SUMMARY In 65 cases of ischemic cerebral infarction, CT scans and quantitative assessments of the neurological disturbances were undertaken at specific intervals during the 4 week period after stroke. Forty-three patients underwent lumbar puncture to determine the serum/CSF albumin ratio. The etiology of the infarction was evaluated on the basis of angiographic, ultrasonic and cardiologic findings. A hemorrhagic transformation of the infarction occurred in 28 patients, eleven within the first week, and 15 within the second. Risks of hemorrhage were correlated with a severe neurological deficit, disturbance of consciousness, large infarction with a mass effect, enhancement of contrast medium in CT (especially if occurring early), Involvement of the cortex, and distinct blood/CSF barrier disturbances. Cardiac embolism was a frequent etiology in patients with secondary hemorrhagic infarction, especially when transformation occurred within the first week after stroke.In addition to a heterogenous pattern of hemorrhage, frank hematoma predominated in those infarcts which underwent early transformation, while those transforming late often showed less hyperdense cortical hemorrhagic changes.Deterioration evident on clinical evaluation was caused by the hemorrhagic transformation in three cases, in each instance within the first week after stroke.
The authors have reviewed the literature and recorded the distinguishing features of intraspinal enterogenous cysts. There are no characteristic clinical findings or history associated with this disease. These congenital space-occupying lesions frequently go undiagnosed, and the patient may be treated for many years as a case of multiple sclerosis. The teratogenic "determination period" is decisive for the development of anomalies affecting one, two, or all three of the germinal layers. All of these cysts belong to the same group, and their structure is an expression of the differing determination periods. The various theories about their etiology are discussed. True intraspinal enterogenous cysts are usually found in the cervical region. After careful operative removal, the prognosis is favorable.
In 25 per cent of patients with persistinc primitive trigeminal artery, and in 27 percent of patients with primitive hypoglossal artery, vascular malformations or a history of subarachnoid haemorrhage were found. There is a high incidence of aneurysms at the site of origin of the persisting embryonic vessels. No relation was found between the persisting embryonic vessels and the age, sex, and time of subarachnoid haemorrhage. Opacification of posterior cerebral arteris, vertebral arteries, and posterior communicating arteries was analysed, and variations of the Circulus arteriosus Willisi were found. Ten patients with persisting embryonic vessels are described. In patients in whom external carotid-middle cerebral artery bypass is planned, attention should be drawn to the possibility of persisting embryonic vessels.
Eight cases of intraspinal arachnoid cysts are described. The clinical, radiological, intraoperative and histological findings are presented and compared with similar reports in the literature. Opinions in the literature concerning the origin of arachnoid cysts are discussed, and compared with our own case reports. A traumatic or inflammatory origin of the arachnoid cysts is denied if accompanying histological changes are lacking. In such cases the arachnoid cysts are to be viewed as congenital malformations.
Nitroglycerin, a vasodilating agent, was administered sublingually in migraine without aura patients and in healthy volunteers. Systolic, diastolic and time-mean flow velocity and pulsatility index, were measured by transcranial Doppler sonography in the major intracranial arteries before and after nitroglycerin administration. Following nitroglycerin administration, a significant decrease in systolic and time-mean velocity and pulsatility index was observed in migraine patients, whereas in control subjects only time-mean velocity decreased significantly. Based on those findings we hypothesize a more marked responsiveness to nitroglycerin in migraine patients as compared to healthy subjects.
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