The severity of coronary artery atherosclerosis correlates with increased plasma concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides and with decreased plasma concentrations of high-density lipoprotein cholesterol (HDL-C). The role of plasma lipoproteins in the pathogenesis of cerebral atherosclerosis, however, is less clear. Several investigators report that lipoprotein abnormalities correlate inversely with the incidence of cerebral infarction. We analyzed risk factors for carotid bifurcation atherosclerosis in 121 consecutive patients who underwent cerebral angiography. This analysis revealed a significant positive correlation between the plasma TC/HDL-C ratio and the extent of carotid bifurcation atherosclerosis (p = 0.01). The extent of atherosclerosis correlated inversely with plasma concentrations of HDL-C (p = 0.02). Triglyceride concentration correlated positively with the extent of atherosclerosis with marginal significance (p = 0.07). LDL-C and TC concentrations did not correlate with bifurcation atherosclerosis (p greater than 0.1). Only 4% of the variation in the extent of bifurcation atherosclerosis was explicable on the basis of plasma lipoprotein concentrations.

SUMMARY We report a patient in whom extreme hyperthermia, rhabdomyolysis, acute renal failure and a residual pancerebellar syndrome occurred while taking a combination of perphenazine and amitriptyline. We postulate that impaired thermoregulation due to psychotropic drugs was responsible for the development of heat stroke and that the cerebellar syndrome resulted directly from the elevated temperature.Residual neurological deficits after recovery from hyperthermia, particularly heat stroke, are well known' and probably result directly from elevated body temperature.2 Impaired thermoregulation in patients taking neuroleptic drugs may lead to hyperthermia. We present a case in which hyperthermia with rhabdomyolysis, renal failure, and a persistent cerebellar syndrome developed during therapy with perphenazine and amitriptyline.Case report A 50-year-old woman was found in her home one hour after having collapsed. When discovered, she was alert, sweating, and unable to walk without assistance. She repeatedly became sweaty and subsequently collapsed again without losing consciousness, but was confused and was admitted to hospital. She had been taking a perphenazine and amitriptyline combination 4-25 and diazepam 10 mg each four times a day for seven years. On physical examination rectal temperature was 42-5C and *Present address:

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SUMMARY One hundred patients with asymptomatic carotid bruit or transient ischemic attack (TIA) underwent continuous-wave Doppier (CWD) and real time ultrasound (RTU) testing of their cervical carotid arteries. After ultrasonic studies, 51 patients also underwent bilateral carotid angiography. There was 95 % agreement between CWD and angiography for the diagnosis of a significant (> 50 %) stenosis. The RTU diagnosis of a normal or occluded vessel was correct in 100% of cases. Seven plaques appreciated on RTU may not have been large enough for detection by angiography. In this small series, ulceration confirmed pathologically was more reliably predicted by RTU than by cerebral angiography.Significant ipsilateral carotid plaques occurred more often in patients with amaurosis fugax than in patients with hemispheric TIAs. Ipsilateral plaque ulceration occurred in 50% of symptomatic carotid bruits, but in only 10% of asymptomatic carotid bruits. Plasma concentrations of total cholesterol were significantly higher in TIA patients with carotid stenosis than in controls. Stroke Vol 17, No 1, 1986 CEREBRAL ANGIOGRAPHY is a reliable technique for diagnosis of cerebrovascular disease, but its usage is limited by its high cost and associated risks. Carotid ultrasound testing is safer and less expensive. We used the combination of continuous-wave Doppier (CWD) and real time ultrasound (RTU) testing to evaluate the carotid bifurcations of 100 patients with asymptomatic carotid bruit (ACB) and transient ischemic attack. Material and MethodsFrom June 1982 to September 1983, 100 consecutive Caucasian patients referred to the Neurosonology laboratory with either ACB or TIA were examined by CWD and RTU. These patients ranged in age from 40 to 84 years (table 1). Of 100 patients, 15 had asymptomatic carotid bruit (ACB), 19 had amaurosis fugax, 28 had vertebrobasilar TIAs and 38 had hemispheric TIAs. Fifty-one also underwent fourvessel cerebral angiography and 19 underwent carotid endarterectomy.All CWD scans were performed on supine patients with the 1050 DOPSCAN* imaging system and a 5 MHz transducer using the techniques described by Spencer et al' and Blackwell et al.2 CWD was interpreted as abnormal whenever there was no flow detectable (obstruction) or there was a doppier frequency shift greater than 6 KHz (> 50% stenosis). RTU studies were performed with an 8 MHz high-resolution Biosonics scannert with patients seated in a dental chair. Longitudinal and transverse images of the carotid bifurcation were obtained and videotaped from anteroposterior, lateral and posterolateral projections.• RTU was interpreted as showing obstruction whenever there was no discernible lumen and no appreciable pulsation. Ulcerated plaque was diagnosed by RTU whenever the atheroma had an undercut, crater-like, or markedly irregular surface.The findings of CWD and RTU were compared with the results of cerebral angiography in the 51 patients who underwent angiography. For the correlation of ultrasound results with clinical data, CWD and RTU results ...

SUMMARY One would think that risk factors for transient ischemic attack (TIA) and asymptomatic carotid bruit (ACB) would be similar. In our referral population and in several previously reported cohort populations, however, men outnumber women among patients with TIA. In contrast, women outnumber men among patients with ACB. We found in two independent populations that women with ACB are up to 5.7 tunes less likely than men to have carotid stenosis. Thus women are more prone than men to have ACB, but their bruits much less commonly reflect carotid stenosis. Women are probably predisposed to have carotid bruit even hi the absence of carotid stenosis. In our referral population of ACB, this tendency among women for carotid bruit without stenosis does not seem to be related to lower hematocrit, higher prevalence of heart murmur, constitutionally smaller carotid arteries, or differences hi pulse rate or body habitus. Stroke Vol 17, No 5, 1986TRANSIENT ISCHEMIC ATTACKS (TTAs) are often caused by atherosclerosis of the carotid bifurcation. One would expect risk factors for TLA, asymptomatic carotid bruit (ACB), and asymptomatic carotid stenosis to be similar; however, in our Stroke Registry men outnumber women with TIA while women outnumber men with ACB. This observation prompted us to study our referral population to confirm this "gender gap" and investigate its cause. Materials and MethodsThree separate, non-overlapping populations of patients were studied. Two were chosen from our Stroke