[Aortic dissection and carotid arteries dissection complicated by ischaemic stroke in a patient with cystic medial necrosis]. / Rozwarstwienie aorty oraz tetnic szyjnych wspólnych i wewnetrznych powiklane udarem niedokrwiennym mózgu u osoby ze zwyrodnieniem torbielowatym blony srodkowej.

We present a case of a 62-year-old man who was admitted in grave condition to the Institute of Psychiatry and Neurology because of ischaemic stroke. Neurological examination re- vealed left-sided pyramidal hemiparesis. Computed tomography (CT) showed the ischaemic focus in the right cerebral hemisphere. Clinical examination and ultrasound examination revealed dissection of the aortic arch and extracranial arteries. Aortic dissection was confirmed in echocardiography and chest CT. The patient remained comatose and died after 7 days. Post-mortem examination identified dissection of the aortic arch, brachiocephalic truncus, common carotid arteries, internal carotid arteries and dissection extending along the whole aorta into both iliac arteries. This examination also showed a massive haemopericardium and a scar in the heart muscle after myocardial infarction. Microscopic examination identified cystic medial necrosis. This type of dissection is very rarely described.

Echolucent internal carotid artery plaques are a risk factor for stroke.

BACKGROUND AND PURPOSE: Atherosclerotic changes in carotid arteries are responsible for 10-20% of strokes. The aim of our study was to examine how the ultrasonic morphology of carotid arteries influences the occurrence of ischaemic stroke (IS). MATERIAL AND METHODS: Ultrasonography of the carotid arteries was performed with a 7-MHz duplex-type scanner Acuson 128XP/10C. We examined 200 consecutive acute IS patients and 100 sex- and age-matched control subjects. Morphology of atheromatic plaques was evaluated with the assessment of degree of stenosis, surface regularity and echogenicity of the plaques. The predictive value of potential prognostic variables in the assessment of the risk of IS was tested using regression models. RESULTS: The most frequent site of atherosclerotic changes was the internal carotid artery (ICA) (right ICAs: 34.5% in IS group vs. 19% in controls, p=0.005; left ICAs: 26.5% vs. 16%, p=0.04). Plaques in ICAs were significantly more severe in IS patients than in controls. Echolucent plaques were observed in the IS group in 11% of right and 5.5% of left ICAs, whereas in controls we found echolucent plaques in only 2% in left ICAs. IS occurrence was independently predicted by: hypertension, congestive heart failure, current smoking status, haemodynamically significant and echolucent plaques in ICAs. CONCLUSIONS: Echolucent plaques in ICAs are an independent risk factor for ischaemic stroke even if they have no impact on haemodynamics of blood flow. Clear characterization of plaques in CAs, especially vulnerable plaques, together with estimation of the degree of stenosis, may improve the selection of patients for invasive secondary prevention methods.

Polymorphisms of apolipoprotein E and angiotensin-converting enzyme genes and carotid atherosclerosis in heavy drinkers.

AIMS: To investigate the influence of apolipoprotein E (APOE) and angiotensin-converting enzyme (ACE) gene polymorphisms on carotid artery atherosclerosis in alcoholism. METHODS: Polymorphism of both genes was identified by DNA analysis in 130 male alcohol-dependent patients. Intima-media thickness (IMT) was measured ultrasonographically. RESULTS: Multivariate regression analysis showed that of all the known risk factors the greatest impact on carotid atherosclerosis in alcoholics was exerted by age, hypertension, LDL cholesterol and fasting plasma glucose levels. Subjects carrying the APO E epsilon4 allele were more liable to develop atherosclerotic changes in carotid arteries compared with subjects with the epsilon3/3 genotype, which showed statistical significance in patients under 50 years of age. No association was shown between ACE I/D polymorphism and carotid atherosclerosis. CONCLUSIONS: APO E polymorphism can increase the risk of carotid atherosclerosis development in an alcoholic subject. The association of the APO E epsilon4 allele with carotid atherosclerosis was significant in younger patients. Since the elevated carotid IMT is considered to be a good marker of increased risk of generalized atherosclerosis the consequences could involve both cardiac and cerebrovascular events.

[Internal carotid artery wall dissection as a cause of stroke in 19 year old patient. Case report]. / Rozwarstwienie wewnatrzczaszkowego odcinka tetnicy szyjnej wewnetrznej jako przyczyna udaru niedokrwiennego mózgu u 19-letniej pacjentki--przypadek kliniczny.

The authors report a case of stroke in a young adult patient caused by intracranial internal carotid artery dissection--result of rapid neck movement. The patient developed hemiparesis, but all neurologic symptoms completely regressed after rehabilitation and now (18 months) after stroke there are no neurological symptoms.

[Atrial fibrillation and carotid artery disease in ischemic stroke patients]. / Migotanie przedsionków i choroby tetnicy szyjnej wewnetrznej u pacjentów z udarem niedokrwiennym mózgu.

Ischemic strokes occurring in patients with non-rheumatic atrial fibrillation (AF) are due to a variety mechanisms, and not necessarily to cardiogenic embolism. The aim of the study was to determine the role and prevalence of carotid artery disease in stroke patients with AF, as well as its influence on the stroke prognosis. 513 consecutive patients with ischemic stroke participated in the study. The diagnosis was based on the clinical examination, brain CT and Doppler ultrasonography. Risk factors and clinical data were collected prospectively according to the Stroke Data Bank NIH protocol. AF was diagnosed in 166 (32.4%) patients. Carotid artery stenosis > 45% was present in 104 (20.3%). AF and co-existing carotid stenosis was found in 27 (5.3%) cases. There were 16.2% patients with carotid stenosis in the group with AF. In all groups 87 patients died (30-day mortality rate: 17%). The highest mortality rate was noted in the group with co-existing AF and carotid artery stenosis (25.9%), followed by the groups with AF only (21.6%) and no changes (15.9%), with the lowest mortality in the group with only vascular changes, i.e. stenosis or occlusion (9.1%). The carotid stenosis group differed significantly both from patients with co-existing AF and carotid stenosis (p > 0.01) and from those with AF only (p < 0.05).