Cerebrovascular disorders and alcohol intake: preliminary results of a case-control study.

The role of alcohol as a risk factor for cerebral infarction and hemorrhage has been assesed in 200 middle-aged and elderly stroke patients and 200 controls matched for age, sex and hospital admission date. Computed tomographic brain scans were done in all but 10 of the stroke patients. Alcohol intake was reckoned on the 12 months preceding hospitalization and expressed in grams daily according to a standard nomogram. The Michigan Alcoholism Screening Test was used for the diagnosis of alcoholism. Cerebral infarction was present in 59% of the stroke patients and cerebral hemorrhage in 9%. The role of alcohol as risk factor for stroke proved to be small (Odds Ratio 1.86) and was practically lost after adjustment for the most common risk factors for cerebrovascular disorders (previous strokes, arterial hypertension, diabetes, obesity and hyperlipidemia). Our findings seem to suggest that alcohol is not an independent risk factor for stroke in the middle-aged and elderly. The data are, however, preliminary and are discussed in the light of methological problems.

The organization of corticopontine fibres in man.

Patients with lesions located in the frontal and temporal lobes, in the parieto-temporo-occipital border zone, and in the anterior limb of the internal capsule, did not present ataxia or other cerebellar signs. On the other hand, patients with the ataxic hemiparesis (AH) syndrome had lesions located in the posterior limb of the internal capsule, in the corona radiata and in the central region of the cerebral cortex. These findings in man do not confirm the existence of large frontal (Arnold's bundle) and temporal (Türck's bundle) projections to the pontine nuclei and indicate that the main bulk of corticopontine fibres originates from the central region of the cerebral hemisphere and courses in the posterior limb of the internal capsule. In man, the anatomical organization of corticopontine fibres is therefore similar to that recently demonstrated in animals.

Hemorrhagic infarction: risk factors, clinical and tomographic features, and outcome. A case-control study.

A radiological diagnosis of hemorrhagic infarction (HI) was made in 41 of 2726 cases with cerebrovascular lesions (1.9%). The clinical records of the cases and those of 82 age- and gender-matched subjects with ischemic infarction were examined, and notes of the principal risk factors of cerebrovascular disorders, the clinico-radiologic features and the outcome of the disease were taken for comparison. Cardiac sources of emboli (atrial fibrillation, native or prosthetic valve disorders, recent myocardial infarction) were present in 44% of cases and in 24% of controls. Diabetes mellitus was recorded in 31% and 18% respectively. Thirteen percent of cases and 35% of controls gave a history of transient ischemic attacks. Stupor or coma during the acute phase and a more severe course were more common among cases. In general, HIs were significantly larger than ischemic infarcts, with mass-effect, although the size of the lesion did not seem to be related to the presence of cardiogenic embolism.

Intracerebral hemorrhage following intravenous administration of epinephrine.

We report a case of intracerebral hemorrhage (ICH) in a young man following intravenous self-administration of epinephrine. Arteriography evidenced normal intracranial vessels, and namely excluded the presence of vascular malformations which could have been implicated in the pathogenesis of ICH. We believe that the main pathogenetic agent in this case was the sudden rise in arterial blood pressure. This report aims at underlying the severe implications of non-medical use of sympathomimetic drugs.

Aphasia and apraxia caused by ischemic damage to the white substance of the dominant hemisphere.

We describe a case of aphasia associated with ideomotor apraxia due to a CT-proven ischemic lesion strictly confined to the dominant hemisphere white substance at the junctional zone of Donnan. The aphasia did not fit any of the known patterns. At first severe, it cleared in 5 days, while the apraxia remained unchanged 25 days after onset.

Ataxic hemiparesis syndrome: sensory disturbances and somatosensory evoked potentials.

26 patients with ataxic hemiparesis syndrome (AHS), due to acute ischemic cerebrovascular disease, have been submitted to clinical and electrophysiological evaluation, in order to assess the frequency of sensory disturbances in this condition. Sensory impairment were present in 78% and SEP abnormalities in 54% of the patients, while they were entirely absent in 23% of them. Lesions responsible for AHS, detected by CT scan, were mainly located in the thalamus, capsula interna, subcortical white matter, centro parietal cortex; sensory and SEP changes were more frequent in gross infarct involving the cortex and in smaller infarcts involving the thalamus, less frequent in the lacunar infarcts of the capsula interna and subcortical white matter, relatively rare in patients with CT scan without hypodense lesions. Although a statokinesthesic defect and/or major SEP abnormalities were often present (38% of patients), our findings do not support the view that they are involved in the pathogenesis of the ataxia, which may rather be attributed to a derangement of cerebro-cerebellar and cerebello-cerebral connections.

Ataxic hemiparesis syndrome: clinical and CT study of 20 new cases and review of the literature.

20 new cases of ataxic hemiparesis syndrome (AHS) are reported and the findings compared with those of published cases. AHS may be due to lesions either of the brainstem or of supratentorial structures, where motor fibers run together with the cerebro-cerebellar pathways. Specific syndromes related to the lesion site cannot be identified from the clinical signs. Ischemic infarct is the most frequent cause of the syndrome, but hemorrhagic, neoplastic and demyelinating lesions have also been reported.

[Semeiologic aspects of circumscribed thalamic lesions. Clinico-tomodensitometric study]. / Aspetti semeiologici di lesioni talamiche circoscritte. Studio clinico-tomodensitometrico.

The classical thalamic syndrome of Dejerine and Roussy is very rare. Sensory disorder are almost constant but the thalamic hyperpathia had not been reported. Clinical findings are reported in 14 patients with restricted lesions of the thalamus visible with the CT scan. Occasionally aphasia was found in patients with left sided lesion (with Thalamic Neglect, apraxia, mainly of ideomotor type and the so-called "Central Dazzle"). Thalamic lesions can produce a great variability of signs and symptoms.