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3-07-04 Clinical and neuroradiological study in pseudobulbar palsy
Cerebrovascular
Diseases 3 07 03 I__I
07
Cerebrovascular Diseases
s143 Risk factors and outcome of cerebral ischemia patients over 80
C. Marini, P. Santalucia, M. Di Napoli, L. Triggiani, Neurology; University of CAquila, L’Aquila, la/y
A. Carolei.
in
Depatiment
of
Objective:
13-07-01
1 Clinical characteristics vascular malformations
of the spinal and intracranial
D. Kozic, N. Stemic ‘, M. Lucid, S. Apostoloski ’ Magnetic Center, Sremska Kamenica, Serbia, Yugoslavia, ’ institute Serbian Clinical Center, Belgrade, Serbia, Yugoslavia
Resonance of Neurolog):
The purpose of the study was to evaluate clinical presentation of the spinal and intracranial vascular malformations (IVM) which were divided into arteriovenous malformation (AVM), venous angioma (VA), cavernous angioma (CA), spinal dural arteriovenous fistulae (SDAVF) and spinal cord CA. Medical records of 22 patients with a radiographic diagnosis of IVM by head MRI scan were reviewed for seizure history, headache, subarachnoid hemorrhage or intracerebral hematoma and neurologic deficit. Clinical characteristics of 4 patients with SDAVF and of 2 patients with spinal cord CA revealed by spinal MRI were evaluated. Head MR scanning revealed 14 patients with AVM. Hemorrhage was the initial manifestation in 4 patients. Focal neurologic deficit was revealed in 2 patients. Severe headache was the main complaint in 3 patients while the seizure history was positive in 5 cases. CA was detected in 4 patients, three of whom presented with temporal lobe involvement and seizures, while in one case the numbness in the right lower extremity was the main symptom. VA was noticed in 4 patients, in one with seizures and in the others as an incidental finding. In 2 of them VA was missed on routine nonenhenced MR examination. Three patients with SDAVF presented with either moderate or severe paraparesis, while the back pain was the only symptom in one patient. Solitary CA was detected in the cervical segment of the spinal cord in both patients who were evaluated for quadriparesis. AVM and CA may cause a wide spectrum of complaints among which the seizures are the most common, while VA is usually asymptomatic brain lesion. SDAVF are followed by progressive paraparesis.
13-07-021 -
Stroke at young adults as an onset in systemic vasculltis-
Marieta Macovei, C. Popa, Luminita Golca, Laurentia Clinic Gh. Marinescu Hospital; institute of Neurology Bucharest, Romania
Nodit. Neurological and Psychiatry
lschemic stroke raise many etiologic diagnosis problems, especially in young patients. The authors present 43 cases of ischemic stroke at young patients (mean age 40 years old, 18 women, 25 men) diagnosed with systemic vasculitis with neurological onset. At 11 cases with stroke in vertebrobasilar territory and pontine and midbrain signs the etiology was: -one case Behcet disease, 8 cases lupus-like syndrome produced by oral contraceptives, 2 cases Stevens-Johnson syndrome, 3 cases Lupus erythematosus. In 22 cases with carotidian stroke, the etiology was: 6 cases Lupus erythematosus (hemorrhagic infarction in 4 cases); 1 case AIDS; 5 cases periarteritis nodosa; 2 cases Kawasaky’s disease; 8 cases systemic undifferentiated vasculitis (hemorrhagic infarction with pseudotumoral evolution). In 9 cases were encountered peculiar clinial aspects: 3 cases limbic dementia (acute lesions with unilateral or bilateral hippocampus infarction in undifferentiated vasculitis), 3 cases with spontaneous dissection of internal carotid artery as an onset in systemic necrotizing vasculitis: 2 cases Churg Strauss allergic angiitis and granulomatosis, 1 case lupus erythematosus disease, 1 case disconnection syndrome (multiple corpus callosum microinfarctions in a periarteritis nodosa case), 2 cases scleroderma with striatonigral degeneration associated with olivopontocerebellar atrophy produced by multiple infarctions caused by endomesovasculitis. The cases have been investigated with: hematological tests, immunological tests, capillaroscopy, oscillometry, transcranial Doppler echography, echocardiography, CT, MRI, cutaneous biopsies (10 cases), cerebral biopsies (2 cases), post-modem examination (1 case). The authors found asymptomatic MRI abnormalities (in 20 cases) suggesting cortico-subcortical demyelinations (caused by lesions in capillary or precapillary vessels) indicating cerebral lesions prior to the stroke which caused the admission. The authors insist on including AIDS as a possible etiology of stroke at young adults. The authors consider the concept of the immunologic manipulation and the mechanism which generates the endothelial inflammation from the capillary and precapillarycerebral vessels, with lymphokines and prostaglandins release and the lack of an adequate answer at acetylcholine.
To determine risk factors profiles and prognostic determinants of over and under 80 years of age with ischemic stroke. Design/Methods: All first-ever ischemic strokes occurring between January 1, 1994 and December 31, 1995, were traced in the CAqui/a Stroke Registr)! We compared the prevalence of vascular risk factors in patients over and under 80 by the logistic regression analysis and their influence on 30-day survival by the Kaplan-Meier method. Results: 496 out of 1351 ischemic strokes (37%) occurred in patients over 80: 217 in men (44%) and 279 in women (56%). Brain CT or MRI were performed in 407 (82%) patients. The crude annual incidence rate was 20.30/1000 or20.06/1000 when standardized to the 1991 Italian population and 20.55/1000 when standardized to the European population. At the multivariate logistic regression analysis, patients over 80 had lower proportions of cigarette smoking (OR = 0.48, 95% Cl 0.36-0.61; P < 0.0001) and hypercholesterolemia (OR = 0.63, 95% Cl 0.48-0.83; P= 0.001) and a higher proportion of coronary heart disease (OR = 1.8, 95% Cl 1.39-2.30; P < 0.0001). Cigarette smoking (OR = 0.51, 95% Cl 0.36-0.72; P = 0.0002) was less frequent in men over 80 and hypercholesterolemia (OR = 0.59, 95% Cl 0.41-0.84; P < 0.004) in women over 80. Thirty-day survival was lower (P < 0.0001; log-rank test) in patients over 80 with respect to patients under that age (70 vs 87%) in the presence of atrial fibrillation (P < 0.0001) and of diabetes mellitus (P c 0.02). Patients over 80 with lacunar infarcts had a better survival than patients with cortical infarcts (P < 0.0001). The survival of patients with lacunar infarcts was reduced in the presence of atrial fibrillation (7.8 vs 23.5%; P = 0.0201). Conclusions: The high proportion of ischemic strokes occurring in patients over 80 suggests to implement preventive measures aimed to risk factors control and to define specific guidelines for the early treatment of acute stroke. patients
3-07-04
Clinical and neuroradiological pseudobulbar palsy
study in
M. Ogasawara, K. Hirata, T. Suga, M. Nagasawa, T. Iwai, K. Yamazaki, M. Fujikane I, S. Katayama’. ‘Department of Neuro/ogK Dokkyo University School of Medicine, Tochigi, Japan, 2Southern Tohoku Brain Research Institute, Fukushima, Japan In order to estimate the localization of lesion and clinical characteristics in pseudobulbar palsy (PBP). Fifty-seven PBP patients were investigated clinically and neuroradiologicaly. The study was carried out in 57 consecutive stroke patients with PBP and 72 patients who showed dysarthria alone or dysphagia transiently as a control group. The diagnosis of PBP was defined as follows. The clinical features of PBP patients develop and persist without improvement both dysarthria and dysphagia by cerebral infarction. MRI using 0.5, 1.0 and 1.5 Tesla were performed in 34 patients of PBP group and in all of control subjects. Brain stem infarction observed in 26 cases of 34 PBP patients (76.4%). Superposition of multiple lesions which were located not only supra tentorial lesion but also infra tentrtal lesion were obtained in PBP patients. These spatial localization is thought to be necessary for developing and persistence of PBP symptom in the majority cases of PBP patients. In addition, previous asymptomatic lesions which mainly located contralateral side of new lesion were found in 11 of 34 PBP patients (32.4%). The previous asymptomatic lesion The incidence of stroke attacks before PBP onset were more than 3 times in many cases. PBP patients easily developed to tetraparesis, and carried a poor prognosis, compared to control group. In the prognosis, PBP is at an increased risk for death due to developing pneumonia. These findings suggest that time-related and spatial multiplicity might be involved in the etiology of PBP.
3-07-05
Preservation of CO2 dependent regulation of cerebral blood flow in patients wlth cirrhosis
L. Patrucco, S. Gerona, 0. Galdame, J. Torres, P. Lopez, P. Bauso Toselli, L. Serra, R. Mastai. Deparfment of Neurology and Hepatology, ltalian Hospital, Buenos Aires, Argentina
Intmductton:
Cerebral blood flow (CBF) is regulated by carbon dioxide tension and by arterial pressure beyond the autoregulatory limits. Objectives: To evaluate CBF autoregulation in patients with cirrhosis. Material and Methods: Eighteen hepatic cirrhotic patients (HC) and 11 healthy subjects (HS) were included. Mean arterial pressure (MAP), cardiac output (CO), and peripheral vascular resistance (PVR were measured in basal conditions. Blood flow velocity (BFV) and pulsatility index (PI) in the middle (PC02)
Diseases 3 07 03 I__I
07
Cerebrovascular Diseases
s143 Risk factors and outcome of cerebral ischemia patients over 80
C. Marini, P. Santalucia, M. Di Napoli, L. Triggiani, Neurology; University of CAquila, L’Aquila, la/y
A. Carolei.
in
Depatiment
of
Objective:
13-07-01
1 Clinical characteristics vascular malformations
of the spinal and intracranial
D. Kozic, N. Stemic ‘, M. Lucid, S. Apostoloski ’ Magnetic Center, Sremska Kamenica, Serbia, Yugoslavia, ’ institute Serbian Clinical Center, Belgrade, Serbia, Yugoslavia
Resonance of Neurolog):
The purpose of the study was to evaluate clinical presentation of the spinal and intracranial vascular malformations (IVM) which were divided into arteriovenous malformation (AVM), venous angioma (VA), cavernous angioma (CA), spinal dural arteriovenous fistulae (SDAVF) and spinal cord CA. Medical records of 22 patients with a radiographic diagnosis of IVM by head MRI scan were reviewed for seizure history, headache, subarachnoid hemorrhage or intracerebral hematoma and neurologic deficit. Clinical characteristics of 4 patients with SDAVF and of 2 patients with spinal cord CA revealed by spinal MRI were evaluated. Head MR scanning revealed 14 patients with AVM. Hemorrhage was the initial manifestation in 4 patients. Focal neurologic deficit was revealed in 2 patients. Severe headache was the main complaint in 3 patients while the seizure history was positive in 5 cases. CA was detected in 4 patients, three of whom presented with temporal lobe involvement and seizures, while in one case the numbness in the right lower extremity was the main symptom. VA was noticed in 4 patients, in one with seizures and in the others as an incidental finding. In 2 of them VA was missed on routine nonenhenced MR examination. Three patients with SDAVF presented with either moderate or severe paraparesis, while the back pain was the only symptom in one patient. Solitary CA was detected in the cervical segment of the spinal cord in both patients who were evaluated for quadriparesis. AVM and CA may cause a wide spectrum of complaints among which the seizures are the most common, while VA is usually asymptomatic brain lesion. SDAVF are followed by progressive paraparesis.
13-07-021 -
Stroke at young adults as an onset in systemic vasculltis-
Marieta Macovei, C. Popa, Luminita Golca, Laurentia Clinic Gh. Marinescu Hospital; institute of Neurology Bucharest, Romania
Nodit. Neurological and Psychiatry
lschemic stroke raise many etiologic diagnosis problems, especially in young patients. The authors present 43 cases of ischemic stroke at young patients (mean age 40 years old, 18 women, 25 men) diagnosed with systemic vasculitis with neurological onset. At 11 cases with stroke in vertebrobasilar territory and pontine and midbrain signs the etiology was: -one case Behcet disease, 8 cases lupus-like syndrome produced by oral contraceptives, 2 cases Stevens-Johnson syndrome, 3 cases Lupus erythematosus. In 22 cases with carotidian stroke, the etiology was: 6 cases Lupus erythematosus (hemorrhagic infarction in 4 cases); 1 case AIDS; 5 cases periarteritis nodosa; 2 cases Kawasaky’s disease; 8 cases systemic undifferentiated vasculitis (hemorrhagic infarction with pseudotumoral evolution). In 9 cases were encountered peculiar clinial aspects: 3 cases limbic dementia (acute lesions with unilateral or bilateral hippocampus infarction in undifferentiated vasculitis), 3 cases with spontaneous dissection of internal carotid artery as an onset in systemic necrotizing vasculitis: 2 cases Churg Strauss allergic angiitis and granulomatosis, 1 case lupus erythematosus disease, 1 case disconnection syndrome (multiple corpus callosum microinfarctions in a periarteritis nodosa case), 2 cases scleroderma with striatonigral degeneration associated with olivopontocerebellar atrophy produced by multiple infarctions caused by endomesovasculitis. The cases have been investigated with: hematological tests, immunological tests, capillaroscopy, oscillometry, transcranial Doppler echography, echocardiography, CT, MRI, cutaneous biopsies (10 cases), cerebral biopsies (2 cases), post-modem examination (1 case). The authors found asymptomatic MRI abnormalities (in 20 cases) suggesting cortico-subcortical demyelinations (caused by lesions in capillary or precapillary vessels) indicating cerebral lesions prior to the stroke which caused the admission. The authors insist on including AIDS as a possible etiology of stroke at young adults. The authors consider the concept of the immunologic manipulation and the mechanism which generates the endothelial inflammation from the capillary and precapillarycerebral vessels, with lymphokines and prostaglandins release and the lack of an adequate answer at acetylcholine.
To determine risk factors profiles and prognostic determinants of over and under 80 years of age with ischemic stroke. Design/Methods: All first-ever ischemic strokes occurring between January 1, 1994 and December 31, 1995, were traced in the CAqui/a Stroke Registr)! We compared the prevalence of vascular risk factors in patients over and under 80 by the logistic regression analysis and their influence on 30-day survival by the Kaplan-Meier method. Results: 496 out of 1351 ischemic strokes (37%) occurred in patients over 80: 217 in men (44%) and 279 in women (56%). Brain CT or MRI were performed in 407 (82%) patients. The crude annual incidence rate was 20.30/1000 or20.06/1000 when standardized to the 1991 Italian population and 20.55/1000 when standardized to the European population. At the multivariate logistic regression analysis, patients over 80 had lower proportions of cigarette smoking (OR = 0.48, 95% Cl 0.36-0.61; P < 0.0001) and hypercholesterolemia (OR = 0.63, 95% Cl 0.48-0.83; P= 0.001) and a higher proportion of coronary heart disease (OR = 1.8, 95% Cl 1.39-2.30; P < 0.0001). Cigarette smoking (OR = 0.51, 95% Cl 0.36-0.72; P = 0.0002) was less frequent in men over 80 and hypercholesterolemia (OR = 0.59, 95% Cl 0.41-0.84; P < 0.004) in women over 80. Thirty-day survival was lower (P < 0.0001; log-rank test) in patients over 80 with respect to patients under that age (70 vs 87%) in the presence of atrial fibrillation (P < 0.0001) and of diabetes mellitus (P c 0.02). Patients over 80 with lacunar infarcts had a better survival than patients with cortical infarcts (P < 0.0001). The survival of patients with lacunar infarcts was reduced in the presence of atrial fibrillation (7.8 vs 23.5%; P = 0.0201). Conclusions: The high proportion of ischemic strokes occurring in patients over 80 suggests to implement preventive measures aimed to risk factors control and to define specific guidelines for the early treatment of acute stroke. patients
3-07-04
Clinical and neuroradiological pseudobulbar palsy
study in
M. Ogasawara, K. Hirata, T. Suga, M. Nagasawa, T. Iwai, K. Yamazaki, M. Fujikane I, S. Katayama’. ‘Department of Neuro/ogK Dokkyo University School of Medicine, Tochigi, Japan, 2Southern Tohoku Brain Research Institute, Fukushima, Japan In order to estimate the localization of lesion and clinical characteristics in pseudobulbar palsy (PBP). Fifty-seven PBP patients were investigated clinically and neuroradiologicaly. The study was carried out in 57 consecutive stroke patients with PBP and 72 patients who showed dysarthria alone or dysphagia transiently as a control group. The diagnosis of PBP was defined as follows. The clinical features of PBP patients develop and persist without improvement both dysarthria and dysphagia by cerebral infarction. MRI using 0.5, 1.0 and 1.5 Tesla were performed in 34 patients of PBP group and in all of control subjects. Brain stem infarction observed in 26 cases of 34 PBP patients (76.4%). Superposition of multiple lesions which were located not only supra tentorial lesion but also infra tentrtal lesion were obtained in PBP patients. These spatial localization is thought to be necessary for developing and persistence of PBP symptom in the majority cases of PBP patients. In addition, previous asymptomatic lesions which mainly located contralateral side of new lesion were found in 11 of 34 PBP patients (32.4%). The previous asymptomatic lesion The incidence of stroke attacks before PBP onset were more than 3 times in many cases. PBP patients easily developed to tetraparesis, and carried a poor prognosis, compared to control group. In the prognosis, PBP is at an increased risk for death due to developing pneumonia. These findings suggest that time-related and spatial multiplicity might be involved in the etiology of PBP.
3-07-05
Preservation of CO2 dependent regulation of cerebral blood flow in patients wlth cirrhosis
L. Patrucco, S. Gerona, 0. Galdame, J. Torres, P. Lopez, P. Bauso Toselli, L. Serra, R. Mastai. Deparfment of Neurology and Hepatology, ltalian Hospital, Buenos Aires, Argentina
Intmductton:
Cerebral blood flow (CBF) is regulated by carbon dioxide tension and by arterial pressure beyond the autoregulatory limits. Objectives: To evaluate CBF autoregulation in patients with cirrhosis. Material and Methods: Eighteen hepatic cirrhotic patients (HC) and 11 healthy subjects (HS) were included. Mean arterial pressure (MAP), cardiac output (CO), and peripheral vascular resistance (PVR were measured in basal conditions. Blood flow velocity (BFV) and pulsatility index (PI) in the middle (PC02)