Dementia is relatively frequent after a clinical first stroke in persons younger than 80 years, and aphasia is very often associated with poststroke dementia. If aphasic patients are not considered, it may be necessary to screen a very large number of subjects to collect an adequate sample of demented cases.
SUMMARY Clinical, neurophysiological and morphological studies of four patients with polyneuropathy and secondary hypothyroidism are reported. Neurophysiological studies revealed signs of muscle denervation and reduction of conduction velocity in all the patients. Sural nerve biopsies showed axonal degeneration in all cases but one. All the patients were treated with replacement therapy and clinical symptomatology and neurophysiological parameters improved in all patients.In the literature two types of abnormality of the peripheral nervous system in hypothyroidism have been described. The first is a mononeuropathy, due to mucinous deposits which cause nerve damage through a compression mechanism;' the second is a sensorimotor polyneuropathy. Morphologically, some studies have shown a primary involvement of myelin,2 3 while more recent studies have shown primary axonal damage.4 5 The present report deals with four patients with sensorimotor polyneuropathy associated with hypothyroidism. These patients were treated by substitution therapy and followed clinically and electrophysiologically until achievement of the euthyroid state. mal. Laboratory data were normal except for a moderate normochromic and normocytic anaemia. CK and LDH were normal. T3 was 0-2 ng/ml (normal 06-2 0 ng/ml), T4 was 13 ng/ml (normal 65-130 ng/ml); TSH was 63-3 IU/ml (normal 2-7IU/ml). Antimicrosomal, antismooth muscle and antigastric wall antibodies were found. Ultrasound and scintiscanning showed a small thyroid gland with poor uptake. The diagnosis was Hashimoto's thyroiditis.Patient 2 E.B., a 58 year old woman, was admitted because of a 5 month history of weakness and paraesthesia in upper and lower limbs. There was no significant past history, except for recent constipation. The general examination showed a dry and cold skin, alopecia on the outer third of the eybrows and a goitre. Neurological examination disclosed dysarthria, slight weakness of all four limbs, especially in the distal muscles of the legs. Knee and ankle reflexes were depressed. She had widebased standing and her gait was slightly ataxic. There was no sensory impairment. Laboratory data were normal except for T3 0-8 ng/ml; T4 12ng/ml and TSH 35-1 IU/ml. Organ specific autoantibodies were absent. Thyroid scintiscanning showed a reduced uptake of radioisotope Tc 99. Patient 3 E.M., a 58 year old man, was seen 2 years after the onset of weakness in the proximal muscles of the legs, distal cramps caused by exposure to cold and fasciculation. A subacute thyroiditis had been diagnosed 4 years before. Neurological examination revealed mild deterioration of higher cerebral functions, dysarthna and scanning speech. The only abnormalities in the upper limbs were reduced tendon reflexes. In the legs, both bulk and strength were reduced, with slight atrophy of both quadriceps muscles and fasciculation. Knee and ankle jerks were absent. Touch and vibration sensations were slightly diminished in all four limbs. Laboratory investigations showed normochromic
Background and Purpose-Heparin is widely used for acute stroke to prevent thrombus propagation and/or multiple emboli generation, although there is, as yet, no demonstrated efficacy. However, all of the available clinical studies allowed long intervals from stroke to treatment. The purpose of this study was to try an intravenous regimen of unfractionated heparin the acute cerebral infarction starting treatment within the first 3 hours of the onset of symptoms. Methods-The study was an outcome evaluator-blind design trial. Patients had to display signs of a nonlacunar hemispheric infarction. Selected patients were randomly allocated to receive intravenous heparin sodium or saline.Heparin was infused at a rate to maintain activated partial thromboplastin time ratio 2.0 to 2.5 ϫ control for 5 days. The primary end point was recovery of a modified Rankin score zero to 2 at 90 days of stroke at phone interview by a single physician blind to treatment. Safety end points were death, symptomatic intracranial hemorrhages, and major extracranial bleedings by 90 days of stroke. Results-A total of 418 stroke patients were included. In the heparin group, there were more self-independent patients (38.9% versus 28.6%; Pϭ0.025). In addition, in the same group, there were fewer deaths (16.8% versus 21.9%; Pϭ0.189), more symptomatic brain hemorrhages (6.2% versus 1.4%; Pϭ0.008), and more major extracerebral bleedings (2.9% versus 1.4%; Pϭ0.491). Conclusions-Intravenous heparin sodium could be of help in the earliest treatment of acute nonlacunar hemispheric cerebral infarction, even keeping into account an increased frequency of intracranial symptomatic brain hemorrhages.
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