walter borg, md brain glucose vmh perfusion
TRANSCRIPT
-
8/9/2019 Walter Borg, MD Brain Glucose VMH Perfusion
1/5
Siep|mhi`akd Bq~mpbkdkhaf Eyfdiyv kv k Gdyfmvi Vievm| 63;
O% Fdae% Aesivp% Pbi Khi|afke Vmfaipq cm| Fdaeafkd Aesivpagkpame Aef%>>;-63;->9 $>Smdyhi 11 Eyhli| 39
Klvp|kfp
Pbi siep|mhi`akd bq~mpbkdkhaf eyfdiyv "SHB! av eifiv(vk|q cm| pbi aepig|kpi` bm|hmekd |iv~mevi pm bq~mgdqfihak%
Pm `ipi|haei pbi |mdi mc pbi SHB kv k gdyfmvi vievm|$ wi~i|cm|hi` ir~i|ahiepv `ivagei` pm v~ifacafkddq ~|isiep gdy(fm~ieak ae pbi SHB$ wbadi ~|m`yfaeg bq~mgdqfihak idvi(wbi|i% Wi yvi` kwkji fb|meafkddq fkpbipi|azi` |kpv$ aewbafb dmfkd SHB gdyfmvi ~i|cyvame ";>> hH m| ;9 hH mc@(gdyfmvi! wkv fmhlaei` wapb k vi{yiepakd iygdqfihafbq~mgdqfihaf fdkh~% Ae pwm fmep|md g|my~v pbi SHB wkv~i|cyvi` iapbi| wapb "
k!
ke avm(mvhmpaf vmdypame dkfjaeg gdy(fmvi$ m| wapb "
l
! emehipklmdazkldi D(gdyfmvi ";>> hH!%
@y|aeg vqvpihaf bq~mgdqfihak gdyfkgme ke` fkpifbmdkhaeifmefiep|kpamev ~|mh~pdq aef|ikvi` ae pbi fmep|md keahkdv~i|cyvi` wapb iapbi| ;>> hH D(gdyfmvi m| pbi avm(mvhmpafvmdypame dkfjaeg gdyfmvi% Ae fmep|kvp$ gdyfkgme$ i~aei~b|aeike` em|i~aei~b|aei |idikvi wkv aebalapi` ae pbi keahkdv aewbafb pbi SHB wkv ~i|cyvi` wapb @(gdyfmvi: bm|hmekd vi(
f|ipame wkv ~k|pakddq vy~~|ivvi` lq pbi SHB ~i|cyvame wapb;9 hH @(gdyfmvi ke` vy~~|ivvi` lq 29) wbie pbi SHBwkv ~i|cyvi` wapb ;>> hH @(gdyfmvi$ kv fmh~k|i` wapb pbifmep|md g|my~v% Wi fmefdy`i pbkp pbi SHB hyvp vievi bq(~mgdqfihak cm| cydd kfpaskpame mc fkpifbmdkhaei ke` gdyfk(gme vif|ipame ke` pbkp ap av k jiq gdyfmvi vievm| cm| bq~mgdq(fihaf fmyepi||igydkpame% "
O% Fdae% Aesivp%
;117% 11?63;639%!Jiq wm|`v? SHB
haf|m`akdqvav
bq~mgdqfihak
gdyfkgme
i~aei~b|aei
Aep|m`yfpame
Pbi fiep|kd ei|smyv vqvpih "FEV!
;
~dkqv ke ah~m|pkep |mdi aevievaeg gdyfm~ieak ke` p|aggi|aeg fmyepi||igydkpm|q bm|hmei|idikvi `y|aeg bq~mgdqfihak% ";6!% Kdpbmygb k |igame wapbaem| ae fdmvi ~|mrahapq pm pbi dasi| hkq kfpaskpi pbi vqh~kpbm(k`|iekd vqvpih "0! pbi FEV k~~ik|v pm li pbi mhaekep fiepi||iv~mevaldi cm| pbi vievaeg ke` aepig|kpame mc bq~mgdqfihaf
vagekdv% Pbav saiw av livp vy~~m|pi` lq `kpk vbmwaeg pbkp ~|i(siepame mc aepi|fi|il|kd gdyfm~ieak lq aecyvame mc gdyfmvi aepmlmpb pbi fk|mpa` ke` si|pil|kd k|pi|aiv eik|dq klmdavbiv fmye(pi||igydkpm|q bm|hmei |iv~meviv pm vqvpihaf bq~mgdqfihak ">>Wksi|dq EQ! fmh~|avaeg mc %9 hh kv hik(vy|i` c|mh pbi l|ighk(dkhl`k ~dkei% Pbi ir~mvi` haf|m`akdqvavhihl|kei wkv ;%>;%9 hh "k~~|mrahkpidq pbi vazi mc pbi SHB! vmpbkp wi fmyd` vidifpasidq ~i|cyvi pbav l|kae |igame% Me pbi hm|eaeg mcpbi ir~i|ahiep pbi ~i|cyvame hi`ayh wkv dmk`i` aepm ;(hd vq|aegivke` `idasi|i` kp k cdmw |kpi mc CH^ ;>0 Eiw Bksie FP >39(2>%^bmei? 6(729(9007: CKR? 6(729(3>;9: I(hkad? gi|kd`]vbydhkeN{h%qkdi%i`y
\ifiasi` cm| ~yldafkpame ;1 Oydq ;113 ke` kffi~pi` ae |isavi` cm|h
9 Emsihli| ;113%
;% Kll|isakpamev yvi` ae pbav ~k~i|?
FEV fiep|kd ei|smyv vqvpih:IFC irp|kfiddydk| cdya`: SHB siep|mhi`akd bq~mpbkdkhaf eyfdiyv%
-
8/9/2019 Walter Borg, MD Brain Glucose VMH Perfusion
2/5
63 hae% K sk|akldi aecyvame mc irmgiemyv gdyfmvi wkv k`(
oyvpi` lkvi` me ~dkvhk gdyfmvi hikvy|ihiepv mlpkaei` kp 9(hae ae(pi|skdv pm kfbaisi pbi `iva|i` gdyfmvi disid% @y|aeg pbi ca|vp 3> haepbi |kpv wi|i hkaepkaei` kp iygdqfihak "hike ~dkvhk gdyfmvi 3%0hH!% Pbi|ikcpi| ~dkvhk gdyfmvi wkv kddmwi` pm ckdd msi|
0> hae pmbq~mgdqfihaf disidv "
;%9 hh%Pb|ii acci|iep fmefiep|kpamevmc @(gdyfmvi "> ;9 ke` ;>>hH! ke` ;>> hH D(gdyfmviwi|i yvi` ae pbi ir~i|ahiep%
-
8/9/2019 Walter Borg, MD Brain Glucose VMH Perfusion
3/5
Siep|mhi`akd Bq~mpbkdkhaf Eyfdiyv kv k Gdyfmvi Vievm|
636
hH "vifme`k|q pm gdyfmvi aecyvame! m| aek`si|piepdq cidd lidmw hH `y|aeg pbi bq~mgdqfihaf ~bkvi% Medq pbi vpy`aiv `y|aeg wbafbpbi hike ldmm` gdyfmvi disid kfbaisi` `y|aeg bq~mgdqfihak wkv aepbi |kegi mc hH@(gdyfmvi ;0) mc keahkdv wapb ~|m~i| fkeydk ~dkfihiep "kv si|acai`bavpmdmgafkddq! `a` emp hiip pbivi f|api|ak% Ae pbi vifme` g|my~ "~i|(cyvi` wapb ;9 hH @(gdyfmvi! ;( ke` 3>(hae!ke` bq~mgdqfihaf ";( ;69( ke` ;9>(hae! ~bkviv mc pbi ir~i|a(hiepv% @y|aeg ldmm` vkh~daeg `adypame lq cdya` ae pbi `ik` v~kfi mcpbi fkpbipi| wkv ksma`i` lq wapb`|kwkd mc >%9 hd mc ldmm` licm|ivkh~di fmddifpame% Pbav smdyhi irfii`i` pbi `ik` v~kfi smdyhi lqklmyp casi cmd`% K eiw vq|aegi wkv pbie yvi` cm| pbi vkh~di fmddif(pame% Vylvi{yiepdq pbi aeapakd vq|aegi wkv |ikppkfbi` ke` pbi fme(piepv |iaecyvi`% Ldmm` |ifiepdq mlpkaei` c|mh dappi|hkpiv wkv p|kev(cyvi` y|aeg pbi fdkh~ pm {ykepapkpasidq |i~dkfi pbi ldmm` wapb`|kwe`y|aeg pbi ir~i|ahiep% Pbi ~|mpmfmd wkv |isaiwi` ke` k~~|msi` lqpbi Qkdi Keahkd Fk|i ke` Yvi Fmhhappii%
Kekdqpafkd hipbm`v ke` fkdfydkpamev%
^dkvhk gdyfmvi wkv hik(vy|i` ae `y~dafkpi yvaeg k Lifjhke Gdyfmvi Kekdqzi| AA "LifjhkeCyddi|pme FK!% ^dkvhk aevydae "Laekr Vmypb ^m|pdke` HK! ke`gdyfkgme "AFE Lamhi`afkdv Aef% Fk|vme FK! wi|i `ipi|haei` lq k`myldi kepalm`q |k`amahhyemkvvkq% Aevydae hikvy|ihiepv `y|aegpbi lkvkd ke` aevydae aecyvame ~i|am`v wi|i hk`i yvaeg |kp ke` ~m|(
faei vpke`k|`v |iv~ifpasidq% ^dkvhk fkpifbmdkhaeiv wi|i hikvy|i`wapb k |k`amiezqhkpaf hipbm` "Khi|vbkh Fm|~% K|daegpme BiagbpvAD! kv ~|isamyvdq `ivf|ali` "3 7!%
@kpk k|i ir~|ivvi` kv hike
VI% Fmh~k|avme lipwiie pbi ir(~i|ahiepkd g|my~v wkv hk`i lq KEMSK wapb k |i~ikpi` hikvy|i`ivage cmddmwi` lq pbi Vpy`iepv p
pivp pm dmfkdazi iccifpv% Gdyfmvi ae(cyvame |kpiv `y|aeg pbi bq~mgdqfihaf vpi~v |i~|iviep ksi|kgi skdyivcm| pbi `ivagekpi` pahi aepi|skd% Skdyiv cm| ~i|fiep vy~~|ivvame mcbm|hmekd |iv~meviv |icdifp fbkegiv c|mh pbi hike mc pbi ~ikj fmye(
pi||igydkpm|q |iv~mevi "a%i% pbi hike mc pbi ;69 ke` ;9> hae `kpk~maepv! |ivydpv ae pbi fmep|md vpy`aiv%
\ivydpv
Kp pbi mypvip mc pbi vpy`q eiapbi| pbi lkvkd fmefiep|kpamev mcgdyfm|igydkpm|q bm|hmeiv em| pbi wiagbp mc pbi keahkdv "Pk(ldi A! wi|i vageacafkepdq `acci|iep ae pbi cmy| ir~i|ahiepkdg|my~v% @y|aeg pbi aevydae aecyvame ~dkvhk aevydae |mvi pmeik|dq a`iepafkd disidv ke` ~dkvhk gdyfmvi wkv fmh~k|kldi`y|aeg ikfb ~bkvi mc pbi vpy`q ae kdd g|my~v "Pkldi AA ke` Cag%> hH m| ;9 hH @(gdyfmvi! bm|(
Cagy|i
-
8/9/2019 Walter Borg, MD Brain Glucose VMH Perfusion
4/5
630
Lm|g ip kd%
hmekd |iv~meviv wi|i `ahaeavbi` `iv~api k vahadk| `ig|ii mcvqvpihaf bq~mgdqfihak% V~ifacafkddq ;>> hH @(gdyfmvi ~i|cy(vame aepm pbi SHB vy~~|ivvi` pbi |idikvi mc i~aei~b|aei ke`em|i~aei~b|aei lq 1>) ke` gdyfkgme lq 79) "
^ >%>9 kvfmh~k|i` wapb lmpb fmep|md g|my~v!% Pbi SHB ~i|cyvame wapb;9 hH @(gdyfmvi bk` k divv ~|memyefi` iccifp lyp kdvm vy~(~|ivvi` i~aei~b|aei ke` em|i~aei~b|aei lq 79) "
^ >%>9
sv% lmpb fmep|md g|my~v! ke` gdyfkgme lq 09) "
^
>%>9medq kv fmh~k|i` wapb pbi SHB ~i|cyvame wapb IFC!% Ae fme(p|kvp pbi|i wkv k vbk|~ aef|ikvi ae pbi fmefiep|kpamev mc~dkvhk fkpifbmdkhaeiv ke` gdyfkgme ae pbi pwm fmep|md g|my~vwbie bq~mgdqfihak wkv ae`yfi`%
Pbi `ahaeavbi` fmyepi||igydkpm|q bm|hmei |iv~meviv aepbi keahkdv |ifiasaeg SHB @(gdyfmvi ~i|cyvame wkv kvvmfa(kpi` wapb k 60(cmd` bagbi| |kpi mc irmgiemyv gdyfmvi aecyvamepbke wkv |i{ya|i` ae pbi fmep|md vpy`aiv pm hkaepkae pbi ~dkvhkgdyfmvi ~dkpiky kp > hH D(gdyfmvi m| wbie |i(
vydpv c|mh pbmvi vpy`aiv k|i fmh~k|i` wapb pbmvi mc ekasi |kpv~|isamyvdq |i~m|pi` "3!% Ae jii~aeg wapb pbivi cae`aegv pbi pwmir~i|ahiepkd g|my~v |ifiasaeg pbi SHB @(gdyfmvi ~i|cyvame|i{ya|i` hm|i irmgiemyv gdyfmvi pm hkaepkae pbi bq~mgdqfi(haf ~dkpiky pbke a` fmep|md keahkdv wbafb bk` aepkfp fmyepi|(|igydkpm|q |iv~meviv%
Wbadi pbi fbk|kfpi|avpafv mc fmyepi||igydkpm|q |iv~meviv`y|aeg bq~mgdqfihak k|i widd ivpkldavbi` "3 7! pbi ~bqvam(dmgaf isiepv pbkp mffy| pm daej gdyfm~ieak wapb fmyepi||igydk(pm|q bm|hmei vif|ipame |ihkae mlvfy|i% Kdpbmygb pbi lydj mc`kpk vyggivp pbkp pbi l|kae ~dkqv k f|apafkd |mdi ae pbav ~|mfivvpbi v~ifacaf kekpmhafkd dmfkpame mc pbi fiepi| cm| vievaeg ke`aepig|kpame mc bq~mgdqfihaf vagekdv av yefi|pkae "9 ;
dkpi|kddq SHB divamei` |kpv kv widd kv ae |kpv wapb divamev ae`acci|iep l|kae k|ikv "3!% K hk|ji` aebalapame mc lmpb pbi gdy(fkgme ke` fkpifbmdkhaei |iv~mevi pm bq~mgdqfihak wkv isa(`iep medq ae pbi SHB(divamei` keahkdv fmevavpiep wapb ik|dai|vpy`aiv ah~dafkpaeg pbi bq~mpbkdkhyv ae pbi kfpaskpame mc bq(~mgdqfihaf fmyepi||igydkpame ";6;9!%
Ae pbav vpy`q wi ivpkldavb ae k hm|i v~ifacaf ke` ~bqvamdmga(fkd wkq pbi f|apafkd |mdi pbkp pbi SHB ~dkqv ae pbi fmyepi||ig(ydkpm|q |iv~mevi pm bq~mgdqfihak% V~ifacafkddq pbivi `kpk`ihmevp|kpi pbkp pbi fkpifbmdkhaei |iv~mevi pm vqvpihaf bq(~mgdqfihak av ldmfji` ke` pbi gdyfkgme |iv~mevi av kppiey(kpi` lq `a|ifp gdyfmvi `idasi|q pm pbi SHB% Lq yvaeg pbi vi(
Pkldi AA% Hike dkvhk Gdyfmvi ke` Aevydae Fmefiep|kpamev`y|aeg Iygdqfihak ke` Bq~mgdqfihak
SHB ~i|cyvamev wapb
;>> hH@(gdyfmvi
;9 hH@(gdyfmvi
> hH@(gdyfmvi
;>> hHD(gdyfmvi
"e
3! "e
7! "e
1! "e
2!
Iygdqfihak "P
>3> hae!
Gdyfmvi "hH! 3%0
>%; 3%0
>%< 3%9
>%; 3%0
>%;
Aevydae "eH! 0%1
>%9 0%7
>%0 0%1
>%9 9%>
>%3
Bq~mgdqfihak "P
;>9;9> hae!Gdyfmvi "hH! %< %; %; %;
Aevydae "eH! 9%>
>%3 0%1
>%0 9%>
>%0 9%%7
Irmgiemyv gdyfmvi
aecyvame |kpi
"hgJg
;
hae
;
! 9%%0
/
^
>%>9% Gdyfmvi skdyiv wi|i mlpkaei` lq ksi|kgaeg hikvy|ihiepv
`y|aeg pbi >3> ke` ;>9;9> hae mc pbi vpy`q% Aevydae kpk cm| pbi iygdq(
fihaf ~bkvi |i~|iviep pbi ksi|kgi aevydae disid mc pbi vkh~di mlpkaei`
kp pbi ie` mc pbav ~bkvi% Aevydae skdyiv `y|aeg bq~mgdqfihak |i~|iviep
pbi ksi|kgi mc hikvy|ihiepv mlpkaei` kp ; ke` ;9> hae%
Pkldi A% Lkvkd Bm|hmekd ke` Wiagbp @kpk mc pbiKeahkdv Vpy`ai`
SHB ~i|cyvamev wapb
;>> hH@(gdyfmvi
;9 hH@(gdyfmvi
> hH@(gdyfmvi
;>> hHD(gdyfmvi
"e
3! "e
7! "e
1! "e
2!
Aevydae "eH! >%;;
>%>0 >%;%>6 >%;6
>%>< >%;%>%7
>%; >%3
>%; ;%%0 ;%;
>%6
Em|i~aei~b|aei "eH! ;%7
>%6 ;%3
>%< %9 %9
Wiagbp "g!
-
8/9/2019 Walter Borg, MD Brain Glucose VMH Perfusion
5/5
Siep|mhi`akd Bq~mpbkdkhaf Eyfdiyv kv k Gdyfmvi Vievm|
639
{yiepakd iygdqfihaf(bq~mgdqfihaf fdkh~ pifbea{yi wi ksma`i`pbi fmecmye`aeg iccifpv mc sk|akldi gdqfihaf disidv khmeg pbivpy`q g|my~v% K``apamekddq pbi ladkpi|kd aep|kf|keakd haf|m`akd(qvav pifbea{yi kddmwi` yv pm haeahazi m| pm klmdavb fiddydk|gdyfm~ieak ae ke k|ik mc l|kae |ivp|afpi` pm pbi SHB% ^|mli~dkfihiep wbadi mlsamyvdq aeskvasi `a` emp k~~ik| pm vageaca(fkepdq kdpi| pbi bm|hmekd |iv~mevi pm bq~mgdqfihak vaefi pbihkgeapy`i mc pbi bm|hmekd |iv~mevi ae pbi fmep|md |kpv |i(
~m|pi` bi|i wkv si|q vahadk| pm pbkp |i~m|pi` lq my| g|my~ aeekasi keahkdv `y|aeg fmh~k|kldi bq~mgdqfihaf fdkh~ vpy`aiv"3!% Ap av empiwm|pbq pbkp SHB ~i|cyvame wapb ;>> hH @(gdy(fmvi wkv vyccafaiep pm ldmfj pbi vqh~kpbm(k`|iekd ke` pm kppie(ykpi ~kef|ikpaf
(fidd |iv~mevi pm vqvpihaf bq~mgdqfihakwbi|ikv medq ~k|pakd aebalapame mc lmpb gdyfkgme ke` fkpi(fbmdkhaei |iv~mevi wkv viie wbie ;9 hH gdyfmvi wkv ~i|(cyvi` pb|mygb pbi ~|mliv% Wbadi pbi |ikvme cm| pbav `avf|i~(kefq av yefi|pkae ap av dajidq pbkp pbi dmw iccafaiefq mc gdyfmvi`idasi|q sak pbi ~|mli hkq bksi ~|isiepi` fmh~dipi klmdapamemc bq~mgdqfihak pb|mygbmyp kdd eiy|mev ae pbi SHB `y|aegpbi ;9 hH lyp emp pbi ;>> hH gdyfmvi ~i|cyvame iv~ifakddqSHB eiy|mev dmfkpi` kp g|ikpi| avpkefiv c|mh pbi ~|mli% Ap avyedajidq pbkp pbi aebalapame mc fmyepi||igydkpm|q |idikvi ae(
`yfi` lq ~i|cyvame mc pbi SHB wapb ;>> hH @(gdyfmvi fkeli kpp|alypi` pm `a|ifp mvhmpaf iccifpv vaefi ~i|cyvame mc pbiSHB wapb ;>> hH D(gdyfmvi bk` em iccifp me pbi fmyepi||ig(ydkpm|q |iv~mevi% Hm|imsi| ae ~|isamyv ir~i|ahiepv ~i|cyvamemc ;>> hH @(gdyfmvi aepm pbi SHB bk` em iccifp me fmyepi|(|igydkpm|q bm|hmei disidv ye`i| iygdqfihaf fme`apamev "7!%
Ap vbmyd` li empi` bmwisi| pbkp vmhi kpk m emp vy~~m|ppbi fmefi~p pbkp pbi `mhaekep gdyfmvi vievaeg eiy|mev k|i dm(fkpi` ae pbi SHB% Vpy`aiv lq @memske ip kd% bksi vyggivpi`pbkp ~i|a~bi|kd gdyfmvievm|v hkq ~dkq k |mdi ae pbi kfpaskpamemc bq~mgdqfihak(ae`yfi` vqh~kpbm(k`|iekd |iv~meviv "0!% \i(fiep vpy`aiv ~i|cm|hi` lq pbivi aesivpagkpm|v bksi vbmwe pbkp~m|pkd iygdqfihak |i`yfiv fmyepi||igydkpm|q |iv~meviv pm bq(~mgdqfihak ah~dqaeg pbkp pbi SHB hkq emp li pbi medq k|ik
`ipifpaeg bq~mgdqfihak ";3 ;7!% Bmwisi| ae m|`i| pm f|ikpifme`apamev mc iygdqfihak ae pbi dasi| gdyfmvi wkv aecyvi` aepmpbi ~m|pkd siae wbafb fkyvi` k eigkpasi k|pi|akd(~m|pkd gdyfmvig|k`aiep% Vaefi pbav eigkpasi g|k`aiep bkv liie vbmwe pm li keah~m|pkep cii`aeg vagekd ";2! ap av ~mvvaldi pbkp pbav hagbp bksikccifpi` pbivi |ivydpv% Me pbi mpbi| bke` pbi fy||iep kpk vyg(givp pbkp ac ~i|a~bi|kd vagekdaeg av aesmdsi` ap fke li msi||a`(`ie ac pbi bq~mgdqfihaf vpahydyv av idahaekpi` kp pbi disid mcpbi SHB% Ae kg|iihiep wapb pbav @ksav ip kd% bksi vbmwe pbkpdmfkdazi` bi~kpaf bq~mgdqfihak av yekldi pm ismji fmyepi||ig(ydkpm|q bm|hmei |idikvi ";1!% Ae k``apame Okfjvme ip kd% "!bksi |ifiepdq |i~m|pi` pbkp ldmfjaeg p|kevhavvame mc pbi skgyvei|siv aeei|skpaeg pbi dasi| bk` em ah~kfp me pbi fmyepi||igy(dkpm|q |iv~mevi pm bq~mgdqfihak% Ae fmep|kvp wbie dmfkdazi` gdy(
fm~ieak wkv ae`yfi` ae pbi SHB lq aecyvame "sak haf|m`akdqvav!mc