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PubMed1996

Cerebral amyloid angiopathy in the brains of patients with Alzheimer's disease: the CERAD experience, Part XV.

We studied the frequency, severity, and clinical correlations of cerebral amyloid angiopathy (CAA) in 117 CERAD subjects with autopsy-confirmed AD. Eighty-three percent showed at least a mild degree of amyloid angiopathy. Thirty of 117 brains (25.6%) showed moderate to severe CAA affecting the cerebral vessels in one or more cortical regions. These brains also showed a significantly higher frequency of hemorrhages or ischemic lesions than those of subjects with little or no amyloid angiopathy (43.3% versus 23.0%; odds ratio = 2.6, 95% CI = 1.1 to 6.2) High CAA scores also correlated with the presence of cerebral arteriosclerosis and with older age at onset of dementia. Our findings suggest that factors contributing to non-AD-related vascular pathology (e.g., atherosclerosis) may play a role in amyloid deposition in cerebral vessels in AD.

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PubMed1975

[Pathogenesis of Wallenberg's syndrome].

In 1895 Wallenberg described a syndrome characterized by neurological symptoms produced by unilateral softening of the dorsolateral medulla oblongata. In the majority of cases the softening was caused by an arteriosclerotic-thrombotic occlusion of the homolateral intracranial vertebral artery or posterior inferior cerebellar artery, respectively. Occasionally an occlusion of the basilar artery or of the distal extracranial vertebral artery was responsible. In contradiction to the original thesis of Wallenberg, an embolic arterial occlusion could rarely be diagnosed. In particular cases the syndrome was caused by syphilitic vascular changes, tumors, metastases or encephalitis in the region of the dorsolateral medulla oblongata. This paper describes two cases of Wallenberg's syndrome. In the first case (70-year-old-male) the softening of the dorsolateral medulla oblongata was caused by occlusive thrombosis of the homolateral posterior inferior cerebellar artery with concomitant severe arteriosclerosis of the extracerebral brain arteries. The latter variation is characteristic for hypertensive vascular diseases. Thus Wallenberg's syndrome must be classified in similar cases as a complication of hypertensive peripheral cerebral arteriosclerosis. The second observation refers to a 51-year-old-male with bronchiectasis and chronic bronchitis. Metastatic encephalitis was found in several parts of the mid-brain, including the medulla oblongata. The dorsolateral medulla oblongata was destroyed by septic softenings (pneumococci). In this case, however, arteriosclerotic stenosis or thrombosis of the cerebral arteries could not be found. According to the literature metastatic encephalitis, as described in the last case, is an extremely rare cause of Wallenberg's syndrome.

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PubMed1976

Some cerebral proteins and enzyme systems in Alzheimer's presenile and senile dementia.

The water-soluble proteins of the cerebral gray matter and some enzyme systems (cholinesterase, acetylcholinesterase, lactate dehydrogenase, malate dehydrogenase, acid phosphatase) were studied in 9 autopsy cases of Alzheimer's presenile or senile dementia, 1 case of Pick's disease and 1 case of cerebral arteriosclerosis. The proteins and enzyme patterns were visualized on polyacrylamide gradient gels after electrophoresis. In all patients studied, the profiles of cerebral gray-matter proteins were normal. In the patients with advanced dementia, the enzyme patterns usually were abnormal. Particularly in Alzheimer's disease, the activity of malate dehydrogenase was markedly increased.

Acetylcholinesterase↗
PubMed2001

Magnetic resonance imaging findings and postoperative neurologic dysfunction in elderly patients undergoing coronary artery bypass grafting.

BACKGROUND: Small cerebral infarctions are common in elderly patients, but the association between the magnetic resonance imaging finding and neurologic dysfunction after coronary artery bypass grafting has not been evaluated. METHODS: We determined, prospectively, whether varying degrees of abnormal findings on magnetic resonance images of the brain increased the incidence of preoperative cognitive decline, postoperative neuropsychological dysfunction, and stroke in 421 elderly patients (> or = 60 years) undergoing coronary artery bypass grafting. RESULTS: Control patients (almost normal or leukoaraiosis, n = 212) had rates of postoperative neuropsychological dysfunction (7%) and stroke (1.4%); the small infarctions group (some small infarctions, n = 126) had rates of 13% and 5.6%, respectively; whereas patients with multiple infarctions (multiple small infarctions or broad infarctions, n = 83) had rates of 20% and 8.4%, respectively (p = 0.004, p = 0.013). In the group with multiple infarctions, 49 patients (59%) were asymptomatic and 21 patients (25%) had cognitive decline. Stepwise logistic regression analysis demonstrated that the significant predictors of multiple small infarctions or large infarctions were history of cerebrovascular disease, renal insufficiency, cognitive decline, and cerebral arteriosclerosis. CONCLUSIONS: Multiple infarctions significantly increase the risk of neurologic dysfunction after coronary artery bypass grafting. Routine screening for preoperative cognitive decline should be performed to detect underlying ischemic cerebral disease in elderly patients.

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PubMed1977

[A case of hypertensive intracerebral hemorrhage associated with cerebral arteriovenous malformation and aneurysm (author's transl)].

A 45-year-old man suddenly developed right hemiparesis and aphasia during work and lost conciousness next day, when he was admitted to us. Lumbar puncture showed bloody C.S.F. with the initial pressure of 220 mm H2O. Physical examination revealed hypertension and arteriosclerosis. Cerebral angiogram revealed an arteriovenous malformation in the left frontoparietal-parasagittal region and a saccular aneurysm at the left internal carotid-posterior communicating artery junction. In addition, the existence of putaminal hematoma was suspected on account of the displacement of the left anterior cerebral artery and the left lenticulostriate arteries. On the fourth day after admission his consciousness returned and the right hemiparesis gradually improved. One month later the disappearance of the displacement of the anterior cerebral artery was demonstrated by cerebral angiogram. A frontoparietal craniotomy was done and no hematoma was found around the arteriovenous malformation and the basis of the aneurysm did not adhere to the temporal lobe. Taking these findings into consideration, it is presumed that the hematoma in putaminal region was due to neither arteriovenous malformation nor aneurysm but was a hypertensive intracerebral hemorrhage.

Cerebral Hemorrhage↗
PubMed2000

Acetazolamide reactivity in atherothrombotic, cardioembolic and lacunar infarctions.

Ten cases of atherothrombotic brain infarction, 10 cases of cardioembolic brain infarction, 10 cases of lacunar brain infarction, 10 cases of transient ischemic attack (TIA) and 10 age-matched controls were studied. The cerebral blood flows in the cerebral cortex and cerebral white matter were significantly lower in the atherothrombotic, cardioembolic and lacunar infarction groups than in the TIA and control groups. The acetazolamide reactivity in the cerebral cortex was significantly lower in the atherothrombotic and lacunar infarction groups than in the cardioembolic, TIA and control groups. The rate of association of hypertension was significantly higher in the atherothrombotic, lacunar and TIA groups than in the cardioembolic and control groups. Plasma fibrinopeptide A, platelet factor 4 and beta-thromboglobulin concentrations were higher in the atherothrombotic, cardioembolic and lacunar groups than in the TIA and control groups. The present study suggests that the degree of thrombolysis and platelet activation is less in TIA than in cerebral infarction and that underlying cerebral arteriosclerosis is more severe in atherothrombotic and lacunar infarction than in cardioembolic infarction.

Acetazolamide↗
PubMed1986

[Long-term follow-up study of 93 patients with TIA].

Long-term outcome and recurrence rate were discussed in 96 patients of TIA out of 792 of cerebral ischemic disease who were admitted to our hospital during the past 11 years. They all had had attacks in the territory of internal carotid artery. Ninety-three patients could be interviewed finally. They included 63 males and 30 females and the age ranged from 36 to 88 years with an average of 60.5 years. The follow-up period ranged from 4 months to 8 years and 10 months with an average of 3 years and 1 month. Cerebral angiography was performed in 88 patients of them and revealed 16 patients of internal carotid artery stenosis, 12 patients of middle cerebral artery stenosis, 19 patients of severe cerebral arteriosclerosis and 41 patients of normal findings. CT scan was performed in 88 patients and showed abnormal findings in 12 patients. Eleven patients of them had lacunar infarction. Twenty-four patients of arterial stenosis (14 patients of internal carotid artery stenosis and 10 patients of middle cerebral artery stenosis) had surgical treatment of STA-MCA anastomosis (the superficial temporal artery-the middle cerebral artery) and carotid endarterectomy because they were considered to be cause of TIA. The other 69 patients were treated conservatively mainly with antiplatelet therapy. Four of 24 surgical treated patients developed another attack of cerebral ischemia thereafter, 2 patients had TIA of the contra-lateral hemisphere, one had cerebral infarction in the territory of posterior cerebral artery and the rest had lacunar infarction in the contra-lateral basal ganglia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Various mental behavioral disorders in Parkinson's disease, primary degenerative senile dementia, and multiple infarction dementia.

Following 2-4 years of hospitalization, the mental and physical ability of 21 patients with typical idiopathic PD, 10 patients with atypical Parkinson's syndrome and signs of cerebral arteriosclerosis, 29 patients with MID. and 14 patients with senile dementia of the Alzheimer type were evaluated according to various rating scales. All idiopathic parkinsonian patients had suffered from the disease for over 8 years. All patients were over 70 years of age and continuously subjected to the same environment. EEG and CT was performed. A rating scale consisting of 18 items for evaluation of the mental and physical capacity and ability to cope with daily psychosocial demands was used for each patient. Statistically highly significant differences resulted between the relative good mental ability of patients with idiopathic Parkinson's syndrome, with the exception of some brief pharmacotoxic psychoses, and the lower rating scores of patients with senile dementia of Alzheimer type and multiple infarction dementia. A smaller subgroup of patients with Parkinson's syndrome and additional focal signs in the neurological status and EEG showed moderate mental functional loss and a more frequent incidence of pharmacotoxic psychoses than the patients with idiopathic PD. Just as few congruencies of mental ability were found between patients with idiopathic, typical PD and patients with senile dementia of the Alzheimer type as between idiopathic PD and MID. Permanent dementia is not characteristic of patients with typical idiopathic PD even in advanced age. It is, however, for patients with MID and SDAT.

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PubMed1969

Neurosurgical aspects of unexplained unconsciousness.

Neurosurgical experiences and diagnostic difficulties with unconscious patients without diagnosis included cases of intracranial neplasia, cerebral arteriosclerosis, subdural hematoma, traumatic subcortical hemorrhage, subdural abscess, rheumatic encephalitis, spontaneous subarachnoid hemorrhage, subacute bacterial endocarditis and emboli, myocardial infarction and emboli, spontaneous subcortical hemorrhage, fat embolism, meningitis, drug intoxication, uremia, cases in which the cause of death was not clearly established, and phycomycosis of the central nervous system.

Adult↗
PubMed1989

[Differential diagnosis of so-called premature performance failure or premature aging].

In a district of about 70,000 inhabitants (two thirds urban, one third rural population) from 1978 to 1987 32 women at the age between 50 and 60 years and 63 men at the age between 50 and 65 years with premature decrease in vitality on cerebrovascular basis were observed and treated. The cases were differential-diagnostically subdivided. 32 patients belonged to the group of more distinct chronic cerebro-organic psychosyndromes, additionally also involution psychoses; the number of the untimely retirement from the working process was 100%. In 24 patients there were pseudoneurasthenic syndromes of the cerebral arteriosclerosis; 75% early retired from the working process. In 39 patients the cases in question were the proper premature decrease in vitality or a so-called premature ageing on biophysical basis; 41% early retired. A premature ageing may exist also without any so-called organ-valued findings, the symptoms are credibly described. Conflicts with the environment and psychic false reaction may be the result. Optimum therapeutic and rehabilitative troubles may bring successes which are not to be underestimated in the cases without distinct organic processes. The question of invalidization is thoroughly to be examined individually.

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PubMed1997

[Dynamics of somatic and psychic manifestations in elderly patients hospitalized for a psychasthenic form of cerebral artery atherosclerosis during the course of hypolipidemic treatment].

Out of a group of patients aged 60 years and more with the diagnosis of psychasthenic form of cerebral arteriosclerosis complicated by hyperlipoproteinaemia three subgroups matched for sex, education, social class and place of residence but differing in disease duration were isolated, and three analogous subgroups were selected from healthy subjects which were regarded as controls in the statistical analysis. As the results of statistical analysis it was found that in elderly patients, taking of hypolipaemic drugs influenced evidently negatively the emotional sphere, and that short duration of neuro- and psychasthenic forms of cerebral artery atherosclerosis had greater influence on the frequency of conflicts in nearest surroundings since short duration of the disease probably made impossible full adaptation and acceptation of the disease. The attention was paid to the necessity of introduction of psychotherapy into hypolipaemic treatment.

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PubMed1978

[Alkaline phosphatase and ATPase activity in the walls of the cerebral vessels in hypertension and arteriosclerosis with disorders of the cerebral circulation].

In hypertensive disease and atherosclerosis without acute disorders of cerebral circulation it was established that in the cerebral vessel walls there was a high activity of alkaline phosphatase and adenosintriphosphtase. In the symmetrical areas of the subcortical nodes differences in the activity of these enzymes were insignificant and not valid. In vessel walls, located in the peripheral zone of the apoplectic hemorrhage and in the adjacent brain tissue the activity of alkaline phosphatase and adenosintriphosphatase drops. The existence of a high activity of enzymes in the vessel walls on the early stages of hemorrhages gives ground to the authors to claim that in the peripheral zone of an extensive hemorrhage a drop in the enzyme activity appears in the process of a development of a stroke.

Adenosine Triphosphatases↗
PubMed2002

Clasmatodendrosis correlating with periventricular hyperintensity in mixed dementia.

We report a 79-year-old woman with possible Alzheimer's disease and confluent periventricular white matter hyperintensities on magnetic resonance imaging in whom postmortem analysis unexpectedly demonstrated no periventricular demyelination or cerebral arteriosclerosis. However, astrocytes in the periventricular white matter exhibited clasmatodendrosis, defined as cytoplasmic swelling and vacuolation of astroglia, with beading of their dendrites. This finding represents a previously unrecognized correlate of periventricular white matter hyperintensities. Ann Neurol 2002;52:378-381

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PubMed1985

[Diagnosis of Alzheimer's disease in old age].

A diagnosis of Alzheimer's disease in persons at the age of 75-89 years is rarely established by clinician as well as by pathologist without aimed attention. As usual it is mixed up with cerebral arteriosclerosis or marasmus senilis. More than 10 drusen were found in a low-magnification field [400X] in hippocampal cortex and in area 21 and 39 according to Brodman of 19 persons in a group of 26 autopsies. Diagnosis of Alzheimer's disease based on this commonly used limitation was quite frequent, then.

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