Stroke in Hispanic veterans: a descriptive study.

BACKGROUND: Differences in risk factor prevalence and distribution of atherosclerotic cerebrovascular disease have been reported among different racial-ethnic groups. Identification of stroke syndromes and risk factors specific to the Puerto Rican male population should lead to more effective diagnosis, treatment, and prevention programs. METHODS: We prospectively and consecutively evaluated 118 Hispanic male veterans admitted to our Stroke Unit from June 1994 to September 1995. RESULTS: Ninety patients (76%) had an ischemic infarct, 26 (22%) had a transient ischemic attack, and 2 (2%) had an intracerebral and/or subarachnoid hemorrhage. Hypertension was the most common risk factor. Echocardiographic studies were done in 64% of the patients, and the most common findings were concentric left ventricular hypertrophy and diastolic dysfunction. Cerebral angiography was done in 40 cases, and findings were abnormal in 32 (80%). CONCLUSIONS: We believe this is the largest descriptive study of Hispanic male veterans with stroke syndromes. It provides baseline data to serve as a comparison group for future research.

Coexistence of primary antiphospholipid syndrome and protein S deficiency in a Hispanic man with ischemic stroke.

The primary antiphospholipid syndrome and protein S deficiency are known hypercoagulable states predisposing to ischemic strokes. The pathogenesis of those hypercoagulable states has been independently studied and, recently, interaction between them has been proposed. A 48-year-old Hispanic man had generalized seizures 5 months after the acute onset of a left middle cerebral artery infarct. He had a strong family history of strokes. After evaluation for cardiologic, rheumatologic, hematologic and metabolic etiologies for stroke, anticardiolipin antibodies and protein S deficiency were detected. Cerebral angiography was normal. First degree relatives were evaluated and screened for these conditions. Lupus anticoagulant was detected in a sister who reported a transient hemisensory deficit. None of the relatives studied had clinical or laboratory criteria for collagen vascular diseases. Coexistence of the primary antiphospholipid syndrome and protein S deficiency, two known prothrombotic states, has rarely been reported in Hispanic adults in association with ischemic stroke.

Cerebrospinal fluid and peripheral white blood cell response to acute cerebral ischemia.

We prospectively evaluated the inflammatory response to acute cerebral ischemia in 57 patients who were seen within 72 hours of ictus. All subjects had cerebrospinal fluid examination, complete blood count, sedimentation rate determination, and body temperature monitoring. Correlation analysis was done between these measurements and infarct volume, which was determined by computed tomography of the brain. We found a positive linear correlation between infarct size and the peripheral white blood cell count, specifically the polymorphonuclear leukocyte count. A relationship was also observed for the cerebrospinal fluid protein level, the gamma globulin level, and the cerebrospinal fluid/serum albumin ratio. The correlations observed presumably reflect the extent of tissue injury and secondary inflammatory response in acute cerebral ischemia.

Acute leukocyte and temperature response in hypertensive intracerebral hemorrhage.

BACKGROUND AND PURPOSE: We undertook this study to investigate the relationship between outcome, hematoma volume, and admission peripheral white blood cell count and body temperature in acute hypertensive intracerebral hemorrhage. METHODS: Eighty-two consecutive patients who presented with hypertensive intracerebral hemorrhage within 72 hours of onset were retrospectively assessed. The peripheral white blood cell count, polymorphonuclear leukocytes, and the body temperature on admission were measured. The outcome at 30 days after ictus was determined with a modified Glasgow Outcome Scale. Correlation analysis was performed between these measurements and hematoma volume, which was calculated by brain computed tomography. We also looked at the presence or absence of intraventricular extension. RESULTS: The mean hematoma volume was significantly greater in those patients who died compared with those with a good, moderate, and severe outcome (79.6 cm3 versus 10.7, 18.3, and 19.9 cm3, respectively; P < .0005). The mean peripheral white blood cell count was higher in those who died than in the other three groups (12.580 +/- 0.521 versus 8.160 +/- 0.543, 8.565 +/- 0.543, and 7.427 +/- 0.786 x 10(9)/L, respectively; P < .0005). The mean body temperature of those who died tended to be higher than those in the good-outcome group (99.12 +/- 0.21 versus 98.18 +/- 0.21 degrees F, P < .05). A positive linear correlation was observed between hematoma volume and white blood cell count (r = .506, df = 77, P < .001), as well as the polymorphonuclear leukocyte count (r = .561, df = 76, P < .001). A trend was also observed for admission temperature (r = .265, df = 74, P < .05). The leukocyte response was enhanced by the presence of intraventricular extension. CONCLUSIONS: There is a relationship between the size of the hematoma and the degree of leukocytosis in hypertensive intracerebral hemorrhage. This relationship appears to most likely represent a stress-induced reaction of the white blood cell count.

Relation between blood pressure and outcome in intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Controversy continues to exist regarding optimal blood pressure control in acute hypertensive intracerebral hemorrhage. Persistent marked elevation of the blood pressure can promote further bleeding, increase cerebral blood flow, and raise intracranial pressure. Relative hypotension, on the other hand, may promote hypoperfusion with secondary ischemia. This study was designed to assess outcome in patient groups defined by the degree of elevation in their pretreatment and posttreatment blood pressures. METHODS: We retrospectively assessed 87 patients who were categorized according to an initial mean arterial pressure > 145 mm Hg (n = 34) compared with those with a pressure < or = 145 mm Hg (n = 53). We also studied blood pressure control within the first 2 to 6 hours of presentation with subjects categorized according to a mean arterial pressure > 125 mm Hg (n = 40) or < or = 125 mm Hg (n = 47). RESULTS: An improved outcome in both mortality and severe morbidity was observed in the < or = 145 (chi 2 = 7.0, P < .005) and the < or = 125 mm Hg (chi 2 = 6.7, P < .005) groups. CONCLUSIONS: Markedly elevated blood pressure on admission and persistent inadequate blood pressure control adversely affect the prognosis in hypertensive intracerebral hemorrhage.

Unmasking a patent foramen ovale during recurrent paradoxical cerebral embolism.

A patient with an acute ischemic stroke had an interatrial septal aneurysm shown by transesophageal echocardiography. Interatrial shunting, compatible with a patent foramen ovale, was observed on a follow-up study after a second stroke. This was seen in association with a right atrial thrombus. This case illustrates that an interatrial septal aneurysm serves as a marker for potential interatrial shunting, which can lead to paradoxical cerebral embolism.

Selective increase in the right hemisphere transcranial Doppler velocity during a spatial task.

Transcranial Doppler ultrasonography of the middle cerebral arteries was performed during two tasks: sorting of mah-jongg tiles and vibratory stimulation. These tasks selectively increase cerebral blood flow by positron emission tomography. The purpose of this study was to determine if analogous increases in cerebral blood flow velocity could be detected. We measured flow velocity during right hand manipulation followed by left hand manipulation, or vice versa, with resting studies in between. The average increase in the mean velocity, by paired t-test, was significant for the right middle cerebral artery with both left hand (p < .0005) and right hand (p < .005) tile sorting. For the left middle cerebral artery, there was an increase in the mean velocity with right hand (p < .005) but not for left hand sorting (p = .13). These findings support the importance of the right hemisphere in the performance of this type of spatial task. No significant flow velocity increase occurred during vibratory stimulation.

Presence of human T lymphotropic virus type I in two patients with progressive myelopathy in Puerto Rico.

Two patients from Puerto Rico with progressive paraparesis had serum positive for human T lymphotropic virus type I (HTLV-I) antibodies by ELISA and Western blot, and one patient had HTLV-I antibodies in CSF by the ELISA method. Although the Caribbean basin is considered to be an endemic area for tropical spastic paraparesis, this is the first report of the isolation of HTLV-I antibodies in the serum and CSF of patients with chronic myelopathies in Puerto Rico.

Hemiballism-hemichorea: unusual neurologic presentation in acquired immunodeficiency syndrome.

A patient with hemiballism-hemichorea as the initial manifestation of the acquired immunodeficiency syndrome is described. Movement disorders in AIDS have not been frequently reported. Possible etiologies and therapeutic trials are presented. To our knowledge this is the first case report of hemiballism-hemichorea as the initial presenting feature of an AIDS patient in Puerto Rico.

Hemiballism-hemichrorea: unusual neurologic presentation in acquired immunodeficiency syndrome

A patient with hemiballism-hemichorea as the initial manifestation of the acquired immunodeficiency syndrome is described. Movement disorders in AIDS have not been frequently reported. Possible etiologies and therapeutic trails are presented. To our knowledge this is the first case report of hemiballism-hemichorea as the initial presenting feature of an AIDS patients in Puerto Rico

Primary lateral sclerosis: a distinct clinical entity in patients with chronic spastic paraparesis.

The development of neurologic deficits confined to the corticospinal tracts has been referred as Primary Lateral Sclerosis (PLS). Through the years, this diagnosis has remained uncertain. In this study we describe seven patients with chronic involvement of the pyramidal system. Two of these patients had serologic evidence of human T-lymphotrophic virus type I infection, one patient had multiple sclerosis and in four patients the clinical diagnosis of PLS was made. The clinical characteristics and diagnostic studies of these patients are presented. A review of the literature with emphasis in the differential diagnosis and a proposed workup for patients with chronic spastic paraparesis are made. This study provides supporting evidence in favor of the clinical entity of PLS.

Primary lateral sclerosis: a distinct clinical entity in patients with chronic spastic paraparesis

La aparición de signos neurológicos confinados al tracto piramidal se conoce como esclerosis lateral primaria. A través de los años, este diagnóstico ha sido cuestionado. En este estudio se describen siete pacientes con daño crónico del sistema piramidal. Dos de estos pacientes tenían evidencia serológica de infección con el virus humano T-linfotrópico tipo I. Un paciente tenía esclerosis múltiple y en cuatro pacientes el diagnóstico de esclerosis lateral primaria fue hecho. Las características clínicas y estudios diagnósticos de estos pacientes son presentados, incluyendo una revisión de la literatura con énfasis en el diagnóstico diferencial de paraparesis espática crónica. Este estudio provee evidencia a favor del diagnóstico de esclerosis lateral primaria como una entidad clínica