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Clinical Neuroscience - 1993;46(07-08)
Content
Clinical Neuroscience
JULY 20, 1993
Pathology of the vestibular system
The vestibular end organ, in spite of its small size, has extremely rich interconnections with other parts of the nervous system. The vestibular system can be damaged at the end organ, along the vestibular nerve, in its brain stem representations and in its cerebellar projections. The nature of the pathological process damaging the vestibular system is manifold: neoplastic, inflammatory, vascular, nutritional and degenerative. Neural complications of AIDS may also involve the vestibular system. The lesions may be focal, multifocal and diffuse. While in the past the results of neurootological examinations could only be correlated with post mortem findings, NMI opens new horizons for neurootological and topoanatomical correlative studies.
Clinical Neuroscience
JULY 20, 1993
[Vascular surgery in the prevention of stroke]
[In Hungary the prevalence of cerebrovascular disorders has increased so that each year vascular reconstruction surgery is needed in 2800 cases. However, only a quarter of these eligible patients are operated. After a thorough examination if all the indications for carotid surgery are met, more and more patients will end up in vascular reconstruction units. Angiography and surgery are recommended if the carotid artery stenosis is asymptomatic and is more than 90%. Also, under special conditions an asymptomatic carotid stenosis may caused by indicate surgery (before coronary by-pass operation, etc.). Another indication is a transient ischemic attack, if carotid artery lesion and the stenosis is above 70%. Ulcerated plaques also need surgery because they are a likely source of emboli. After stroke surgery may be necessary if the angiologic status is unstable and further ischemic events, that may lead to disability are expected. An acute stroke rarely calls for surgery. In contrast to this, immediate surgery is needed after repeated, TIA, or crescendo TIA because the risk of stroke is very high in these cases. Finally, sometimes surgery is indicated because of the occlusion of internal and common carotid artery. With vertebrobasilar vascular reconstruction, we do not have enough experience. Cerebrovascular syndromes due to supraaortic vascular lesions are other indications for reconstruction surgery. However, surgery is never a satisfactory substitute for pharmacological treatment.]
Clinical Neuroscience
JULY 20, 1993
[Transcranial doppler detection of cerebral vasospasm following aneurysmal subarachnoid haemorrhage]
[In 22 patients with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms serial neurological evaluations, transcranial Doppler examinations and computer tomographic scans were performed. Transcranial Doppler flow velocities were significantly elevated for the group with vasospasm on posthemorrhage day 2. The maximum blood flow velocities were recorded between days 9 and 18, with normalization occurring within the following 3 weeks. Increase in velocity preceded clinical symptoms and could therefore be used as a prognostic factor for the management of patients with subarachnoid hemorrhage. The data also indicated that the extent and location of blood in the subarachnoid space determine the severity and location of vasospasm.]
Clinical Neuroscience
JULY 20, 1993
[Spinal lipomas and their surgery]
[18 intraspinal lipomas were operated, mostly in childhood. Surgery seems to be indicated unavoidably in view of preoperative clinical progression and postoperative improvement. Prior MR investigation was indispensable to the surgical procedure.]
Clinical Neuroscience
JULY 20, 1993
[Elective extra-intracranial arterial bypass in the treatment of giant aneurysms of the carotid artery]
[Clinical details are presented of 5 patients with a giant carotid aneurysm in whom both the occlusion of the aneurysm and the parent internal carotid artery were performed with an extra-intracranial arterial bypass. In the first case ligature of the giant carotid-ophthalmic aneurysm narrowed the parent artery critically and hemiplegia developed. The bypass operation did not improve the clinical outcome. In the second case the occlusion of the aneurysm was performed after an extra-intracranial anastomosis and in spite of the severely narrowed carotid artery the postoperative course was uneventful. In three cases of giant intracavernous aneurysm the occlusion of the carotid artery on the neck and just proximal to the ophthalmic artery was performed in the presence of an arterial bypass. All of the anastomoses were patent and no ischemic event developed during the follow up period. On the basis of these experiences the authors suggest that, if the preoperative tests (TCD, EEG, SPECT) reveal impending ischemic lesion after carotid compression, surgery should be performed with the combination of extra-intracranial bypass.]
Clinical Neuroscience
JULY 20, 1993
[Experimental and clinical methods for the measurement of cerebral blood volume]
[A review is given of the methods utilized in evaluating of regional cerebral blood content, both in animal experiments of and the clinical studies with emphasis on the importance and methodological problems of these measurements. A new, double radiolabel method is presented, which is suitable to determine blood content in tissue chunks of 10–30 mg. Red cells are labeled in vivo by 55Fe. The labelled donor” red cells are mixed with 1251-labelled serum albumin and injected intravenously to experimental rats. Red cell and plasma distribution spaces are measured after 3 min circulation time. Regional blood volumes range from 7-30 ul/g, with lowest values in the white matter. Tissue (microvascular) hematocrit is 25-30% lower than large vessel hematocrit.]
Clinical Neuroscience
JULY 20, 1993
[Blood reflux into the ventricular system in subarachnoid haemorrhage]
[Medical histories are given of the three patients with subarachnoid hemorrhage (aneurysma rupture was established in two of them) who had also blood in the large quantities in the intraventricular space during the acute phase. Relying upon CT examinations and favourable disease-process the authors suggest it is not the otherwise well known mechanism, when the aneurysm ruptures into the ventricular system resulting in intraventricular and subarachnoid hemorrhage. It is supposed that the blood flowed from the subarachnoid space into the ventricular system by "ventricular reflux" in their cases. The aim task is to analyse the origin of this phenomenon, and to study its possible connection with the development of chronic hydrocephalus after subarachnoid hemorrhage. ]
Clinical Neuroscience
JULY 20, 1993
[Life events as risk factors in stroke]
[This preliminary study focused on whether there is any direct correlation betwen Life Events (LE) and stroke; and, additionally thethar hare is a temporal connection between stroke and LE. The number of LE in the stroke-group (21 persons) and that of the controls (21 persons) was not significantly different. In the 6-12 months prior to stroke the LE were significantly higher in the stroke-group than in the control group. The cerebrovascular patients proved to be „untrained" regarding stress. The role of Type A Personality (TABP) in the development of stroke was evaluated as well; it servad as a control for earlier observations.]
Clinical Neuroscience
JULY 20, 1993
[Forum]
[Letter from Dr. Tamás Dóczi. In memory of Artúr Sarbó. Summary of the meeting of the College of Neurology held on 16 April 1993.]
Clinical Neuroscience
JULY 20, 1993
[Hungarian Society of Neurologists and Mental Doctors]
[Report of the two-day event "Neurorehabilitation - Practice and Perspectives", held in mid-May 1993, organised jointly by the MIET and the MRT Working Group on Neurorehabilitation and the Austrian Neurorehabilitation Society.]
Clinical Neuroscience
JULY 20, 1993
[Hungarian EEG and Clinical Neurophysiological Society]
[A summary of the decisions made by the EEG Board at its meeting of 31 March 1993.]
Clinical Neuroscience
JULY 20, 1993
[The Hungarian Society of Pediatric Neurology, Neurosurgery, Child and Adolescent Psychiatry]
[Summary of the annual congress of the Hungarian Society of Paediatric Neurology, Neurosurgery, Child and Adolescent Psychiatry held in Seregélyes, Hungary, 22-23 April.]
Clinical Neuroscience
JULY 20, 1993
[Hungarian Spine Association]
[Further scientific programme of the Hungarian Spine Society in 1993.]
Clinical Neuroscience
JULY 20, 1993
Clinical Neuroscience
JULY 20, 1993
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