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PubMed1981

Circulatory response in Aschner and Czermak-Hering tests, with special reference to cerebral circulation.

The Aschner and Czermak-Hering tests were carried out in 7 normal young males and 15 elderly patients with cerebral arteriosclerosis. Alterations in the heart rate, blood pressure and blood flow in the internal carotid artery and brachial artery were studied by means of the on-line Doppler ultrasonic apparatus before, during and after the maneuvers, simultaneously and continuously. Aschner Test. Bradycardia, biphasic alteration of blood pressure, increase of blood flow in the internal carotid artery and decrease of blood flow in the brachial artery were observed in the maneuver. The changing rate of the findings was diversified individually. However, no significant difference was observed between the normal young males and the elderly patients. Side effects consisted of slight and transient nausea and dizziness in 6 subjects. Czermak-Hering Test. Bradycardia, hypotension, and decrease of blood flow in the brachial artery were observed in the maneuver. The changing rate of the findings is more conspicuous in the elderly patients than in the normal young males. Alterations in the blood flow in the internal carotid artery were observed. There was a conspicuous increase of the blood flow in the internal carotid artery on the noncompressed side during the maneuver in all the normal young males and in half of the elderly patients. The remainder of the elderly patients showed either no alteration or decrease of the blood flow in the internal carotid artery on the noncompressed side. Slight nausea in 2 subjects, slight dizziness in 5 subjects, and moderate disturbance of consciousness in 1 subject were observed as side effects. The results indicate that the Czermak-Hering test will be more advantageous in investigating the autonomic nervous function (vasovagal reflex) and autoregulation of cerebral circulation in elderly subjects.

Adult↗
PubMedDate not supplied

[EEG studies in Alzheimer dementia and multi-infarct dementia at various times of the day].

From three men and seven women (mean age 70 years) with dementia of the Alzheimer-type (DAT), and from four men and six women (mean age 77 years) with multi-infarct dementia (MID) closed-eye EEGs were registered at 0800, 1200, 1600, and 2000 hours and recorded on tape for computer processing. The data of both groups were compared statistically and also compared with data of former investigations conducted with 10 healthy elderly volunteers and 10 patients who suffered from cerebral arteriosclerosis with serious disorder of sleep-walking rhythm (HA). Most pathological EEG deviations are found in the MID-patients, but there is no significant distinction compared to the DAT-patients, although three of the latter showed normal EEGs. Compared to the HA the EEGs of the MID-patients differed more from those of the healthy volunteers; however, the physiological circadian variations were not leveled as in the HA. Even in consideration of daytime dependent fluctuations of frequency-parameters, a clear-cut discrimination between DAT and MID by means of the EEG seems impossible.

Aged↗
PubMed1983

Cerebral vasomotor responsiveness during 100% oxygen inhalation in cerebral ischemia.

Cerebral vasoconstrictor responsiveness to 100% oxygen inhalation was measured in 149 subjects, including normal healthy volunteers and those with risk factors for cerebral arteriosclerosis (N = 87). Test results were compared among patients with hemispheric stroke and vertebrobasilar insufficiency (N = 62) with the 133Xe inhalation method. Normal volunteers without risk factors (N = 49), aged 25 to 86 years, showed symmetrical vasoconstriction. Asymptomatic subjects with risk factors (N = 38) and those with vertebrobasilar insufficiency (N = 25) had decreased hemispheric gray matter flow (Fg) values during rest, but vasoconstrictor responsiveness to 100% oxygen inhalation was not significantly reduced. In patients with acute hemispheric infarction, regional vasoconstrictor responsiveness to 100% oxygen inhalation was lost and/or paradoxically reversed; in patients with chronic hemispheric infarction, it was decreased. Testing vasomotor responses during hyperoxia is safe, clinically helpful, and demonstrates impaired vasomotor reactivity in infarcted regions.

Adult↗
PubMed1981

Distribution of 5-hydroxytryptamine and 5-hydroxyindoleacetic acid in human brain in relation to age, drug influence, agonal status and circadian variation.

The post-mortem brain concentrations of 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) were determined in 16 parts of the brain from patients with no history of neurologic, psychiatric or metabolic illness. The causes of death were either ischemic heart disease, infections disease, cancer or accidents. Forty-two men with a mean age of 57 years (range 18-95 years) and 19 women with a mean age of 62 years (range 23-79 years) were included. The influence of several factors were studied: brain weight, time between death and autopsy, storage time before chemical analysis, age, sex, agonal status, cerebral arteriosclerosis, cancer, opiate treatment and time of death during the day. Most correlations between the 5-HT concentrations in different brain parts were positive, the strongest correlations in the basal ganglia and the limbic system. No consistent pattern of age-related 5-HT changes were found. The females had significantly higher 5-HIAA concentrations in the cortex of the gyrus hippocampus. Final hypoxia seemed to decrease 5-HT concentrations. Opiate treatment reduced 5-HT and increased 5-HIAA concentrations. A marked circadian variation of 5-HT was found, most pronounced in the hypothalamus, the limbic system and some neocortical areas.

Adolescent↗
PubMed1998

[The observation of edema in the substantia alba during postoperative brain irradiation. The role of computed tomographic studies].

BACKGROUND: The aim of our study was to determine on CT whether a relation exists between a radiation-induced brain edema, treated with diuretics and its corresponding Houndsfield Units (HU). PATIENTS AND METHODS: Seventy-five patients (age 20 to 65 years, suffering from headaches but without hypertension brain tumors or cerebral arteriosclerosis were examined as a reference group. Three slices with 8 mm thickness, 24 mm apart in the upper, middle and lower third of the brain were obtained to measure the HU of the white matter. The second group consisted of 20 patients with brain tumors, which underwent brain surgery. HU of the white matter were measured before radiation and after 10, 20, 30, 40 and 50 Gy. If a reduction in density was detected, diuretic therapy with 40 mg furosemide per o.s. was initiated. If no increase in density was found on follow-up additional therapy with glycerine (4.5 g/kg body weight) was started. In this cases follow-up was on day 4 after initiation of diuretics. If clinical symptoms suggested an increasing in intracranial pressure, CT-examination was performed immediately. Therapy was started according to measurement results. The third group consisted of 64 patients with brain tumors, that underwent postsurgical radiation therapy. Prior to radiation therapy 40 mg furosemide per o.s. were given. CT-examinations, intensified diuretic therapy and follow-up examinations were performed as in group 2. If, despite therapy, the HU decreased, infusion of mannites was added. The second and third group of patients received radiation therapy with telecobalt and/or a linear accelerator (6 and 9 MeV X-ray). RESULTS: In the first group white matter density was > 30 HU. In the second group white matter density was between 25 and 29 HU prior to diuretic therapy. Under 25 HU a continuous headache, vertigo and confusion ensued. Diuretic therapy was intensified until the measured values reached 25 to 29 HU. Forty-seven of 64 patients in the third group had 25 to 29 HU prior to radiation therapy. Despite prophylactic diuretic therapy in 28 cases density decreased to 20 to 24 HU. Improvement was achieved with an additional glycerine per o.s. The measured values reached again 25 to 29 HU. In 1 case the values dropped under 20 HU. Additional mannite infusion was necessary. In 17 of 64 patients white matter density was > 30 HU prior to radiation therapy, dropping to 25 to 29 HU during radiation. Prophylactic diuretic administration kept the values in this range. A correlation between age of the patient, radiation source, total dose, tumor histology and degree of change in HU was not found. CONCLUSION: Measurements of HU can serve as a good indicator for spontaneous or diuretic induced changes of a white matter edema during radiation therapy.

Adult↗
PubMed2005

The underdiagnosis of the vascular contribution to dementia.

The existence of vascular dementia (VaD) was first identified by Marie, who described the etat lacunaire, and by Binswanger, who identified white matter lesions in the brain subcortical areas. Alois Alzheimer, when defining the disease now bearing his name, did so in a patient with a presenile onset. The majority of demented elderly people were then believed to have cerebral arteriosclerosis underlying their cognitive decline. The role of cortical vascular lesions, while clear to clinicians, was highlighted only later, by the pathological studies of Tomlinson et al. and the clinical demonstrations of Hachinski et al. who have defined multi-infarct dementia. Lately, the emphasis shifted to pathogenic mechanisms for vascular brain disease with the identification of a multitude of processes, such as lipohyalinosis, cardiac dysfunction and genetic causes, to name only a few. Epidemiologic studies have demonstrated the high frequency of vascular lesions in brains of demented individuals, as well as the fact that vascular factors can contribute to Alzheimer's disease (AD). Moreover, many factors, which were identified as contributing to cerebrovascular disease in general and VaD in particular, are frequently suspected as predisposing to AD as well. All these considerations converge to the realization that vascular components are extremely important in the pathogenesis of old-age dementia and that prevention and perhaps treatment of dementia are within reach. These surprising findings highlight the importance of mixed vascular-degenerative dementia as a disorder that has to be properly defined.

Dementia, Vascular↗
PubMedDate not supplied

The impact of age-related changes in event-related P300 potentials on detecting early cognitive dysfunction.

Event-related P300 potentials that closely reflect cognitive brain functions show significant age-related latency prolongations. This aging-P300 interaction can best be approximated by third-order polynomial regressions. To delineate the clinical impact this special kind of regression function may have on detecting early cognitive dysfunction, we applied visual P300 potential data of healthy subjects (n = 344; age range, 18-98 years) to nondemented patients with either (i) chronic liver disease (n = 104; age range, 19-74 years) or (ii) cerebral arteriosclerosis (n = 80; age range, 38-80 years). As compared with linear regressions, third-order polynomial regressions for the age-related changes in P300 potential latencies showed a smaller latency increase during middle age, with an accelerating latency prolongation from age 60 onward. In patients with liver cirrhosis, third-order polynomial regressions yielded a rate of abnormal P300 potential latencies exceeding that of linear regressions absolutely by 17-21%, and relatively by 67-71%. Although the rate of P300 abnormalities was much lower in the CAD patients with either regression model, the relative increase in P300 abnormalities due to third-order polynomial regressions was 40-112.5%. In conclusion, normal data for the latencies of P300 potentials based on third-order polynomial regressions result in a higher sensitivity of P300 potentials for detecting early cognitive dysfunction. This gain in diagnostically important information is not offset by a loss in specificity, and may depend on the kind as well as stage of the disease, the age distribution of the patients and the degree of the P300 potential abnormalities.

Journal Article↗
PubMed1999

The reported clinical utility of taurine in ischemic disorders may reflect a down-regulation of neutrophil activation and adhesion.

The first publications regarding clinical use of taurine were Italian reports claiming therapeutic efficacy in angina, intermittent claudication and symptomatic cerebral arteriosclerosis. A down-regulation of neutrophil activation and endothelial adhesion might plausibly account for these observations. Endothelial platelet-activating factor (PAF) is a crucial stimulus to neutrophil adhesion and activation, whereas endothelial nitric oxide (NO) suppresses PAF production and acts in various other ways to antagonize binding and activation of neutrophils. Hypochlorous acid (HOCl), a neutrophil product which avidly oxidizes many sulfhydryl-dependent proteins, can be expected to inhibit NO synthase while up-regulating PAF generation; thus, a vicious circle can be postulated whereby HOCl released by marginating neutrophils acts on capillary or venular endothelium to promote further neutrophil adhesion and activation. Taurine is the natural detoxicant of HOCl, and thus has the potential to intervene in this vicious circle, promoting a less adhesive endothelium and restraining excessive neutrophil activation. Agents which inhibit the action of PAF on neutrophils, such as ginkgolides and pentoxifylline, have documented utility in ischemic disorders and presumably would complement the efficacy of taurine in this regard. Fish oil, which inhibits endothelial expression of various adhesion factors and probably PAF as well, and which suppresses neutrophil leukotriene production, may likewise be useful in ischemia. These agents may additionally constitute a non-toxic strategy for treating inflammatory disorders in which activated neutrophils play a prominent pathogenic role. Double-blind studies to confirm the efficacy of taurine in symptomatic chronic ischemia are needed.

Angina Pectoris↗
PubMed1980

An orientation scale for geriatric patients.

An assessment scale consisting of 10 questions was constructed from an initial 20 questions. The scale encompassed orientation to time, place and person and was intended for geriatric patients and patients suffering from psychogeriatric disorders who had been institutionalized for at least 14 days. The reliability according to the Kuder-Richardson formula number KR20 was 0.83 and the test-retest reliability was 0.84. The scale differentiated between patients with senile dementia and/or cerebral arteriosclerosis and patients without such disorders.

Aged↗
PubMed1994

Reduction of cerebral blood flow with induced tachycardia in rats and in patients with coronary artery disease and premature ventricular contractions.

A reduction of cerebral blood flow (CBF) was observed in experimental studies in rats immediately after the onset of parasystolic rhythm or with stable, but haemodynamically compromising, tachycardias. Based on these data and with a view to studying the effects of premature ventricular contractions (PVCs) on the cerebral circulation in humans, CBF was measured using the 133-Xenon inhalation method in 24 age matched human controls (group A1: age 58.5 +/- 6.2 years; group A2: 52.2 +/- 7.8 years) in nine coronary artery disease (CAD) patients without PVCs (B), in 11 CAD patients with frequent PVCs (> 300.h-1) (C) and in nine patients, after exclusion of CAD by angiography, also with frequent PVCs (> 300.h-1) (D). Holter monitoring was performed during the CBF measurement. CBF determined in the human control groups A1 and A2 was 79.9 +/- 9.9 ml.100 g.-1 min-1 and 81.5-13.0 ml. 100 g-1 min-1, respectively. CBF was 74.1 +/- 13.6 ml . 100 g.-1 min-1 (P = 0.267 vs A1) in group B, 65.8 +/- 11.8 ml.100 g-1 min-1 (P = 0.004 vs A1) in group C and 74.2 +/- 15.6 ml.100 g.-1 min-1 (P = 0.218 vs A2) in group D. The significant reduction of CBF in CAD patients with frequent PVCs suggests that arrhythmias have a significant impact on CBF. Non-CAD patients with frequent PVCs did not show significant CBF decreases in comparison with controls. One can hypothetize that an impairment of electrical postextrasystolic potentiation, due to premature ventricular depolarization, and hence myocardial dysfunction leads to CBF reduction in CAD patients. The CBF reduction with CAD could also reflect concomitant coronary and cerebral arteriosclerosis.

Aged↗
PubMed1996

Nicergorine-induced lichen planus-like eruption.

A case of a lichen planus-like eruption due to nicergorine on the lower legs of an 84-year-old woman is reported. She presented with slightly pruritic, erythematous plaques of six months' duration. She had taken eight kinds of drugs, including nicregorine for cerebral arteriosclerosis, for two years. After nicergorine was discontinued, the eruption gradually disappeared. Readministration of nicergorine induced a similar eruption within two months. Histologic findings were identical in the two biopsy specimens obtained at the first visit and from the recurrent lesion. To our knowledge, this is the first report on nicergorine-induced lichen planus-like eruptions.

Aged↗
PubMed1993

Drug interactions with inhalational anaesthetics.

The literature concerning the interactions between volatile anaesthetics, nitrous oxide and other compounds is reviewed. The majority are well known and most can be managed by careful dosage of the anaesthetics. The following interactions should be stressed since these are less predictable or potentially fatal. Of the cardiovascular drugs mainly the Ca++ channel blockers require attention. The volatile anaesthetics act synergistically with these drugs on the inhibition of cardiac conduction and may induce cardiac arrest. Aminoglycoside therapy should prompt an alternative to enflurane because of increased nephrotoxicity with this combination. Thiopentone induction makes the dog heart more susceptible to arrhythmias, especially during anaesthesia with volatile anaesthetics. Probably pentobarbitone, etomidate or a benzodiazepine should be preferred as an alternative to thiopentone when the use of adrenergic drugs peroperatively is anticipated. Nitrous oxide augments the sequelae after coronary air emboli and impaired cerebral perfusion in animals. The necessity of this drug should therefore be considered when anaesthetizing patients undergoing open heart surgery and patients with severe carotid or cerebral arteriosclerosis.

Anesthesia, Inhalation↗
PubMed1978

Sinus bradycardia in the aged.

In the aged, sinus bradycardia represents the sinus-node-dysfunction component of diffuse conduction system disease associated with coronary and cerebral arteriosclerosis. Findings are presented on 15 patients whose ages ranged from 69 to 93 years at the time of admission to a home for the aged. They remained under observation (with electrocardiographic data) for from less than 1 year up to 18 years. The findings illustrate the evolution of conduction system abnormalities, including sinus node dysfunction, occurring either as an initial or an interval event. These abnormalities represent positive indications for pacemaker insertion in the aged.

Aged↗
PubMed1984

Thiethylperazine and tardive dyskinesia.

Over a 14-month period in the outpatient department of a geriatric hospital, 7 female patients over 75 years of age were identified with tardive dyskinesia associated with the use of thiethylperazine. The indication for thiethylperazine treatment had been vertigo or dizziness. 3 of the patients also had symptoms related to cerebral arteriosclerosis and 2 had mild Parkinson's disease without levodopa therapy. None of them were markedly demented nor had chronic psychosis. Tardive dyskinesia appeared after a treatment period of 3 weeks to 6 years. These findings suggest that association of tardive dyskinesia with the use of thiethylperazine is not uncommon in geriatric outpatients.

Aged↗
PubMed1987

Subcortical arteriosclerotic encephalopathy (Binswanger's disease): a report of five patients.

Five patients with variable clinical symptoms were diagnosed as having--subcortical arteriosclerotic encephalopathy (Binswanger disease) based on the presence of lacunar infarcts in basal ganglia, various abnormalities of subcortical white matter and severe thickening and hyalinization of penetrating arteries and arterioles. One case had a classical clinical picture while in the others the course of the disease was short and was associated with severe systemic abnormalities. The variability of the clinical features, the identify of "classical" clinical symptoms with other forms of cerebral arteriosclerosis, the similarity between "atypical" cases and other entities, and the high frequency of associated conditions makes it difficult to characterize the clinical pathological entity called subcortical arteriosclerotic encephalopathy.

Aged↗
PubMed1995

Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people.

OBJECTIVES: To determine whether vitamin C status, as measured by dietary intake and plasma ascorbic acid concentration, is related to mortality from stroke and coronary heart disease in people aged 65 and over. DESIGN: A 20 year follow up study of a cohort of randomly selected elderly people living in the community who had taken part in the 1973-4 Department of Health and Social Security nutritional survey and for whom dietary and other data had been recorded. SETTING: Eight areas in Britain (five in England, two in Scotland, and one in Wales). SUBJECTS: 730 men and women who had completed a seven day dietary record and who had no history or symptoms of stroke, cerebral arteriosclerosis, or coronary heart disease when examined by a geriatrician in 1973-4. RESULTS: Mortality from stroke was highest in those with the lowest vitamin C status. Those in the highest third of the distribution of vitamin C intake had a relative risk of 0.5 (95% confidence interval 0.3 to 0.8) compared with those in the lowest third, after adjustment for age, sex, and established cardiovascular risk factors. The relation between vitamin C intake and stroke was independent of social class and other dietary variables. A similar gradient in risk was present for plasma ascorbic acid concentrations. No association was found between vitamin C status and risk of death from coronary heart disease. CONCLUSION: In elderly people vitamin C concentration, whether measured by dietary intake or plasma concentration of ascorbic acid, is strongly related to subsequent risk of death from stroke but not from coronary heart disease.

Aged↗
PubMed1969

Iatrogenic epilepsy due to antidepressant drugs.

AN ANALYSIS OF THE CASE HISTORIES OF NINE PATIENTS WHO DEVELOPED EPILEPTIC FITS SHORTLY AFTER STARTING TRICYCLIC ANTIDEPRESSANT DRUGS SHOWED THAT ALL OF THEM HAD ONE OR MORE OF THE FOLLOWING FACTORS: previous or family history of epilepsy, pre-existing brain damage, cerebral arteriosclerosis, alcoholism, withdrawal of barbiturates, and history of previous electric convulsive therapy. Before prescribing antidepressant drugs these factors should be sought for in the history, and if any are present prophylactic anticonvulsant medication is indicated. From a limited experience we do not think that chlordiazepoxide is adequate to counteract the convulsant effect of antidepressant drugs.

Adolescent↗