[Etiological spectrum of symptomatic epilepsy in adults]. / Aspekty etiologiczne padaczki objawowej ludzi doroslych.

The purpose of this study was to establish the frequency of incidence of epileptic seizures among adult patients of the Neurological Department. The second aim was to establish the causes of the symptomatic epilepsy. The material comprised of 205 patients, who were hospitalized because of first epileptic seizures. The etiology of epilepsy was based on history, neurological findings and diagnostic investigations. Only the patients over 20 years old were included in the study. The analysed group of 205 cases was 6.6% of all hospitalized patients during a period 5 years. The average age of these patients was 57.5; 58%--were male, 42%--female. Vascular lesions of the brain were the most frequent cause of epilepsy (46.4%); alcohol abuse--13.6%, brain tumor--10.2%, head trauma--8.8%, alcohol and head trauma--6.3%. Inflammation, degeneration and metabolic processes were very rare. In 8.8% of cases with late epilepsy, the etiology of disease remained unknown. In the group with vascular lesions of the brain, ischaemic stroke was the most frequent (62.8%). Among the patients with ischaemic stroke females prevailed. Alcohol-associated seizures were disorders very often among males. The literature analysis and our own notices showed that the frequency of symptomatic epilepsy in the elderly population increased. The connection between this observations and the higher average survival and the frequency of vascular diseases of the brain, is possible. The etiology of epilepsy in very elderly people is not clear and probably is associated with several factors. This group of patients comprised 25.5% of all our material.

[Clinical types of Guillain-Barré syndrome]. / Kliniczne warianty zespolu Guillain-Barré.

A detailed history and the results of the physical examination of seven patients with unusual and not typical Guillain-Barré syndrome were described. The patients presented various levels of lesions and some signs and symptoms were not typical of classic clinical features. The variety of the clinical picture suggests the damage of nervous system in many places and at various levels, not only in the peripheral nerves, but also in the central nervous system. The heterogeneity of aetiology and aetiopathogenesis and immunological individual patient's reaction probably is the cause of the involvement of different structures.

[Clinical symptomatology of primary brain atrophy]. / Symptomatologia kliniczna pierwotnego zaniku mózgu.

A group of 185 patients with brain atrophy found in CT is presented. The purpose of the study was to call attention to the the significance, frequency and clinical signs of brain atrophy. All patients were divided into two groups: 78 cases with secondary brain atrophy associated with other diseases of central nervous system and 107 cases of "primary" brain atrophy. The last one was an only finding without any other pathological lesions in the brain. Depending on the localisation, three groups of brain atrophy were isolated: generalized, subcortical and cortical. The clinical picture was analysed in the group of "primary" brain atrophy. In the studied group the most frequent cause of hospitalisation were epileptic seizures, the next one: headache, one-side hemiparesis or hemihypaesthesia, dizziness and incoordination. Neurological examination showed that one-side signs were observed very often in generalized brain atrophy. In the group of patients with cortical brain atrophy most patients were without any neurological signs. The analysis of the relationship between the clinical examination and "primary" brain atrophy found in CT, showed lack of characteristic, typical signs, which could be connected with brain atrophy. The problem of difficulty in the diagnosis of brain atrophy is stressed aesthesia. The definition and the significance of brain atrophy should be verified in diagnosis and the conclusions after finding brain atrophy have to be very careful.

[Brain atrophy: neuropsychological and electroencephalographic tests]. / Zanik mózgu: badania neuropsychologiczne i elektroencefalograficzne.

Neuropsychological and electroencephalographic investigations of 200 patients with tomographically confirmed brain atrophy failed to demonstrate significant differences in relation to control group of patients without this atrophy in whom CT was done for the same clinical indications as in the studied group. In both groups the results of neuropsychological investigations were correlated with age. In the EEG the only statistically significant difference was a greater frequency of seizure activity in the patients with brain atrophy.

[Brain atrophy: radiological-neurological correlations]. / Zanik mózgu: korelacje radiologiczno-neurologiczne.

Computerized tomography of the head was done in 5021 patients aged 21 to 81 years from various neurological, neurosurgical and neurotraumatological indications. Brain atrophy as an only finding (primary) was noted in 11.5%- and in 5.4% of cases it was associated with other changes. The neurological-radiological correlations were established in 200 cases of primary strophy. History data included: headaches in 54.5%, dizziness in 15.0%, epilepsy in 24.5%. Objective examination showed: slight hemiparesis in 37.5%, spastic-atactic gait disturbances in 31.5%, isolated damage to the corticospinal tracts with signs limited to one side of the body was more frequent in cortical atrophy, and these signs associated with ataxia were more frequent in subcortional atrophy. The authors explain this as a loss of cortical cells or damage to the paraventricularly coursing nerve fibres. A probable aetiology of "primary" atrophy was established in 405% of cases (hypertension, atherosclerosis, minor craniocerebral trauma). No signs or neurological syndromes were observed which could be regarded as more or less characteristic of brain atrophy.

[Ischemic complications of ruptured intracranial aneurysms]. / Powiklania niedokrwienne w przebiegu peknietych tetniaków wewnatrzczaszkowych.

Eighty patients are reported with ischaemic complications developing during subarachnoideal haemorrhage due to aneurysm rupture. Ischaemic complications developed in 12.82% of cases in the whole group of subarachnoideal haemorrhages caused by aneurysm rupture. The causes of ischaemia were: closure or stenosis of the afferent artery during the operation, arterial spasm, thrombosis at the site of the aneurysm and brain oedema. Ischaemia during intracranial aneurysm rupture caused in most cases pale infarcts. Ischaemic complications of aneurysm rupture had a serious prognosis, nearly half the patients with this complication died.

[Effectiveness of antifibrinolytic, edema-preventing and hypotensive agents in the prevention of recurrent bleeding from intracranial aneurysms]. / Skutecznosc leków antyfibrynolitycznych, przeciwobrzekowych i hipotensyjnych w zapobieganiu nawrotom krwawienia z tetniaków mózgu.

On the basis of a material of 561 patients with ruptured intracranial aneurysms treated at the Department of Neurosurgery, Institute of Neurology, Medical Academy in Cracow in the years 1971 to 1977 the authors discuss the effectiveness of conservative treatment for prevention of recurrent bleeding from these aneurysms. The whole group of 561 patients were divied into two subgroups: 361 patients (group A) receiving standard antifibrilytic treatment, drugs preventing oedema formation and reducing the arterial blood pressure, and 254 patients (group B) who were not given antifibrinolytic agents and the other pharmacological agents were given to them only sporadivally. Recurrent bleeding developed in 8.86% of cases of group A and 11.02% in group B. The difference was not significant.

[Early manifestations of vascular anomalies of the central nervous system and indications for angiographic studies prior to hemorrhage]. / Wczesna symptomatologia wad naczyniowych osrodkowego ukladu nerwowego i wskazania do badan angiograficznych w okresie poprzedzajacym krwotok.

In a group of 556 patients with ruptured intracranial aneurysms in 80 (14%) prodromal manifestations were present before haemorrhage. They included most frequently headaches vomiting, disturbances of eye movements and transient disturbances of consciousness. Prodromal symptoms were most frequent in cases of vertebral-basilar aneurysms.