital REGs are symmetrical, d - on the right; s - left

Synchronously recorded EEG and REG of patient L. with extensive subarachnoid hemorrhage in the base of the brain and blood spreading along the left Sylvian fissure to the convexital surface of the brain.

Leads: EEG - occipito-parietal (OP), fronto-temporal (FT); REG - frontomastoidal (FM) and occipitomastoidal (OM), d - left; s - on the right. The arrow marks the venous wave.

Against the background of dysrhythmia, there is greater suppression of the alpha rhythm in the occipital region on the right. A sharp decrease in rheographic waves of the occipital region on the left; their increase and the appearance of a venous wave on the right.

Hemispheric and regional REGs of patient Ch. with a hematoma located lateral to the internal capsule of the left hemisphere.

Pronounced asymmetry of hemispheric (FM) REG due to reduction and flattening of pulse waves on the left with a sufficiently high and symmetrical amplitude of regional frontal (FF1) REG

Hemispheric and regional REGs of patient B. with hemorrhage from a ruptured aneurysm of the right anterior cerebral and anterior communicating artery

Asymmetry of hemispheric (FM) REG due to a decrease in the amplitude of the curve on the right and regional REG in the frontotemporal (FT) lead due to an increase in the amplitude of pulse waves on the right. Frontal (FF1) REGs are symmetrical.

REG of patient B. with massive hemorrhage in the deep parts of the left hemisphere.

Sharply expressed asymmetry of hemispheric (FM) and occipital (OM) REG due to a decrease in pulse waves on the left

REG of patient N. with massive hemorrhage in the deep parts of the left hemisphere, complicated by the penetration of blood into the ventricular system.

Significant increase in the amplitude of hemispheric and occipital REG

Rheoencephalograms of patient K. with diapedetic hemorrhage in the brainstem

Leads: ECG. fronto-mastoidal, bitemporal and bnmastoidal

EEG and REG of patient M. with a massive tumor in the left posterofrontal parasagittal region.

Interhemispheric REG asymmetry due to a decrease in the amplitude of the curve on the left in the frontomastoid and especially in the occipitomastoid leads. Diffuse gross EEG changes: the presence of slow waves in all areas, more pronounced in the parieto-sagittal and frontal-sagittal leads behind

EEG and REG of patient S. with arachnoidendothelioma of the right occipital-parietal region. a - a significant change in the shape of the REG in the occipitomastoid leads (more on the right), correlating with mild changes in biopotentials in the right parietotemporal region (T - P); b — continuation of REG recording at low paper speed; the manifestation of respiratory waves on the REG is noticeable, especially occipital on the right

Dynamics of REG and EEG of patient A. with a pituitary tumor

1 - pronounced asymmetry of the initial hemispheres of the REG due to a decrease in pulse waves on the right (on the side of greater vision loss); 2 - a sharp increase in the amplitude of hemispheric REG on the right and desynchronization of the cortical rhythm after a light muscle load, which led to the disappearance of REG asymmetry

Dynamics of REG and EEG of patient G. with a tumor of the left temporo-parieto-occipital region.

1 - interhemispheric asymmetry of the occipital REG due to a decrease in pulse volition on the left; 2 - the appearance of evoked potentials on the EEG is accompanied by an increase in REG waves only on the right - on the healthy side

EEG and REG of patient N. with carotid-cavernous anastomosis on the right

Interhemispheric REG asymmetry is sharp in the frontomastoid (FM) and noticeable in the occipitomastoid (OM) leads due to an increase in the amplitude and steepness of pulse waves on the right in the absence of EEG changes. Leads: EEG - occipital-sagittal, parieto-sagittal, frontal-sagittal and temporo-frontal

EEG and REG of patient E. with arteriovenous aneurysm of the right middle cerebral artery.

Interhemispheric asymmetry of global (A - M) and occipital (O - M) REG due to an increase in the amplitude and steepness of the curve on the right. Mild irritative changes in the EEG without signs of a focus

REG of patient F. with an arterial aneurysm (verified by section), recorded three weeks before death from hemorrhage from a ruptured aneurysm. Interhemispheric asymmetry of the REG due to a decrease in pulse waves on the left

Dynamics of REG in patients with closed craniocerebral injury

A - patient, 33 years old

1 - acute period; 2 - after 1 month; 3 - 4 months after injury

B patient N.

1 - acute period; 2 - 4 - long-term period of cranial injury

Dynamics of rheograms of the cerebral hemispheres and musculocutaneous tissue of patient U. with hepatocerebral dystrophy during pharmacological tests.

1 - a significant increase in rheographic waves, especially the catacrotic phase 5 minutes after intravenous administration of 50 mg of nicotinic acid (b), and the appearance of a venous wave (marked by an arrow) when lowering the head down (c); 2 - a slight increase in the amplitude of rheograms 5 minutes after intravenous administration of 40 mg of papaverine (b) and a noticeable increase after lowering the head down (c) by 20° - Trendelenburg position

Dynamics of rheograms of patient K. with hepato-cerebral dystrophy during a transient circulatory disorder in the basin of the right middle cerebral artery.

1 - pronounced interhemispheric asymmetry of the REG due to a decrease in the amplitude of the curve on the right; 2 — slight increase; 3 – noticeable decrease in amplitude hemispheric REG on the right after internal administration of 50 mg of nicotinic acid

Significant increase in the amplitude of hemispheric and regional REG of patient K. with major epileptic seizures

REG of patient P., 56 years old, with Jacksonian-type convulsions in the right arm. Noticeable asymmetry of hemispheric (FM) and occipital (OM) REG due to sharpening of the apex of pulse waves on the right. Noticeable asymmetry of hemispheric (FM) and occipital (OM) REG due to sharpening of the apex of pulse waves on the right

EEG and REG of patient M., 15 years old, with focal epilepsy due to scar changes after surgery in the right hemisphere

REG and rheograms of patient P. with migraine

a - pronounced asymmetry of hemispheric REG due to an increase and flattening of pulse waves on the right and asymmetry of rheograms of the musculocutaneous surface due to an increase in the amplitude of the curve on the left during an attack of pain in the area of ​​the right temple;

b — REG and rheograms of the same patient outside of a headache attack; amplitude asymmetry remained, but the shape of the REG waves was somewhat normalized

REG of patient S. with migraine

a - a sharp decrease in the amplitude of the hemispheric (LI) REG on the left - on the side of migraine pain outside of an attack: b - pronounced asymmetry of the REG persists even after sublingual application of nitroglycerin (0.0002)

Dynamics of regional frontal (FF1) and parieto-central (PC) REGs of patient G. (hypertension)

1 - before, 2 - after sublingual use of nitroglycerin

Occipital REG of patient O. with complete blockage of the right vertebral artery. Pronounced interhemispheric asymmetry of the shape of REG waves and their first derivatives (d1 and s1) in the occipitomastoid lead

Operating principle of the device

The essence of rheoencephalography is that with the help of a special device - a rheograph - an electric current of low frequency is passed through the brain, as a result of which the resistance of brain tissue is visualized on the monitor. In this way, abnormalities in the arteries, veins and small vessels are detected. The presence of six channels in the device makes it possible to examine several areas of the brain simultaneously. Metal electrodes are installed in the projection of the studied areas using an elastic rubber band, which transmit the image to the monitor.

Methodology of the procedure

To perform rheoencephalography, you need a special device ─ rheograph. The patient is placed on his back and asked to close his eyes. The doctor fixes the electrodes on the head of the patient using rubber bands. Next, a weak high-frequency current is passed through them, and this way the condition of the vessels is recorded. During the examination, the doctor may ask you to hold your breath or, conversely, to breathe frequently.

The main condition when undergoing REG is calmness

The main difficulty of the procedure is that if the patient worries too much during the examination, this affects vascular tone and the results may be unreliable.

The result is visualized in the form of a rheoencephalogram, which is deciphered by a neurologist. REG analysis can be carried out both from the monitor screen and in paper form.

When is an REG prescribed?

• patient complaints of dizziness;
• deterioration of condition with changes in atmospheric pressure;
• osteochondrosis;
• noise in ears;
• debilitating headaches;
• suspicion of ischemic disease;
• memory losses;
• weakened vision;
• hearing loss;
• atherosclerosis;
• hypertensive crisis;
• dystonia;
• hypertension of the cerebral arteries.

For all pathologies associated with a violation of the condition of blood vessels - their blood supply, changes in blood flow speed and viscosity, it is necessary to conduct an REG.

Cost of rheoencephalography

Equipment for conducting REG is available in many clinics, hospitals, and diagnostic centers. If you sign up for the procedure in advance, it can be done for free. Otherwise, one session will cost from 1000 to 3500 rubles, depending on the medical institution and the need for functional tests. Some centers provide the service at home, but in this case its cost will be at least 10,000 rubles.

Despite the increase in the number of specialists who are skeptical about the approach, REG of the brain is still actively used in diagnosing problems with the vessels of the central nervous system. Safe and accessible manipulation can not only identify existing problems, but also warn of potential risks. In particular, it is recommended that older people suffering from hypertension or atherosclerosis undergo it at least once a year.

What the study shows

1. Based on rheoencephalography of the vessels of the head, specialists receive significant information about the condition of the object of examination. Among them is the possibility of studying vascular tone, their elasticity, blood circulation speed and blood inflow/outflow.
2. The use of rheoencephalography makes it possible not only to identify abnormalities in the vessels of the brain, but also to monitor blood flow after complex operations or severe injuries.
3. With the help of REG, various pathologies are detected, and the severity of the pathological process is established.

In this case, the high speed of obtaining results is of no small importance.

What problems are being identified?

• presence of traumatic brain injuries;
• localization of hematomas formed as a result of head trauma;
• pre-stroke condition;
• damage to blood vessels by atherosclerotic plaques (atherosclerosis);
• thrombus formation in the vessels of the brain;
• predisposition to increased blood pressure;
• diseases associated with circulatory disorders.

The procedure facilitates the task of making an accurate diagnosis, on the basis of which the doctor prescribes an adequate course of treatment. With the help of it, he subsequently monitors the effectiveness of therapy. Thanks to the complete safety of such an examination for the patient’s health, it can be carried out repeatedly. One of the most significant advantages of encephalography is the ability to distinguish between pre-stroke indicators, which have certain differences for men and women.

Other features of the method

Specialists receive even more information by conducting functional tests. The simplest and most accessible of them is with nitroglycerin. This substance helps reduce vascular tone. This test is used to differentiate organic and functional disorders.

Electroencephalography (EEG)

Electroencephalography (EEG) is an accessible and safe method of studying the brain by recording brain biocurrents.
Neurons - the main elements of the central nervous system (and the brain, including) - are capable of generating and conducting electrical impulses that are recorded by an electroencephalograph. This method is of great importance for the early detection of injuries, tumors, vascular and inflammatory diseases of the brain, and epilepsy. In addition, this is the only neurological outpatient study that is performed during attacks of loss of consciousness.

In our clinic, electroencephalography is performed by highly qualified neurologists-neurophysiologists with extensive practical experience in working with patients of various age groups.

1 Electroencephalography (EEG)

2 Electroencephalography (EEG)

3 Electroencephalography (EEG)

EEG is absolutely harmless, has no contraindications, and therefore is used for patients of any age, both children and the elderly.

Electroencephalography is a highly informative study that reflects the functional state of the cortex, subcortical structures of the brain, as well as complex cortical-subcortical interactions, including the hidden pathology of diseases that have not yet manifested against the background of the complete clinical health of the subject.

EEG allows you to monitor the course of the disease over time, adjust treatment if necessary, and evaluate the effect of drug therapy (overdose or withdrawal of antipsychotics, tranquilizers, barbiturates, antidepressants) on brain activity. Unlike CT and MRI studies, EEG reveals structural and functional (reversible) changes that persist for a long time in the brain, for example, after a mild traumatic brain injury.

The role of EEG in the diagnosis of epilepsy

EEG is the most important diagnostic method for epilepsy. Every year, from 20 to 120,000 new cases of epilepsy are registered per year (on average - 70 - 100,000). In the CIS countries alone, about 2.5 million people suffer from this disease. Epilepsy is often combined with other diseases, such as cerebral palsy, chromosomal syndromes, and hereditary metabolic diseases. The incidence of epilepsy, for example, in patients with cerebral palsy is up to 33%.

An experienced neurologist/neurophysiologist can confirm the diagnosis of epilepsy based on the results of an EEG. In addition, diseases that occur without clinical manifestations have recently become widespread, but are characterized by pathological activity in the brain that significantly impairs its functioning (for example, epileptic encephalopathies). In such cases, EEG is the leading research method.

Electroencephalography technique

EEG is completely harmless and painless. During the examination, the patient sits comfortably in a chair. Using a special helmet, small electrodes are attached to his head, connected by wires to an electroencephalograph. The device amplifies the biopotentials received from the sensors hundreds of thousands of times and records them in the computer memory.

1 Electroencephalography (EEG) in MedicCity

2 Electroencephalography (EEG) in MedicCity

3 Electroencephalography (EEG) in MedicCity

No special preparation is required to conduct an EEG, but there are several recommendations. It is important that the patient is not hungry during the examination, as this may cause changes in the EEG. And you should wash your hair the day before the test - this will allow for better contact of the electrodes with the scalp and, accordingly, the results will be more reliable. You should not give up your usual medication intake, as this can provoke seizures and even epistatus. The interpretation of EEG results may depend on the patient’s age, medications he is taking, the presence of tremor of the head and limbs, visual impairment, skull defects, etc.

1 Electroencephalography (EEG) in MedicCity

2 Electroencephalography (EEG) in MedicCity

3 Electroencephalography (EEG) in MedicCity

Diagnostic capabilities of EEG

With EEG you can:

• distinguish epileptic seizures from non-epileptic ones and classify them;
• identify areas of the brain responsible for triggering seizures;
• track the dynamics of the action of drugs;
• assess the functional state of the brain (even in the absence of changes on a CT scan of the brain);
• resolve the issue of professional suitability (the detection of epileptiform phenomena serves as the basis for the selection of professions related to driving, requiring constant attention and quick response to sudden situations and stimuli in conditions of increased risk).

Indications for EEG:

• epilepsy and other types of paroxysms;
• brain tumors;
• traumatic brain injuries;
• vascular diseases;
• inflammatory diseases;
• degenerative brain lesions;
• headache;
• dysontogenetic diseases;
• hereditary diseases of the central nervous system;
• functional disorders of nervous activity (neuroses, neurasthenia, obsessive movement neurosis, somnambulism, etc.)
• psychiatric pathology;
• encephalopathy of various origins (vascular, post-traumatic, toxic);
• post-resuscitation conditions due to somatic pathology.

Our clinic uses the latest biofeedback-EEG training technique, which includes taking an electroencephalogram, which records the main rhythms of the brain (alpha, beta, delta, tetarhythms). An EEG (electroencephalogram) assessment is carried out by an experienced neurologist-neurophysiologist, and a conclusion is given about the characteristics of brain rhythms and the distribution of biopotentials in various areas of the cerebral cortex. Depending on the indications, the necessary course of biofeedback-EEG training is selected (relaxing, activating, etc.).

How to decipher the results

When assessing the examination results, the patient’s age must be taken into account. This is explained by the fact that the walls of blood vessels lose their elasticity over the years, become more fragile, and react differently to various stimuli. An REG shows graphical wave fluctuations. The following indicators are taken into account:

The specialist reads the diagnostic results, taking into account the regularity of the waves, the appearance and rounding of the apex, as well as the location of the tooth and incisura. The normal fluctuations of the wave shown on the screen in adults differ from the manifestations of acceptable indicators in a child. Rheoencephalographic study makes it possible to classify the condition of the vessels into three types their behavior:

1. Dystonic. Characterized by frequent manifestations of changes in vascular tone. Hypotonia with difficulty in venous outflow of blood and low pulse filling is more often observed.
2. Angiodystonic. Its symptoms are similar to those of the previous type. The difference is that the cause of the tone disorder is a defect in the vessel wall.
3. Hypertensive type according to REG. Significantly different from the species described above. Vascular tone is significantly increased. Venous outflow is impaired.

These types of behavior are not independent pathologies. They are only signs of other diseases and make it possible to identify them in the early stages of development.

You should not attempt to decipher the examination results yourself. It is better to leave this to qualified doctors who will do it professionally and establish an accurate diagnosis.

Decoding the results

To correctly assess the data obtained, the doctor takes into account the patient’s age, since the indicators will be very different for young and elderly people.

• MRI of cerebral vessels - what it shows, indications and contraindications, how it is performed

The resulting rheoencephalogram is studied, which has a wave-like appearance and consists of an anacrota (growing part), catacrota (falling part), incisura (bend between them) and a dicrotic tooth that appears immediately behind it.

Based on the waves of the resulting graph, the doctor evaluates the work of blood vessels

The doctor evaluates the regularity of the waves, the nature of the construction of their peaks, the appearance of anacrota and catacrota, the location of the incisura and the depth of the dicrotic tooth. The presence of additional waves is also being studied.

After evaluating the data obtained, we can talk about the following results based on the appearance of the rheogram:

• dystonic type of REG indicates possible hypotonic deviations, decreased pulse filling and problems with blood outflow through the veins;
• angiodystonic type indicates a decrease in the tone of the vascular walls and a decrease in blood flow speed;
• The hypertensive type indicates increased pressure and tone of the vessels through which blood flows to the head and their obstructed outflow.

The amplitude indicator of the rheogram (APR) indicates volumetric pulse filling:

• APR less than normal by no more than 40% indicates a moderate decrease in pulse blood supply;
• at 40–60% - a significant decrease;
• at 60–90% - pronounced;
• at 90–100% - critical.

The coefficient of asymmetry (CA), which indicates differences in blood supply to different parts of the brain, is very important for studying. Depending on the severity of CA, several degrees of asymmetry are distinguished:

• less than 7% - no pronounced asymmetry;
• 8–14% - weak asymmetry;
• 15–25% - moderate asymmetry;
• more than 26% - severe asymmetry.

What deviations do the external characteristics of waves show - table

How is the procedure performed?

The described diagnostic method is completely painless and safe. During the procedure, there is no impact on the patient’s skin, and no various instruments are used.

During the procedure, the patient is placed on a couch or offered to sit on a chair. To obtain more accurate information, the patient is asked to tilt his head forward, turn it to the right or left. The procedure lasts 10-15 minutes. The results of the study are displayed immediately on the monitor screen and are assessed by a neurologist.

Recommendations

To avoid distorting the results, you should consider some simple tips:

1. Before installing the electrodes, some areas of the head are treated with alcohol. It is advisable not to stress and take it calmly.
2. Eyes should be kept closed during the procedure.
3. You need to completely relax. Anxiety can cause a sharp constriction of blood vessels. This will affect the wave oscillation performance.
4. It is advisable to rest for 15-20 minutes before the procedure.
5. The day before the scheduled examination, you should not take medications that can affect the speed of blood flow.
6. The session should not be interfered with by any objects, so you need to remove chains, earrings, hairpins and let your hair down.

If you are examining a small child, you should tell him in advance everything about the upcoming procedure. You can pick him up and sit on a chair with him. Then he will not be afraid and nervous.

About contraindications

Due to the absolute absence of harm to the body, rheoencephalography has virtually no contraindications or side effects. This examination is contraindicated for newborn children. This is explained by the small amplitude of the reflected waves, the large size of the anacrote and the complete absence of incisura. Such indications do not provide an accurate picture of the condition of the vessels of the head. Rheoencephalography is an effective and affordable method for examining the vessels of the brain. Its widespread use is due to the presence of the device in every hospital and, of course, the absence of side effects and contraindications for use.