Primary care. Symposium on cerebrovascular disorders. Foreward.
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A group of patients suffering from cerebrovascular insufficiency was submitted to a pilot EEG investigation using physical exercise as a provocative method. Two control groups, one of young (20--30 years) and another of older (more than 50 years) subjects, were also investigated. Quantitative EEG spectral data, determined at rest and during a period after physical exercise, showed that deviations of the frequency distribution of the alpha band were related to cerebrovascular insufficiency.
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A double-blind clinical trial of vincamine hydrochloride and a known dihydrogenated ergotoxine derivative, administered i.m. for 10 days, was conducted on 2 groups of 10 hospitalised cerebrovascular patients. Hemiplegia was evaluated prior to treatment and on its 5th and 10th day, by a scoring system. Statistical assessment of the results and the clinical observations showed that vincamine hydrochloride can be usefully employed in the treatment of acute cerebrovascular accidents on account of its marked effectiveness and rapid action--these being attributable to its cerebral vasoregulatory and metabolic mechanism, and to increased availability due to salification of the basic molecule--, coupled with its excellent local and general tolerability.
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The authors determined the level of neuraminic acid in the serum of 50 patients with encephalomalacia and 25 patients with cerebral haemorrhages on the 1st, 3d and 7th days of the disease. Twenty healthy subjects served as controls. A statistically significant rise in the concentration of this substance was observed in both groups of patients throughout the whole period of observations.
The cholesterol and lipoid phosphorus levels in the serum and liquor' cerebrospinalis were studied in 40 patients suffering from ischaemic cerebral lesions. A chromatographic determination was also performed for eight sub-fractions of polar and neutral fats (lysolecithin, sphingomyelin, lecithin, phosphatidyl-ethanolamine, non-esterified fatty acids, cholesterol, triglyceride and cholesterol ester). Furthermore, five sub-fractions of cholesterol esters were prepared according to the degree of unsaturation in the individual fatty acids. The results were compared with a group of 25 control persons. No significant changes in the lipide sub-fractions were found in the serum. Total cholesterol was lower for cerebral haemorrhages, lipoid phosphorus was higher. In the liquor, no increase was found in total lipides but only a shift in some lipide fractions, the most pronounced being a lowering in triglyceride and an increase in free cholesterol and sphingomyelin. It would seem that a determination of lipides in the serum and liquor is not decisive for the diagnosis of acute vascular cerebral haemorrhages. These questions require thorough research and experimentation.
Cerebral circulatory disturbances occurred in 42 women between the ages of 17 and 52 who were taking oral contraceptives. The disturbances were primarily in the form of cerebral haemorrhages. The symptoms ranged from ephemeral neurological deficiencies to massive hemi-syndromes. Complete remission occurred in 16 patients, partial remission in 24 patients, two patients died. The patients were subdivided into two age groups, one comprising 31 persons between 17 and 39, and the other 11 persons between 41 and 52 years of age. The aim was to ascertain facts which were related to the possibility of haemorrhage in women taking ovulation inhibitors. The first finding, statistically significant, was that the possibility of a cerebro-vascular disturbance increases with the period during which the pill is taken and that this possibility is especially great in the presence of migraine which may also be existent in the family, and in the case of hypertension. The second finding, not significant however, was that the risk was higher in the presence of several factors in one person. These factors include familial factors with a predisposition to migraine and thrombosis, past illnesses of the peripheral vascular system, a predisposition to allergic reactions, obesity and kidney damage. Should one of these situations or both prevail, the patient will be advised to stop taking the pill, and the contraceptive will be discontinued if certain prodromes are observed in a general form, or if focal symptoms occur.
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After reviewing new aspects in the pathophysiology of the poststenotic cerebral ischemia as the cause of the various syndromes of cerebrovascular disorders, therapeutic approaches are discussed. The fatal vicious cycle of the disturbances of the nutritive blood flow within the cerebral microcirculation can be interrupted by means of pentoxifylline. By amelioration of the disturbed flow properties of blood in the microcirculation due to improvement of red cell deformability and inhibition of platelet aggregation, oxygen supply is enhanced and more glucose offered. Membrane permeability and functions of the cells are normalized by the inhibitory action on edematous changes in the brain tissue and by removal of the mechanical obstacles of microcirculation. The disturbed cerebral metabolism is stimulated by enhancement of the energy-rich phosphates in the brain cells. The combined rheological, antiedematous and metabolic effects of pentoxifylline offer a complex therapy of cerebrovascular insufficiency.
The adrenergic control of the cerebral circulation was subjected to pharmacological analysis. The status of the cerebral circulation was assessed using radioisotope, electromagnetic and resistographic methods. EEG, ECG and arterial pressure were recorded. The acid-base equilibrium and oxygen tension were measured in the arterial blood and cerebrospinal fluid. The experiments showed that the sympathetic innervation plays an important role in controlling cerebral circulation and in the development of cerebrovascular disorders. This was indicated by the constriction of intracranial arteries induced by noradrenaline, stimulation of sympathetic nerves, reflex sympathetic activations and the effect of potassium chloride on the centrol nervous system. The pharmacological study demonstrated that constriction of the intracranial vessels is brought about by an activation of the sympatho-adrenal system which is mediated via alpha-adrenoreceptors of cerebral blood vessels.