Pregnancy induced hypertension complicated with cerebrovascular accidents

Fourteen patients suffering from pregnancy induced hypertension (PIH) complicated with cerebrovascular accidents were admitted for treatment from 1977-1990. These were 8 cases of cerebral hemorrhage, 4 cases of cerebral infarction and 2 cases of cerebral arteriovenous malformation with intracerebral hematomas. These accounted for 0.34% of all hospitalized PIH cases during the same period and three died. The mortality rate was 0.72%. The etiology, pathology, brain CT scan features, clinical manifestations and treatment of these accidents were discussed.     

Diagnosis and treatment of cerebrovascular accidents of cardioembolic origin

Compared to the normal population, patients with atrial fibrillation are at a significantly enhanced risk for cerebrovascular insults, in particular when the fibrillation is of recent occurrence, chronic rather than paroxysmal, and when it is associated with cardiopathy. Several studies have documented the efficacy of anticoagulation in prevention of cerebrovascular insults. Aspirin may be a valid alternative in young patients without cardiopathy; however, anticoagulation is more effective in patients which have experienced thromboembolism. In elderly patients (over 75 years) the situation is unclear, because the favorable effects of anticoagulation are offset by an increased risk for intracerebral hemorrhage. The treatment must thus be individualized by assessment of a risk/benefit ratio.     

Acute cerebrovascular accidents with severe ovarian hyperstimulation syndrome

Cerebrovascular complications are by far the most serious side-effects of ovarian hyperstimulation syndrome. We report a case in which the patient developed cerebral infarction with right sided hemiplegia as a result of severe hyperstimulation syndrome after using a gonadotrophin-releasing hormone agonist for intracytoplasmic sperm injection.     

Evaluation of serum lipid profile and cardiac enzyme changes in cerebrovascular accidents

Serum lipid profile is, total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides and serum cardiac enzymes ie, creatinine phosphokinase (CPK), creatinine phosphokinase isoenzyme MB (CPK-MB), lactate dehydrogenase (LDH) and serum aspartate aminotransferase (AST/SGOT) levels were estimated in 50 cases of cerebrovascular accidents (CVA) consisting of 26 cases of cerebral haemorrhage and 24 cases of cerebral thrombosis. All analyses were made on day 1 and day 7. Serum cholesterol, LDL and triglycerides levels were significantly higher in CVA patients on day 1. Lipid level fell significantly on day 7 in respect to day 1. On comparing the lipid levels between cerebral haemorrhage and cerebral thrombosis, no significant difference was observed. Cardiac enzymes like CPK and CPK-MB were significantly raised whereas, AST/SGOT and LDH were marginally raised on day 1 in CVA patients. However, there was no change in cardiac enzyme levels between cerebral haemorrhage and cerebral thrombosis patients.     

Muscle sympathetic nerve activity during cold pressor test in patients with cerebrovascular accidents

BACKGROUND AND PURPOSE: Autonomic dysfunction is frequently present in patients with cerebrovascular accidents (CVA). However, the pathophysiological mechanisms of these disorders are not clear. The purpose of the study was to assess the effects of CVA on the autonomic nervous system. METHODS: In eight male patients with a history of CVA with damage of the cortical or subcortical structures, we measured the cold pressor response during recording of muscle sympathetic nerve activity (MSNA) from the peroneal nerve on the hemiplegic side. We also studied 10 age-matched male control subjects. Tests were performed before, during, and after immersion of the nonhemiplegic hand in ice water for a period of 3 minutes in each phase. We also recorded changes in heart rate (HR), arterial blood pressure, skin temperature of the middle finger, and perception of pain using the Borg's score. RESULTS: During the control period, the mean burst count of MSNA in CVA (57.2 +/- 3.9 beats/100 HR) was higher than in control subjects (36.3 +/- 3.2 beats/100 HR) (P<.05). Total MSNA (the mean burst amplitude per minute times burst rate) increased significantly in CVA and control during the immersion period by 79.9 +/- 18.4% and 133.1 +/- 25.6%, respectively. The percent change in total MSNA in CVA was attenuated during immersion compared with control subjects. The HR and skin temperature responses as well as the Borg's score were similar in both groups during control, hand immersion, and recovery periods. CONCLUSIONS: The present results suggest that increased MSNA in CVA may be due to damage of cortical or subcortical structures or stroke-related changes in other areas or nonspecific changes that cause continuous increase in basal MSNA.     

Swallowing changes in cerebrovascular accidents: incidence, natural history, and repercussions on the nutritional status, morbidity, and mortality

OBJECTIVE: To determine the frequency of dysphagia in CVA, its natural history and value as a risk factor of respiratory infection, malnutrition and death. PATIENTS AND METHODS: A prospective study was made of 187 consecutive patients with cerebrovascular accidents (CVA). A standardized test for dysphagia was done during the first two days of the illness and repeated three days a week. The levels of urea, total proteins and albumin were determined on admission and on discharge. The patients were questioned by phone after 6 months. RESULTS: There was dysphagia of liquids in 36.4% of the patients. The incidence of dysphagia for semisolids was of the same frequency but more severe. Coma was the cause of inability to swallow in 25.7% of the patients. During their stay in hospital one third of the patients with dysphagia died, one third became normal and one third still had dysphagia when they were discharged. After one week, one, three and six months respectively, the cure rate for dysphagia was 29.4%, 4.1%, 55.9% and 55.9%, and survival 83.8%, 67.6%, 61.8% and 60.3%. Thus after 6 months only 3 patients (4.4%) were alive and dysphagic. Half of the 'cures' occurred in the first week, and none occurred after more than 77 days. As compared to the non-dysphagic patients, the dysphagic patients had 10 times more risk of respiratory infection, 18 times higher risk of death, greater loss of albumin and less loss of urea. CONCLUSIONS: There is a high prevalence of dysphagia in CVA and although functional prognosis is not unfavorable, respiratory infections, malnutrition and death are frequent.     

Lupus pancreatitis

We report the case of a sixteen year old female patient, admitted to a general hospital due to fever, poliarthritis, malar rash and vasculitis. Diagnostic studies confirmed the existence of Systemic Lupus Erythematosus. Shortly after admission, the patient was transferred to an intensive care unit due to severe acute pancreatitis. In spite of its infrequency, the diagnosis of acute pancreatitis must always be considered whenever a patient with SLE presents abdominal pain. The authors emphasise the importance of an early diagnosis of this rare complication, with high mortality rates, and present a brief review of the international literature.     

Cyclical calendar and lunar patterns in automobile property accidents and injury accidents

Nine years of traffic accidents involving damage to property (n = 246,926 accidents) and involving nonfatal injury (n = 50,492) in Saskatchewan were examined by regression and spectral analyses. Both calendar and seasonal periodicities were found in both sets of data. After data were adjusted for calendar effects, no relationship was found with the total or half synodic and anomalistic lunar cycles or between the waxing and waning synodic cycle. No sudden change on the day of the full moon or surrounding days was found.     

Thrombosis and cerebrovascular disease

Strokes are heterogeneous not only with respect to their presentation, but more importantly in terms of the underlying pathology. There are now a number of choices available for the treatment of ischemic stroke, and the causative mechanisms responsible for each individual stroke must be considered in choosing an appropriate form of treatment. This article explores the underlying pathophysiological mechanisms responsible for the major categories of stroke and also examines the reasons why strokes worsen or evolve.     

Childhood accidents

Tuberculosis of the middle ear is a rare disease. Due to a change in the typical clinical signs in recent years and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media is reported, re-emphasising the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.     

Lupus anticoagulants and antiphospholipid antibodies

In recent years, clinical syndromes involving lupus anticoagulants and antiphospholipid antibodies have come into increasing clinical prominence. Since the discovery that most antiphospholipid antibodies require the presence of anionic phospholipid-binding proteins such as B2-glycoprotein I and prothrombin, a large number of studies have attempted to delineate the specificity of these antibodies. Several mechanisms have been proposed to explain the hypercoagulable state associated with these antibodies. This review attempts to summarize these data and the challenges that confront efforts to delineate the pathogenesis of the prothrombotic state associated with the presence of these antibodies.