摘要:

Lacunes of the human brain are most often considered to represent microinfarcts but several experimental investigations favor the role of edema as an important pathogenetic factor in the formation of lacunes. We have observed 3 cases of Binswanger''s encephalopathy which, apart from typical lacunes, showed edematous lesions most likely representing developing lacunes. These edematous lesions differed from microinfarcts in their fewer number of macrophages, numerous hypertrophic astrocytes, less distinct demarcation from the surrounding tissue and the presence of a surrounding rim of edematous tissue. Our observations are in line with the hypothesis that focal chronic edema is an important pathogenetic factor in the formation of lacunes in Binswanger''s encephalopathy.

ISSN:1015-9770    

DOI:10.1159/000108216

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Ninety-four diabetic patients, asymptomatic for cerebrovascular disease, stratified according to the presence of proliferative retinopathy (PDR), background retinopathy (BDR) and no diabetic retinopathy (NDR) underwent transcranial Doppler evaluation. Impairment in neither blood flow velocity and pulsatility index recorded at the ophthalmic and intracranial arteries, nor in the vasodilatory response to a breath-holding test was found in patients, when compared to age-matched controls. The subgroup analysis showed that PDR patients had significantly higher pulsatility index and lower cerebrovascular reactivity values than BDR and NDR patients. Such a difference was not just due to age or disease duration, being greatest in patients under the sixties. In asymptomatic diabetic patients, PDR may be a predictor of early cerebral vessel involvement and should lead to investigate brain hemodynamics by screening procedures.

ISSN:1015-9770    

DOI:10.1159/000108217

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108218

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

We analyzed the relationship between 24-hour blood pressure variability and spatial distribution and extent of early carotid atherosclerosis in 208 hypertensive and 216 normotensive patients aged over 55 years. Circadian blood pressure patterns were evaluated noninvasively with a long-term blood pressure monitor. The extent of atherosclerosis was measured as the intima-to-media wall thickness (IMT) of the internal (ICA) and external carotid artery (ECA). No significant differences regarding age, sex, smoking, diabetes, cholesterol and triglycerides were found in either patient group. In both groups, a linear correlation between ICA and ECA IMT was observed. However, the slope of the regression line was clearly increased in hypertensive patients [0.563 (95% confidence interval 0.522, 0.604) vs. 0.436 (0.364, 0.509); p < 0.01]. Multivariate regression analysis revealed the strongest correlation between the IMT of the ICA and the diurnal systolic blood pressure variability; this parameter was not significantly associated with the ECA IMT. The odds ratio of having ischemic heart disease was significantly raised in patients with early atherosclerosis of the ICA but not the ECA [4.7 (2.5, 8.8); p < 0.001 vs. 1.6 (0.7, 3.6)]. Our results show that the diurnal systolic blood pressure variability is closely correlated with early carotid atherosclerosis of the ICA but not the ECA territory. The analysis of circadian blood pressure patterns is useful to explain the focal effects of blood pressure on the development of atherosclerosis.

ISSN:1015-9770    

DOI:10.1159/000108219

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Several correlational studies have suggested an association between stroke mortality rates and geophysical parameters, but none have assessed the influence of these parameters on stroke occurrence in a general population. We conducted a population-based study (2,195 stroke patients) to determine whether there are relationships between stroke occurrence and solar and/or geomagnetic activity. A multivariable logistic regression analysis was used to estimate the odds ratio (OR) and to identify the geophysical parameters of most importance; 95% confidence intervals (CI) were calculated for the variables studied. In a multivariate analysis, large fluctuations of solar (OR = 1.21; 95% CI 1.14–1.30) and geomagnetic activity (0R = 1.20; 95% CI 1.11–1.31) on the preceding day and low level of solar activity (OR = 1.14; 95% CI 1.08–1.21) on the day of stroke onset were independent predictors of stroke occur

ISSN:1015-9770    

DOI:10.1159/000108220

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Brain edema following ischemic stroke often results in significant morbidity and death. Decompressive craniotomy has been advocated and may result in a surprisingly satisfactory outcome. We present a 17-year-old patient who developed a right middle cerebral artery territory infarction associated with a cardiac myxoma. Five days after the ictus and two days after a thoracotomy to remove the obstructing tumor, he developed clinical signs of uncal herniation. CT scans showed massive cerebral edema and development of obstructive hydrocephalus. An intracranial pressure monitor measured 30 mmHg on insertion. Management with mannitol reversed the clinical and radiologic signs of uncal herniation. There is a renewed interest in decompressive craniotomy. Our patient indicates that conventional management of increased intracranial pressure may reverse brain edema when associated with hemispheric infarction. Decompressive craniotomy needs validation in a randomized trial.

ISSN:1015-9770    

DOI:10.1159/000108221

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108222

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108223

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108416

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

For most of his life, Joseph Haydn (1732–1809) was a healthy man, apart from a chronic nasal polyp. With increasing age, Haydn is said to have suffered from progressive forgetfulness which prevented him from composing for about the last 8 years of his life. He spent his days immobilized and inactive, suffering from frequent leg swelling, which has commonly been regarded as the reason for Haydn''s gait disturbance. Most biographers quote diffuse atherosclerosis and congestive heart failure as the diagnosis of the composer''s final illness and a reason for his death. A more sophisticated pathography, however, can be inferred from a detailed analysis of documents and sources, which leads to a diagnosis of subcortical vascular encephalopathy. This is a variant of cerebral microangiopathy with a classical triad of sequential symptoms: a dyspraxic gait disturbance (i.e. frontal gait apraxia), neuropsychological ''frontal lobe'' deficits (i.e. cognitive slowing and mnestic deficits leading to an abulic syndrome and slowly progressive dementia, and mood disorders of various degrees (i.e. depression, lability of affect, abnormal crying and laughing). All three components can be documented from Haydn''s biographies. In the classical descriptions of the composer''s contemporaries Dies, Carpani and Griesinger – despite his legs being swollen in various degrees as a symptom of congestive heart failure – there are clues for a severe dyspraxic gait disturbance contrasting with initially preserved but progressively deteriorating bimanual motor interaction, which eventually led to Haydn''s complete immobiliz

ISSN:1015-9770    

DOI:10.1159/000108224

出版商:S. Karger AG    

年代:1997

数据来源: Karger