A follow-up study of 107 patients with lacunar syndromes has been performed using the analysis of the survival curves and the recurrence curves for new focal cerebrovascular acute episodes. At the end of the 7th year of follow-up, the survival rate of lacunar patients was 479 per 1000, lower than the survival rate of the normal population matched for sex and age (755 per 1000). A more severe prognosis was observed in subjects over 65 years of age, in patients with pseudobulbar syndrome, hypertension and higher degree of disability. The average recurrence rate for new cerebrovascular episodes was 4.74 per 100 patient-years, much lower than that in survivors from cerebral infarction.
The evaluation of headache in patients with transient ischemic attacks (TIA) has various sources of difficulty, the definition of TIA being the most relevant. The classical definition needs to be supplemented with a normal CT scan if a misleading diagnostic statement is to be avoided. The clinical features of 90 patients suffering from TIA and who had contrast-enhanced CT scans are reported. Headache occurred in 30% of the patients. Headache prevailed in patients with vertebrobasilar TIA compared with carotid TIA (p less than 0.05). Headache prevailed as a preceding (24 h) and/or concomitant sign compared with other neurological symptoms (77.8% of the patients). Headache was ipsilateral, in the anterior half of the head in the carotid TIA and in the posterior half of the head in the vertebrobasilar TIA. In about 50% of the patients generalized non-localized headache occurred. Headache usually preceded the neurological symptoms in cases of arterial occlusion (20 carotid, 3 vertebral artery), usually appearing during or after the attack in cases without arterial occlusion. Only 2 cases out of 20 with positive CT scan had headache. These two patients suffered from a rather large hypodense lesion. The other 18 patients showed lacunar lesions. Different hypotheses concerning the physiopathology of the headache associated with TIA are discussed.
Motor potentials evoked in the biceps, thenar, and tibialis anterior muscles by electrical stimulation of the scalp and of the spinal regions were recorded in 12 patients with progressive supranuclear palsy (PSP) and in a control group. Abnormalities of central motor conduction for at least one muscle were present in five patients (41.7%), characterized by a long illness duration. The central sensory conduction time of the median nerve was normal, but five patients showed a depressed frontal N30 wave. These findings support the possible occurrence of functional damage to the corticospinal tracts and to the supplementary motor area in PSP.
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