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Cerebral hemodynamics was studied by transcranial Doppler (TCD) in 50 patients with chronic, previously untreated post-traumatic stress disorder (PTSD), with simultaneous determination of catecholamines by 24-hour urine analysis of vanillylmandelic acid (VMA) as the end-product of PTSD, pointing to the importance of the circle of Willis hemodynamics in this patient population. At the same time, increased levels of VMA were recorded in 58% and decreased levels of corticol in 56% of these patients. Following 3-week pharmacotherapy, elevated VMA and decreased cortisol persisted in 10% and 14% of patients, respectively. None of the control subjects had elevated VMA or decreased cortisol levels. Coexistence of the circle of Willis vasospasm, elevated VMA and decreased cortisol was initially observed in 50% of patients with chronic, previously untreated PTSD and none of the control subjects. Post-therapeutically, the same pattern persisted in 14% of PTSD patients. Study results pointed to the role of simultaneous analysis of cerebral hemodynamics, and cortisol and catecholamine levels in patients with chronic PTSD, catecholamine metabolism, and urine cortisol. The same analyses were performed in the patients following 3-week psychopharmacotherapy during their hospitalization at psychiatric ward, and in 50 healthy subjects as a control group. Vasospasm of the circle of Willis was observed in 68% and of vertebrobasilar basin in 22% of patients with chronic, previously untreated PTSD before therapy introduction. After 3-week psychopharmacotherapy, vasospasm of the circle of Willis and vertebrobasilar basis persisted in 18% and 10% of the patients, respectively. In the control group, vasospasm was recorded in only 4% of subjects. Statictical analysis yielded a statistically significant difference in the presence of the circle of Willis and vertebrobasilar basin vasospasm in patients with chronic, untreated PTSD, pointing to the importance of the circle of Willis hemodynamics in this patient population. At the same time, increased levels of VMA were recorded in 58% and decreased levels of corticol in 56% of these patients. Following 3-week pharmacotherapy, elevated VMA and decreased cortisol persisted in 10% and 14% of patients, respectively. None of the control subjects had elevated VMA or decreased cortisol levels. Coexistence of the circle of Willis vasospasm, elevated VMA and decreased cortisol was initially observed in 50% of patients with chronic, previously untreated PTSD and none of the control subjects. Post- therapeutically, the same pattern persisted in 14% of PTSD patients. Study results pointed to the role of simultaneous analysis of cerebral hemodynamics, and cortisol and catecholamine levels in patients with chronic PTSD. |
