ISSN : 2146-3123
E-ISSN : 2146-3131

Evaluation of Cerebral Blood Flow Alterations and Acute Neuronal Damage due to the Water Pipe Smoking
Onur Karakayalı1, Uygar Utku2, Serkan Yılmaz1
1Department of Emergency Medicine, Kocaeli University of Health Sciences, Derince Training and Research Hospital, Kocaeli, Turkey
2Department of Neurology, İstinye University School of Medicine, İstanbul, Turkey
DOI : 10.4274/balkanmedj.2018.0704

Background: Although water pipe smoking is a great public health problem, data regarding the acute and chronic effects and the degree of toxin exposure are limited. While water pipe-related malignancy, pulmonary, infectious, cardiac effects, infertility and biological effects have been described in a meta-analysis, there are no studies in the literature about its neurologic effects. 
Aims: To evaluate water pipe-related acute neurological effects and cerebral blood flow through transcranial doppler ultrasonography and serum s100b protein level measurements. 
Study Design: Prospective observational study.
Methods: Vital signs and baseline carboxyhemoglobin (COHb) and S100b levels, cerebral flood changes with Transcranial Doppler Ultrasound were evaluated and recorded before and after water-pipe smoking. 
Results: The mean age of the 31 volunteers was 30,61 (±5,67) years and 24 of them (77,42%) were male. A statistically significant difference was determined in heart rate, oxygen saturation, systolic and diastolic arterial pressure values before and after water pipe smoking (p<0,001, p=0,035, p=0,009, p=0,021, respectively). Mean COHb level was 2,68 % (±1,68) before, 14,97 % (±4,83) after water pipe smoking (p<0,001). The S100b protein level was 25,05 µ/ml (±8,34) at the beginning, 40,71 µ/ml (±14,06) after water pipe smoking (p<0,001). An increase was determined in peak and median middle, anterior and posterior cerebrale artery blood flow rates, and a decrease was determined in the pulsatility index and resistivity index values after water pipe smoking through transcranial Doppler ultrasound. 
Conclusion: Cerebral vasodilation develops due to the increase in cerebral blood flow rate and the decrease in pulsatility index, resistivity index values, and the elevation in COHb, S100b level indicates that water pipe smoking leads to neuron damage in the acute period. 

Keywords : Water pipe, cerebral blood flow, transcranial doppler ultrasound, carbon monoxide, S100b protein
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