The effect of warfarin administration on platelet aggregation.

BACKGROUND: The aim of this study was to assess the effect of anticoagulation treatment on platelet aggregation. METHODS: The study group consisted of 24 patients on long-term warfarin therapy without any antiaggregation therapy. Platelet aggregation was measured using VerifyNow with arachidonic acid (AA) as an inducer in 23 patients and with light transmission aggregometry (LTA) in 19 patients using four different agonists. All patients had their international normalized ratio (INR) checked regularly. RESULTS: The mean INR value was 2.07 (SD 0.6). The average aggregation measured by VerifyNow was found to be 637.5 (SD 36.6) aspirin reaction units. The values of average aggregability in LTA were 73.3 % (SD 4.5 %), 73.2 % (SD 6 %) and 72.1 % (SD 4.8 %) in case of aggregation induced by AA, ADP, and collagen, respectively. Epinephrine­induced aggregability was 65.3 % (SD 14.7 %). Regression analysis between INR and values of collagen- or epinephrine­induced aggregability (r = 0.654 and 0.575) was found statistically significant (p = 0.004 and 0.016); every increase in INR by 0,1 brings about an increase in collagen- and epinephrine­induced aggregation values by 1.5 and 4, respectively. CONCLUSION: Administration of warfarin does not produce a significant reduction in platelet aggregation. On the contrary, prolonged INR evokes a mild increase in aggregation induced by collagen or epinephrine (Tab. 2, Fig. 3, Ref. 32). Text in PDF www.elis.sk Keywords: platelet aggregation, anticoagulation, warfarin, platelet function tests, chronic ischemic heart disease.

Recommendations for cerebrospinal fluid analysis.

Diseases of the central nervous system (CNS) mean for the human organism a potentially dangerous situation. An investigation of cerebrospinal fluid (CSF) provides important information about a character of CNS impairment in the decision-making diagnostic and therapeutic algorithm. The authors present a brief overview of available cerebrospinal fluid assays, shortened indication criteria, a recommended algorithm of CSF assessment in different suspected diseases, and a view of the external quality system. The whole portfolio of obtainable CSF methodology is further subdivided according to the adequate choice into the first and inevitable basic routine panel, and following complicated analyses of highly specialized character. The basic panel is considered for standard laboratories, the complete specialized assessment should be provided by a super-consulting laboratory.

Cerebral infarction due to vasoconstriction after a hymenoptera stin.

A 22-year-old woman developed an anaphylactic reaction after two hornet stings. Left-sided hemiparesis and gaze paresis were revealed after extubation 24 hours later. The vasoconstriction of the right MCA together with hypotension are the suggested pathogenetic determinants of the stroke.

Neuroprotective treatment with cerebrolysin in patients with acute stroke: a randomised controlled trial.

BACKGROUND AND PURPOSE: Cerebrolysin is a compound with neurotrophic and neuroprotective activity. It is produced by enzymatic breakdown of purified brain proteins and consists of low molecular weight peptides and amino acids. Cellular and animal models of cerebral ischaemia have shown that it is a potent neuroprotective agent. We explored the safety and preliminary outcome of Cerebrolysin treatment in patients with acute stroke. METHODS: Randomised, placebo-controlled, parallel group trial. Patients with acute stroke were randomised within 24 h of stroke onset to IV therapy with placebo or Cerebrolysin 50 mL/day for 21 days. Both groups received concomitant treatment with ASA 250 mg/day PO and pentoxifylline 300 mg/day IV. Clinical examinations were performed on days 1, 3, 7, 21 and 90 post baseline. Outcome measures were the Canadian Neurological Scale, the Barthel Index, the Clinical Global Impressions, the Mini-Mental State Examination, and the Syndrome Short Test. Treatment emergent adverse events, lab tests, and vital signs were recorded to assess the safety of Cerebrolysin. RESULTS: 146 patients were enrolled in two groups: 78 Cerebrolysin and 68 placebo. At baseline, no significant group differences were observed. Patients in the Cerebrolysin group had no significant improvement in the CNS score, the Barthel Index and the Clinical Global Impressions when compared to the placebo group. A significant improvement of cognitive function of the patients on Cerebrolysin was observed in the Syndrome Short Test when compared to the placebo group. Cerebrolysin was well tolerated and safe. Adverse events occurred with a similar frequency in both groups. CONCLUSION: The results demonstrate that neurotrophic treatment with Cerebrolysin is safe and well tolerated by patients with acute stroke. The findings, despite the small sample size, also indicate a potential treatment effect of Cerebrolysin in acute stroke. Larger studies, however, are needed to confirm and extend these findings.

[Loss of intelligence in aphasic disorders]. / Ztráta inteligence u fatických poruch.

BACKGROUND: Certain level of aphasia is considered to be an integral component of dementia. More controversial is the question whether every--e.g. also strictly focal--aphasia must be accompanied with dementia. METHODS AND RESULTS: 41 persons hospitalized after the cerebral stroke (17 men, 24 women, average age 64.6, 47 to 89 years old) were tested to correlate the level of aphasia with mental and intelligence scores. 35 patients had an ischaemic stroke, 6 had a hemorrhagic one; according to CT/MRI there were 37 patients with left sided impairment, one patient with a right sided one and 3 patients with bilateral lesions. As an aphasiologic test the Western Aphasia Battery (WAB) was used, to determine the general mental performance as an equivalent of IQ test the non-verbal Raven's and verbal Euro-ADAS test were used. Correlation analysis using non-parametric Spearman's coefficient showed a significant relation between results in phatic functions and the score in intelligence tests. Phatic performance had in all elementary tests closer relation to verbal IQ in Euro-ADAS than with non-verbal IQ in Raven's test. The highest correlation was found in the relation between "apprehension vs. Euro-ADAS" (-0.842) and "apprehension vs. Raven" (0.782), while the lowest correlation was found for "repetition vs. Euro-ADAS" (-0.769), and "repetition vs. Raven" (0.646). The correlation was in all cases significant (p < 0.00001). Similar narrow relation occurred between the clinical forms of aphasia and intelligence tests. Sensory aphasia was associated most closely with both relations, with Euro-ADAS (-0.800), and Raven's test (0.800), while global aphasia had the lowest correlation with Euro-ADAS (-0.451) and with Raven's test (0.517). CONCLUSIONS: Speech is not only a product of thinking but also represents a source and structural tool for thinking.

Postgraduate education in neurology in Central and Eastern Europe.

The policy of the European co-operation in the new atmosphere of an international solidarity became one of the priorities of the European Federation of Neurological Societies (EFNS). It could be hardly pursued more efficiently in any other field of neurological performance as in education. To review several aspects of neurological practice and education the 'First European Co-operation Neurology Workshop' was held in the castle of Trest', Czech Republic, 13-20 April 2000. Participants from 15 countries (Albania, Belarus, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Hungary, Moldova, Poland, Romania, Russia, Slovak Republic and Slovenia), covering a region of 316 million inhabitants and 25 000 neurologists, presented their national postgraduate education systems (besides other topics). We refer data on density of medical doctors and that of neurologists, pre-board certification phase, board examination, continuing medical education (CME), and qualification rewards. Illustrative data were put in the comparative tables. This first meeting has founded the basis for a dynamic future collaboration in order to continue the integration process and an exchange of current information regarding CME amongst central and eastern countries as well as western Europe.

Arnold Pick and German neuropsychiatry in Prague.

Circumscribed focal atrophy with frontal lobe dementia and progressive aphasia, as described originally by Arnold Pick, has been recognized recently as being much more common than previously believed. Although Pick disease became linked with argyrophilic inclusions (Pick bodies) and swollen neurons (Pick cells), the majority of focal atrophies have findings that are a variation of the classic histologic features. We discuss Pick's background and the circumstances that led to his major contributions to the study of behavioral neurology. We also review his original articles, the articles that subsequently established the entity of Pick disease, and historical documents pertaining to the continuation of German-language education in Prague after Prague's independence from the Austro-Hungarian monarchy. Arnold Pick's life and career exemplify the integration of neurology, psychiatry, and neuropathology, which represents one of the major contributions of German neuropsychiatry to the study of the nervous system. Pick is a major intellectual ancestor of present-day neurology.

Clinical correlates of proton magnetic resonance spectroscopy findings after acute cerebral infarction.

BACKGROUND AND PURPOSE: We sought to determine whether lactate and N-acetyl signals measured by proton magnetic resonance spectroscopy (MRS) in the first days after stroke correlate with clinical measures of disability and functional outcome. METHODS: One-dimensional spectroscopic imaging was performed after stroke on 32 patients using a 2.1-T magnet. The Toronto Stroke Scale score at the time of the MRS study and the Barthel Index score at hospital discharge were determined from patient records. Lesion volume was estimated by a tracing algorithm from the scout magnetic resonance image obtained as part of the MRS study. The scaled lactate and N-acetyl signals from the voxel having the highest measured lactate were used to predict the clinical variables and lesion volume, as well as relative perfusion within the lesion, in those patients who underwent single-photon emission computed tomography (SPECT) blood flow imaging, using a multiple regression analysis. The correlation of lesion volume with the clinical variables was also evaluated. RESULTS: Lesion lactate signal was correlated with the Toronto Stroke Scale score, Barthel Index score, lesion volume, and SPECT score, all at P < .01. The N-acetyl level correlated with the Barthel Index score and lesion volume at P < .05. Lesion volume was also strongly correlated with the clinical variables (P < .0001). CONCLUSIONS: This is the first study to document the clinical predictive value of proton MRS measurements in patients after stroke. The association with functional outcome is stronger for lactate than for N-acetyl. Spectroscopic assessment of the metabolic status of cerebral tissues shortly after infarction may have significant clinical utility.

[The most frequent localization of cerebral ischemia attacks. III. Status lacunaris cerebri]. / Nejcastejsí lokalizace mozkových ischemických iktu. III. Status lacunaris cerebri.

The initial two parts of a 3-volume study on cerebral ictus concerned with analysis of macroangiopathic ischaemic defects are concluded with a final study analyzing microangiopathic defects. In a group of 93 patients with status lacunaris cerebri, the authors evaluated the presence and morphology of three main manifestations of status lacunaris: cerebral atrophy (periventricular and cortical), subcortical arteriosclerotic encephalopathy and the position of cerebral lacunae. The cerebral lacunae were mostly localized at the interphase of the individual cerebrovascular systems, which shows that their pathogenesis was due to interterritorial infarct.

CT findings in cerebral metastases.

In a series of 120 patients presenting a CT image of a cerebral tumor metastasis an analysis of 88 verified cases has been performed aiming at a determination of the morphological criteria which might enable us to speculate on the site of the primary lesion. The following properties have been studied: the location, size and shape of the lesions, their number, the extent of the surrounding edema and their postcontrast enhancement. Lung cancer participated as a source in 30.8% of the disclosed metastases, in 15.8% it was breast cancer, in 11.7% renal cancer, in 9.2% malignant melanoma and the remaining 32.5% were miscellaneous others. Our results demonstrated a certain degree of probability of identifying some of those sources of the CT detected metastases which had hitherto been unknown. Their degree of malignancy might be deduced from their size and shape.

CT response of brain parenchyma to intravenous contrast injections.

Pre- and postcontrast scans of the same normal brain tissue layer were compared in 20 patients in order to evaluate postcontrast density response. The original purpose of this investigation was to explain a paradoxical phenomenon of density decrease, which has been regularly observed in our patients. Control phantom measurements revealed that the decrease of density values is a function of the time interval between the analysed and the previous scan. Prolonged interscan interval--due to contrast injection--enables a change in the sensitivity of CT detectors to be registered. It is probable that any study of cerebral blood volume could be unfavourably influenced by this phenomenon. Comparison between the postcontrast brain scan density decrease and density decrease of a phantom showed substantially no difference, so that we estimate the contrast response of the brain parenchyma in toto as insignificant. Further, a comparative analysis between contrast response of the white and gray matter has been made. The gray-white matter difference increased from precontrast 4.56 H to postcontrast 7.82 H. The relatively high difference of 3.26 H between the white and gray matter enhancement compared with negligible enhancement of the brain slice as a whole leads us to the hypothesis, that an absolute decrease of white matter density, as a biological reaction to the injected contrast solution, has to be presumed.