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Stroke. A symposium held in Stockholm, April 19–21, 1966
BOOK REVIEWS
Stroke. A Symposium held in Stockholm, April 19-21, 1966. - - A. Engel and T. Larsson (Eds.) (Thule Internat. Symposia, Vol. I, 1967, 288 p., Sw. Kr. 45.00, $8.75). This book contains the reports presented at a Stockholm Symposium together with the transcripts of the ensuing discussions. It is in itself noteworthy that it was sponsored by a group of insurance companies and organized by a life insurance company. It is to be welcomed that, at last, an insurance company acknowledges " . . . that it has both a privilege and an obligation to support all types of effort to improve health" and that as a consequence it organized, we hope as a start to a much larger effort, such a Symposium. There were 28 participants, seven of whom came from abroad. A wide spectrum of aspects was covered. Statistical aspects of cerebrovascular disease (CVD) are discussed in papers by Larsson and by Sj6str6m. In Sweden there do not seem to be large geographical differences as regards mortality and morbidity from CVD. The discussion points to some inevitable weak spots, e.g. as regards diagnosis of the various types of stroke. Ziilch and Kleihues give a survey of their well-known studies on the pathogenesis of ischaemic cerebral lesions, paying particular attention to haemodynamic factors. The pathogenesis of intracranial haemorrhage is discussed by ~str6m. Kety presents a clear and succinct survey of the investigations of his group of workers on the cerebral circulation during the past 20 years. He draws attention to the observation that lowering of the blood pressure leaves the cerebral circulation unaltered in cases of essential hypertension whereas it does diminish in cases of arteriosclerotic hypertension, thereby increasing the risk of the occurrence of ischaemic lesions. There is some discussion on the importance of hypotensive drugs as a cause of cerebral infarction. Ingvar summarizes the literature and the investigations of his group concerning the EEG, the measurement of regional cerebral blood flow with Sakrypton and laaxenon and the correlation between the results of both methods in cases of stroke. Particularly in the acute phase of apoplexy there is no good correlation, but this improves in the subacute and chronic stages. It is of interest that in some cases a depression of the activity of the EEG is associated with post-hypoxic cerebral hyperaemia. In the discussion Kety confirms Ingvar's findings referring to autoradiography of cats' brains. Porj6 discusses the relation between disturbances of the systemic circulation and cerebral infarction. It is noteworthy that there is a close correlation between the blood pressure and cerebral blood flow only in older patients with arteriosclerosis (Hedlund). Wid6n et al. confirm the importance ofecho-encephalography for the differential diagnosis between cerebral infarction and haemorrhage. Greitz compares the results of cerebral angiography from a Swedish group with the American "joint study of extracranial arterial occlusion". Apart from minor differences similar results were obtained. It is stressed that investigation of the extracranial vessels not infrequently reveals
493
a stenosis or occlusion of a vessel which is not directly related to the area of infarction. S6derberg gives a very concentrated survey of the metabolic aspects of stroke, with extensive references. The various factors involved in the complex mechanism of coagulation and t h r o m b u s formation are discussed by inga M. Nilsson. Katsuki and Omae report on an extensive prospective population survey concerned with cerebrovascular disease, covering a period of 4 years and over 1600 subjects. Many variables were measured in all subjects and correlated wit,, the occurrence of CVD. Those who developed CV episodes were investigated in more detail. Rehabilitation is discussed by H66k, treatment by Peart and by Hood et al. and surgery of extracranial cerebral arteries by Rob and by Bellman. This volume gives a fairly comprehensive and at the same time concise survey of the subject. The inclusion of the discussions of the various reports makes it more lively and not infrequently adds valuable information. The book is recommended both for reading and as a source of references to all those who are interested in the various aspects of "stroke", one of the major causes of illness and death of our time. O. MAGNUS
St. Ursula Kliniek, Wassenaar (The Netherlands) Electroenceph. clin. Neurophysiol., 1968, 26:493 Interoception and behaviour. (in English) - - G. Addm. (Akad6miai Kiad6, Budapest, 1967, 152 p., $8.00). In this book the results of twelve years work by an experimental physiologist are presented. One more gap in our far from full knowledge of behavioural mechanisms is filled. By means of positive conditioned reflexes and their differentiation on stimulation of various parts of the same visceral organ or adjacent organs of the same system, the discriminating ability of the higher levels of the nervous system was studied in relation to interoceptive efferents and the topography of the central interoceptive representation. Studying the conditioned reflex to stimulation of a region with symmetrical innervation, the "readiness'" phenomenon, A,dfim both confirms and develops the data known from the time of Bykov's study of the same process in skin receptors. For instance, Adfim, contrary to Bykov, shows the possibility of elaborating both positive and difl'erentiative conditioned reflexes, taking the stimulation of symmetrical points as a conditioned signal. In the first chapters both effector and electrographic phenomena in the central nervous system are investigated during interoceptive stimulation and interoceptive conditioned reflexes. Recording of brain activity under these conditions supplies additional elements to the chain of phenomena connected with the elaboration of positive and inhibitory conditioned reflexes from the symmetrical organs, the e[ectrographic differentiation being very difficult. The electrophysiological data are used adequately to the task. However, it would be useful, in this and the
Eleetroenceph. olin. Neurophysiol., 1968, 26:493-494
Stroke. A Symposium held in Stockholm, April 19-21, 1966. - - A. Engel and T. Larsson (Eds.) (Thule Internat. Symposia, Vol. I, 1967, 288 p., Sw. Kr. 45.00, $8.75). This book contains the reports presented at a Stockholm Symposium together with the transcripts of the ensuing discussions. It is in itself noteworthy that it was sponsored by a group of insurance companies and organized by a life insurance company. It is to be welcomed that, at last, an insurance company acknowledges " . . . that it has both a privilege and an obligation to support all types of effort to improve health" and that as a consequence it organized, we hope as a start to a much larger effort, such a Symposium. There were 28 participants, seven of whom came from abroad. A wide spectrum of aspects was covered. Statistical aspects of cerebrovascular disease (CVD) are discussed in papers by Larsson and by Sj6str6m. In Sweden there do not seem to be large geographical differences as regards mortality and morbidity from CVD. The discussion points to some inevitable weak spots, e.g. as regards diagnosis of the various types of stroke. Ziilch and Kleihues give a survey of their well-known studies on the pathogenesis of ischaemic cerebral lesions, paying particular attention to haemodynamic factors. The pathogenesis of intracranial haemorrhage is discussed by ~str6m. Kety presents a clear and succinct survey of the investigations of his group of workers on the cerebral circulation during the past 20 years. He draws attention to the observation that lowering of the blood pressure leaves the cerebral circulation unaltered in cases of essential hypertension whereas it does diminish in cases of arteriosclerotic hypertension, thereby increasing the risk of the occurrence of ischaemic lesions. There is some discussion on the importance of hypotensive drugs as a cause of cerebral infarction. Ingvar summarizes the literature and the investigations of his group concerning the EEG, the measurement of regional cerebral blood flow with Sakrypton and laaxenon and the correlation between the results of both methods in cases of stroke. Particularly in the acute phase of apoplexy there is no good correlation, but this improves in the subacute and chronic stages. It is of interest that in some cases a depression of the activity of the EEG is associated with post-hypoxic cerebral hyperaemia. In the discussion Kety confirms Ingvar's findings referring to autoradiography of cats' brains. Porj6 discusses the relation between disturbances of the systemic circulation and cerebral infarction. It is noteworthy that there is a close correlation between the blood pressure and cerebral blood flow only in older patients with arteriosclerosis (Hedlund). Wid6n et al. confirm the importance ofecho-encephalography for the differential diagnosis between cerebral infarction and haemorrhage. Greitz compares the results of cerebral angiography from a Swedish group with the American "joint study of extracranial arterial occlusion". Apart from minor differences similar results were obtained. It is stressed that investigation of the extracranial vessels not infrequently reveals
493
a stenosis or occlusion of a vessel which is not directly related to the area of infarction. S6derberg gives a very concentrated survey of the metabolic aspects of stroke, with extensive references. The various factors involved in the complex mechanism of coagulation and t h r o m b u s formation are discussed by inga M. Nilsson. Katsuki and Omae report on an extensive prospective population survey concerned with cerebrovascular disease, covering a period of 4 years and over 1600 subjects. Many variables were measured in all subjects and correlated wit,, the occurrence of CVD. Those who developed CV episodes were investigated in more detail. Rehabilitation is discussed by H66k, treatment by Peart and by Hood et al. and surgery of extracranial cerebral arteries by Rob and by Bellman. This volume gives a fairly comprehensive and at the same time concise survey of the subject. The inclusion of the discussions of the various reports makes it more lively and not infrequently adds valuable information. The book is recommended both for reading and as a source of references to all those who are interested in the various aspects of "stroke", one of the major causes of illness and death of our time. O. MAGNUS
St. Ursula Kliniek, Wassenaar (The Netherlands) Electroenceph. clin. Neurophysiol., 1968, 26:493 Interoception and behaviour. (in English) - - G. Addm. (Akad6miai Kiad6, Budapest, 1967, 152 p., $8.00). In this book the results of twelve years work by an experimental physiologist are presented. One more gap in our far from full knowledge of behavioural mechanisms is filled. By means of positive conditioned reflexes and their differentiation on stimulation of various parts of the same visceral organ or adjacent organs of the same system, the discriminating ability of the higher levels of the nervous system was studied in relation to interoceptive efferents and the topography of the central interoceptive representation. Studying the conditioned reflex to stimulation of a region with symmetrical innervation, the "readiness'" phenomenon, A,dfim both confirms and develops the data known from the time of Bykov's study of the same process in skin receptors. For instance, Adfim, contrary to Bykov, shows the possibility of elaborating both positive and difl'erentiative conditioned reflexes, taking the stimulation of symmetrical points as a conditioned signal. In the first chapters both effector and electrographic phenomena in the central nervous system are investigated during interoceptive stimulation and interoceptive conditioned reflexes. Recording of brain activity under these conditions supplies additional elements to the chain of phenomena connected with the elaboration of positive and inhibitory conditioned reflexes from the symmetrical organs, the e[ectrographic differentiation being very difficult. The electrophysiological data are used adequately to the task. However, it would be useful, in this and the
Eleetroenceph. olin. Neurophysiol., 1968, 26:493-494