摘要:

The time course and extent of changes in plasma prolactin, noradrenaline, vasopressin and oxytocin levels is reported following serial observations of a prolonged epileptic seizure arising in the temporal lobe, recorded by video‐EEG‐telemetry, in which the epileptic activity evolved from a simple partial to complex partial to secondarily generalised attack. The prolactin levels were markedly elevated during the phase of the simple partial seizure, at a time when consciousness was preserved, when motor activity was minimal and when EEG activity was highly localised. The hormonal levels continued to rise during the subsequent seizure evolution, suggesting that the duration (or intensity) of the seizure is an important, perhaps the most important, factor determining the degree of prolactin release during limbic seizures. Indeed, the prolactin elevation in this case (26 times the baseline level) is higher than any previously recorded, reflecting the unusual duration and intensity of this seizure. We did not observe the phenomenon of “exhaustion” of prolactin release and levels peaked after 49 min, and were high for over 2 h after the onset of the seizure, and after the convulsion had ceased. The concentrations of vasopressin, oxytocin and noradrenaline remained low during the aura, but rapidly increased during the phase of generalisation. The oxytocin and noradrenaline levels peaked during the phase of generalised convulsion, but the vasopressin levels peaked well into the post ictal phase, and remained high for several hours. The differing patterns of hormone release are likely to be related to the different anatomical sites of the hypothalamic perikarya, the relative importance of excitatory and inhibitory hypophysiotrophic agents in the release of anterior pituitary hormones and the localised release of neuromodulatory

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02682.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In a prospective study, 129 consecutive patients with transient ischemic attacks (TIAs) and 80 consecutive patients with minor ischemic stroke, involving the carotid artery territory in both cases, were followed‐up for six years from their inclusion during the period from January 1984 to October 1985. All patients were 40–80 years old at inclusion, the median age being 74 years in the TIA group and 76 years in the minor stroke group. Overall mortality in the TIA group was significantly higher than in the minor stroke group, [44%, (57/129)vs20% (16/80), p<0.0006 after correction for age], and that in the general population of Malmö. Pre‐existing vascular disease was slightly more prevalent in the TIA than in the minor stroke group [27% (35/129vs21% (17/80), NS]. Of the 19 patients with intermittent claudication, who all died [12 (63%) of them due to myocardial infarction (MI)], 18 belonged to the TIA group and only one to the minor stroke group. The respective frequencies of the putative risk factors in the TIA and minor stroke groups were 28% (36/129)vs9% (7/80) for hypertension (p = 0.016), 9% (12/129)vs6% (5/80) for diabetes mellitus (NS), and 8% (10/129)vs9% (7/80) for cardiac arrhythmia (NS). Mortality due to MI was higher in the TIA than in the minor stroke group[24% (31/129)vs6% (5/80), p = 0.001]. Of the minor stroke patients, none without vascular disease died of MI. Regarding the risk of death in the study population as a whole (i.e., both groups), mortality was greater among those with vascular disease than among those without [81% (42/52)vs20% (31/157), p = 0.0001], the corresponding figures for death due to MI being 56% (29/52)vs4% (7/157), p = 0.0001. All six patients with both vascular disease and hypertension died, five of them due to MI. Thus, both in the TIA and minor stroke groups, mortality was greatest among those with preexisting vascular disease. To significantly reduce mortality among TIA and minor stroke patients, it is suggested that very active measures need to be taken against cardiovascular d

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02683.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

We retrospectively studied 1200 hospitalized acute strokes of all etiologies between July 1990 and August 1992. Ninety‐six % of all strokes underwent computed tomography of the head. Fifty‐eight percent of the 1200 strokes were brain infarction, 32% brain hemorrhage, 6% subarachnoid hemorrhage and 4% were other stroke subtypes. Thirty (2.5%) of all strokes suffered from early seizures. The incidences of early seizures were 2.8% in brain hemorrhage, 2.3% in brain infarction, 2.7% in subarachnoid hemorrhage and 2% in other stroke subtypes. Early seizures were documented in 6% of the patients with carotid territory cortical infarctions and 12% of the patients with lobar hemorrhage, whereas only 0.6% of the patients without carotid territory cortical infarctions and 0.6% of the patients without lobar hemorrhage were affected. Sixty‐ six percent of 30 early seizures were partial seizures, 24% generalized and status epilepticus were seen only in 10%. In conclusion, we found the early seizure incidence was 2.5% in Chinese patients hospitalized with acute strokes. There was no correlation between seizure occurrence and stroke subtypes. Early seizure developed significantly higher in acute stroke patients with lesions of the cortex than those patients without cortical involvement. The partial seizures were the most frequent type occurring in 66% of all acute stroke patients with early sei

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02684.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Anticardiolipin antibody (aCL) is known as a risk marker for stroke, particularly in subjects younger than 50 years of age. We studied the effects of aCL on stroke types, recurrences, and the coagulation‐fibrinolysis system in 257 elderly patients (63.2 ± 11.4 years). Follow‐up was performed for 3.1 years on 184 patients, for whom the rate of symptomatic and asymptomatic reinfarcts on CT was studied. aCL was positive in 30 (12%) of the patients. The incidence of atherosclerotic changes in the cerebral arteries was not significantly different between aCL‐positive and aCL‐negative patients. The aCL‐positive patients had a greater rate of individuals not having any of the known risk factors (p<0.05), a greater incidence of cortical infarctions (p<0.05), more frequent symptomatic recurrences (p<0.05). They had significantly greater changes in molecular markers for the coagulation‐fibrinolysis system in the acute phase (p<0.05), but not in the c

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02685.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Effect of hypothermia on cerebral infarcts was studied in rats embolized in the right carotid territory. Thirty‐four served as normothermic controls receiving saline infusion only. In 16 rats hypothermia of 32°C was induced by cooling with a fan, followed by embolization. The rats were kept hypothermic for the following 3 h before body temperature was raised to 37°C. In 26 rats, treatment with human recombinant tissue plasminogen activator (20 mg/kg i.v. during 45 min), started 2 h after embolization. Finally, 14 rats were treated similarly with hypothermia for 3 h followed by additional rt‐PA treatment starting after 2 h. Thrombolytic therapy reduced median infarct volume from 19.5% of affected hemisphere among controls to 4.6% (p = 0.006) in the treated group. Three hours of hypothermia reduced infarct volume to 1.6% (p = 0.0007). Additional rt‐PA could not demonstrate further improvement in this experimental

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02686.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

We have studied intracranial pressure (ICP) B‐waves and their association with rhythmic changes in blood flow velocity (B‐wave equivalents) by transcranial Doppler sonography (TCD) monitoring. In overnight TCD recordings in 10 normal young adults, these rhythmic changes in blood flow velocity were higher and more frequent during REM sleep and sleep stage 1 than during other sleep stages. B‐wave equivalents also had a longer wavelength during REM sleep. Their relative frequency in these normal subjects over one night ranged from 35 to 73%. Peripheral resistance (assessed by the Pourcelot index) was lower and heart rate was higher at the peak of these oscillations. These results support the hypothesis that ICP B‐waves are caused by vasodilation. A non‐linear relationship between ICP and blood flow velocity was found during B‐waves in 9 of 11 patients with suspected NPH. Our results throw doubt on the suggestion that a relative frequency of less than 80% B‐wave activity can be a valid indicator for shunt responsiveness in patients with suspected normal pressure hydrocephalus (NPH). ICP recordings in suspected NPH should be accompanied by polysomnography to avoid misleading results due to variability of B‐wave appearance dependant o

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02687.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In a longitudinal prospective study, we followed 56 patients (17 men, 29 women) with definite multiple sclerosis (MS), who were treated with high‐dose intravenous methylprednisolone (IVMP), 10 consecutive days with 1000 mg IVMP daily. Mean follow‐up period after entry was 2.6 years (range 1.7–3.5 yrs.). All patients were treated because of a symptomatic deterioration. Independent of the disease courses (RR‐relapsing remitting/CP‐chronic progressive/CP + RR‐ mixed course), 65% of the 46 MS patients (30/46) showed a clinical improvement after the first IVMP course, expressed by a decrease in the EDSS rating (1.0 point or more). During the follow‐up period 59 additional IVMP courses (range 0–5 courses per patient) were given; 8 patients were treated with a combination of cyclophosphamide and prednisone, because of strong continuous progression. During the follow‐up period 19 patients (41%) showed an increase in the EDSS‐rating (1.0 point or more) compared with the EDSS level just after the first IVMP; 22 patients (48%) had no changes in the EDSS‐rating, and 5 patients (11%) showed a clinical improvement (decrease of 1.0 point or more). In the relapsing MS patients (RR and CP + RR, n = 38) mean relapse rate/patient/year prior to the first IVMP was 2.6, which significantly (p<0.0001) decreased to 0.8 during the follow‐up period. Statistically no significant difference was found between baseline EDSS and EDSS ratings after the follow‐up period in relapsing MS patients. In the CP MS patients clinical decline (increase of 1.0 point or more on the EDSS) during the follow‐up period was most prominent: 11 (58%) of the CP MS patients showed an increase of the EDSS‐rating, followed by 3 (37.5%) of the CP + RR MS group. Clinical deterioration was lowest for the RR MS patients (26%; 5/19). After the follow‐up period a significant (p<0.05) increase in the mean EDSS was noted compared with baseline EDSS (3.8 to 4.6) in chronic progressive MS (CP and CP + RR). The cerebrospinal fluid (CSF) variables (CSF mononuclear cells, CSF myelin basic protein (MBP), number of oligoclonal bands on iso‐electric focusing (IEF), IgG index and intrathecal IgG synthesis) decreased significantly after the initial IVMP. After the follow‐up period, all variables showed a persistent decrease compared with the levels prior to the first IVMP, both in patients receiving a single as well as multiple courses of IVMP. Our study suggest, that (repeated) IVMP reduces the relapse rate in relapsing MS patients, although development of disability is not prevented in RR disease. In chronic progressive MS (repeated) IVMP seems not decrease the clinical deterioration in comparison with the natural course. Prolonged effects are noted in the CSF of MS patients treated with IVMP, 1.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02688.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

We investigated the prevalence of Parkinson's disease in a representative sample of the elderly population living in the Girondedépartement, France. Among 3149 people over age 65, the prevalence ratio for Parkinson's disease was 1.4%, without significant difference between men and women. We found that age‐specific prevalence ratios increased with age from 0.5% in the age group 65 to 69 to 6.1% in individuals over age 90. This age pattern is consistent with that found in other population‐based studies. Interestingly, the slope of age‐specific prevalence ratios for Parkinson's disease was similar to that previously reported for Lewy bodies. Our study showed that a high proportion (42%) of Parkinson's disease cases in elderly subjects living in institutions were undia

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02689.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In 24 adults and 29 children both with Gilles de la Tourette syndrome and in 24 control adults and 17 control children we studied auditory event‐related potentials (ERP's) evoked in 2 different oddball paradigms: a passive listening paradigm (PLP) in which subjects had only to attend tones (260 standards, 40 deviants), followed by an active discrimination paradigm (ADP) in which subjects had to press a microswitch in response to the deviant tones. In the adult Tourette patients the PLP disclosed between 200–300 msec at all derivations (Fz, Cz, Pz, C3, C4, P3, P4) a significantly more negative activity than in the controls. In the Tourette children such a result was only found at Fz. In the ADP the differences between both adult groups disappeared, but the curves of the control children became now significantly more positive than those of the Tourette ones except at C3 and P3. Between 200–300 msec the curves of all 4 groups were significantly less negative in the ADP than in the PLP. This decrease in negativity was significantly larger in the adult Tourette patients than in the adult controls, but in the children groups the reverse occurred. It is hypothesized that the differences in amplitude between patients and controls and between both paradigms are due to differences in amplitude of an endogenous negative component overlapping the exogenous N100–N200 standard curve. Based on this hypothesis the results could suggest that one of the problems in Tourette syndrome is an increased attention to non‐relevan

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02690.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Use of cocaine in the USA, has reached epidemic proportions since 1983, when “crack” was introduced, its higher potency compared with cocaine HCl has been associated with a tremendous increase in the incidence of strokes. This study reports our experience with 55 cases of neurovascular events (25 ischemic and 30 hemorrhagic) related to cocaine use in 54 patients. Only 15 patients had other risk factors for stroke. Twenty six patients smoked “crack”, 10 snorted cocaine and 12 injected it intravenously. Strokes occurred within 3 h of cocaine use in 15 patients with infarcts and 17 with hemorrhages. Ten infarcts occurred after an overnight binge. Of the hemorrhage group 9 were subarachnoid, 16 intracerebral (8 basal ganglia, 7 hemispheric and one brain stem) and 5 intraventricular. Computerized tomography (CT) showed an aneurysm of the anterior communicating artery, as well as one of the vein of Galen. Four aneurysms and 3 AVMs were identified on angiography. CT revealed 15 infarcts; it was normal in 7 patients with pure motor hemiparesis and in 3 with findings consistent with anterior spinal artery infarction. Several mechanisms may be responsible for the cerebrovascular complications. A sudden rise in systemic arterial pressure may cause hemorrhages, frequently in association with an underlying aneurysm or AVM. Vasospasm, arteritis, myocardial infarction with cardiac arrhythmias and increased platelet aggregation may provoke i

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb02691.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY