Takayasu arteritis and atherosclerosis: illustrating the consequences of endothelial damage.

The excess of cardiovascular morbidity associated with chronic vasculitic disease has become a focus of considerable research, particularly regarding the link between endothelial damage and the development of atherosclerosis. We describe a case of Takayasu arteritis treated sub-optimally by today's standards, giving rise to an 11 year history of progressive, stepwise decline associated with cerebrovascular events and leading to early death. Postmortem findings presented a picture of chronic atherosclerotic disease but in a distribution consistent with lesions of Takayasu arteritis.

Modality of Communication and Recall of Health-related Information.

A health warning was presented to 89 female and 19 male students aged 17-36 years via three modalities or channels of communication: a 'talking head' (video), an audiotape recording (audio) or a printed transcript (print). The verbal content of the message was identical in all three conditions. Participants' free recall, cued recall (recognition) and global recall of the message were then measured. On two separate dependent measures and a combined measure, recall was significantly (p < .005) better in both the audio and print conditions than in the video condition. No significant differences in recall were found between the audio and print conditions. These results, and those of earlier studies of modality effects on recall of information, are discussed in terms of self-pacing and distraction theories.

Clinical diagnosis of intracranial haemorrhage using Guy's Hospital score.

We tested the Guy's Hospital stroke diagnostic score using the clinical data from two independent samples of patients with acute stroke. These were 228 patients from the Oxfordshire community stroke project and 130 referred to the National Hospital for Nervous Diseases in London. The diagnosis was confirmed by computed tomography or necropsy in each case. The optimum cut off point on the clinical score for the differentiation of intracranial haemorrhage from infarction was found to be the same for both the patients in our study and those from whose data the score was derived originally. Set at this level, the score achieved a sensitivity for the diagnosis of haemorrhage of 81% and 88% in the patients from Oxford and London, respectively. In those from Oxford infarction was diagnosed with a sensitivity of 78% with an overall predictive accuracy of 78% with an overall London the sensitivity for infarction was also 78% with an overall predictive accuracy of 82%. When it is essential to exclude intracerebral blood before starting treatment in the small proportion of patients with stroke who require anticoagulation the Guy's Hospital score is not sufficiently accurate to replace computed tomography. The score is, however, the most accurate clinical means of differentiating haemorrhage from infarction as the cause of stroke. It is suggested that it should be used as a screening test in epidemiological studies and in large scale trials of low risk treatment for the secondary prevention of stroke when computed tomography in all cases is impracticable.

Hypersensitivity to azathioprine in myasthenia gravis.

A patient with myasthenia gravis is described who exhibited hypersensitivity including an apparent acute exacerbation of the underlying disorder when treated with azathioprine. 6-mercaptoprine (6-MP) also produced hypersensitivity which, in contrast, did not manifest as a myasthenic exacerbation.

Prognosis in middle cerebral artery stenosis.

Among 21 patients with angiographically demonstrated stenosis of the middle cerebral artery (MCA) 14 presented with a stroke and 7 with transient ischaemic attacks (TIAs). Of the former 4 had further strokes (3 fatal); of the latter one had a fatal stroke. Only 2 of the 21 patients had TIAs during the follow-up period. The present study indicates that the prognosis for patients with MCA stenosis is less good than the literature suggests. There is appreciable risk of fatal stroke especially in those who present with a stroke. This perspective is important when deciding on the need for EC/IC bypass.

Craniovertebral junction pathology: assessment by NMR.

In nuclear magnetic resonance (NMR) studies choice of imaging plane is achieved by a variety of methods that restrict data collection to the desired region. This means that the additional perspectives of direct sagittal and coronal views are possible. In sections traversing the brainstem and cervical cord the neural tissue is clearly seen contrasted against the surrounding cerebrospinal fluid (CSF). NMR studies of a wide variety of lesions in the vicinity of the craniovertebral junction, including congenital and acquired bony deformities, intrinsic tumors, and syringomyelia, are evaluated. It is concluded that the assessment of clinical problems involving this region is simplified by NMR imaging and that its use will probably allow more invasive procedures to be avoided.

The application of NMR imaging to the evaluation of pituitary and juxtasellar tumors.

Nuclear magnetic resonance (NMR) imaging was used to evaluate pituitary and juxtasellar tumors in 37 patients representing a wide range of pathology. The value of the multiplanar facility of NMR is emphasized in providing accurate volumetric information and establishing the topographical relation of tumors to adjacent structures. Current limitations of the method and possible future developments to improve diagnostic precision are discussed.

NMR imaging in the recognition of giant intracranial aneurysms.

Most giant aneurysms present clinically as intracranial mass lesions. Many contain an organized lamellated thrombus with only a small eccentric lumen remaining that can be opacified at angiography. Four patients with such aneurysms were studied using flow-dependent nuclear magnetic resonance scanning sequences. The aneurysms show a smooth rounded margin, and the thrombus within is clearly distinguishable from the blood flowing through the patent lumen, which gives a low signal. By using different scan sequences it is possible to prove that the area of low signal is indeed fluid in rapid motion, thus confirming the diagnosis.

Transient global amnesia in four brothers.

The case histories are described of four brothers who suffered attacks of transient global amnesia. The coincidence of this disorder in four siblings suggests that the causative factors in transient global amnesia may have a familial basis and that its incidence is more common than generally realised.

The assessment of drug treatment of spastic gait.

The technique of polarised light goniometry was used to quantify objectively parameters of the spastic gait during a double-blind cross-over trial comparing the spasmolytic effects of DS103-282, baclofen and placebo. Only minimal objective and subjective changes in gait were found when the results of treatment with DS103-282 or baclofen were compared with those of treatment with placebo.

Cerebrospinal fluid amino acid concentrations in patients with viral and tuberculous meningitis.

Serial measurements have been made of the cerebrospinal fluid and plasma amino acid concentrations in 11 patients with viral meningitis and in four with tuberculous meningitis. A small increase in the concentrations of a few amino acids in cerebrospinal fluid has been found in a viral meningitis in contrast to a marked increase in most amino acids in tuberculous meningitis. The findings are compared with those found in patients with purulent meningitis and the possible causes and the diagnostic significance of these findings are discussed.

Abnormalities of cerebrospinal fluid amino acids in patients with the Guillain-Barré syndrome.

Measurements of cerebrospinal fluid (CSF) and plasma amino acid concentrations have been made in 12 patients with the Guillain-Barré syndrome. The CSF protein concentration was normal in seven specimens and raised in 13. Abnormalities of the CSF amino acid profile were found in all specimens but were more marked in those with a raised CSF protein concentration. The possible causes and diagnostic significance of these changes are discussed.

Abnormalities of cerebrospinal fluid amino-acids in purulent meningitis.

Serial measurements were made of the cerebrospinal fluid and plasma amino-acid concentrations in 12 patients with purulent meningitis. Marked increases in the concentrations of most CSF amino-acids were found, possibly caused by altered transport mechanisms in the inflamed meninges and choroid plexuses.

The effect of haemodialysis on cerebrospinal fluid and plasma amino acids.

The concentration of free amino acids in CSF and plasma has been measured in 19 patients with renal disease undergoing haemodialysis therapy. The values obtained have been compared with those measured in non-haemodialysed patients. At the end of a 10-h dialysis period, the total CSF amino acid concentration had fallen by only 23.3% compared with a 57.7% fall in plasma. Examination of the results for individual amino acid concentrations showed 3 different patterns of inter-relationship between plasma and CSF.