Electron microscopy analysis of skin biopsies in CADASIL disease.

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is an inherited vascular disorder, non-amyloid and non-atherosclerotic, affecting predominantly the central nervous system. We examined samples of skin biopsies from six patients (men, 43-52-year-old), admitted for treatment in the Neurology Clinic regarding the presence of partial motor impairment on upper and lower right limbs, facial asymmetry and phrasing impairment (three of the patients); These three patients had family history remarkable for early-onset strokes: mother and two brothers deceased by early strokes (40-50-year-old). Skin biopsy samples were fixed in glutaraldehyde and post-fixed in osmium tetroxyde. After dehydration, tissue samples were embedded in Epon. Ultrathin sections were mounted on copper grids and stained with uranyl acetate and lead citrate as usual and examined with a transmission electron microscope Phillips CM100. In all cases ultrastructural study showed granular osmiophilic material (GOM) in extracellular locations, between degenerating smooth muscle cells in dermal arteries or in their indentations. Deposits of GOM varied in size and electron density. Degeneration and loss of smooth muscle cells (SMCs) leads to abnormal enlargement of the space between these cells Ultrastructural analysis in three cases showed chromatin condensation and peripheral aggregation of nuclear material suggesting cells entry to apoptosis. These aspects and the marked destruction of the vascular wall were correlated with MRI findings and the severity of clinical manifestations at these patients. Our study showed that findings of GOM deposits, degeneration and loss of SMCs (probably by apoptosis), cell adhesion elements disturbance are characteristic for CADASIL disease and sufficient for diagnose of certainty. Moreover, electron microscopy analysis of skin biopsies is a useful tool for a differential diagnosis and can be considered as first choice method.

[Neuropsychological disturbances in thalamic hemorrhage--clinical study]. / Tulburari neuropsihologice în hemoragia talamica. Studiu clinic.

UNLABELLED: Neuropsychological disturbances are frequently associated with hemorrhagic stroke of the thalamus. MATERIAL AND METHOD: We present our personal findings on 117 patients admitted in the Ist Neurological Clinic, lasi with hemorrhagic stroke of the thalamus. RESULTS: Transcortical aphasia for the left-sided strokes and anosognosia or hemi-neglect were among the most prominent clinical features, especially for large thalamic hemorrhage. Visual or tactile extinction, memory disturbances, agitation and hallucinosis were also exhibited in various proportions.

[Clinical and prognostic considerations in thalamic hemorrhage. Clinical study on 117 cases]. / Aspecte clinice si prognostice in hemoragia talamica. Studiu pe 117 cazuri.

UNLABELLED: Intracerebral hemorrhage located in the thalamus is one of the most frequent forms of hemorrhagic stroke in hypertensive patients. In this study the authors investigated the most important aspects related to thalamic hemorrhage : risk factors, initial signs, neurologic and EEG findings, the prognostic impact of the presence or absence of ventricular penetration, as well as the extension of hematoma. MATERIAL AND METHOD: 117 patients with thalamic hemorrhage confirmed by cerebral computerized tomography were included in the study. RESULTS: Hypertension was the most significant risk factor in our patients. Headache was the most common early clinical symptom, while pyramidal signs were the most frequent findings at neurological examination. Patients with hemorrhagic extension to the putamen had the worst prognosis for stroke.

[Psychocognitive impairment evaluation in early post-stroke period]. / Evaluarea afectarii psiho-cognitive in perioada precoce post-stroke (AVC).

UNLABELLED: There are many interconnections between pathological mechanism involved in production of dementia and cognitive impairment even in stroke patients. Early detection and management of these disorders provide better prevention of possible dementia. AIM: To explore the factors which can affect psychocognitive impairment of poststroke patients. METHOD: using the MMSE (mini-mental state examination), GDS (Geriatric Depression Scale), NIH (National Institute of Health) Stroke Scale we evaluated 47 consecutive patients with ischemic stroke, admitted in I Neurological Clinic of "N. Oblu" Hospital from Iassy. RESULTS: Our patients had relative important cognitive impairment (11 individuals--MMSE < 20, but only 4 below 10) and important depression (GDS > 10 in 35 cases and > 20 in 7 cases). We found correlation between some risk factors and cognitive impairment / depression (hypertension, overweight, dyslipidemia, diabetes, arrhythmia, carotid system lesion). CONCLUSION: Cerebrovascular disease can produce important cognitive and psychological impairment, which we can easily evaluate using some "bedside" tools MMSE, GDS.

Cheyne stokes respiration in stroke patients.

Cerebral-vascular events represent a major cause of mortality worldwide. Resulting respiratory complications are common and possibly composing a marker of severe neurological disorder. Cheyne-Stokes respiration is a disorder characterised by recurrent central apnoeas during sleep, alternating with a crescendo-decrescendo pattern of tidal volume, thus constituting an additional burden to the patient. In this paper the authors review the physio-pathological background, clinical presence and latest therapy-related data on Cheyne Stokes respiration in stroke patients.

Mechanical ventilation in vascular coma patients.

Vascular coma is one of the leading complications in patients suffering cerebrovascular accidents and it is therefore entirely appropriate that we should consider what critical care has to offer in this devastating disease process. Vascular coma patients need ventilatory assistance; Intubation and mechanical ventilation represent a life saving intervention. As critical care is subjected to progressive changes, careful definition of the role of mechanical ventilation, its types, and the ability of such a form of life sustaining support to affect patient outcome in multi-sided directions is mandatory.

[Acute myocardial infarction with neurological symptoms: clinical and pathologic aspects]. / Infarctul miocardic acut cu manifestari predominant neurologice: aspecte clinice si anatomo-patologice.

A variety neurological symptoms can be the onset of an acute myocardial infarction. The study includes 96 patients who have undergone necropsies (from 1978 to 2003), hospitalized at the "Sfânta Treime" University Hospital, Iasi, in the Neurology Clinic. They were admitted for various neurological manifestations: hemiparesis, hemiplegia, aphasia, coma of the 1st degree up to the 4th. Death of these patients was due to acute myocardial infarction in the cases of most of them, even those with significant brain damage. We have taken into account the anatomic pathology of the heart, brain, kidneys and lungs. The prevalence of the factors of cardiovascular risk was considered in our study, as well as the topography of the myocardial infarction. Patients with acute myocardial infarction can present major neurological symptoms with no significant cardiovascular clinical symptoms.

[Prospective epidemiologic and clinical observations on the prevalence of risk factors for stroke, performed on 374 inpatients, during the period of June 2001-June 2004]. / Observatii prospective epidemiologice si clinice asupra prevalentei factorilor de risc pentru accidentul vascular cerebral, realizate pe un lot de 374 de bolnavi, în perioada iunie 2001-iunie 2004.

UNLABELLED: Within the framework of cardiovascular pathology, with an epidemopandemic aspect, the stroke, through its mortality and sequels, represents, worldwide, a major problem of community health. In this context, we present the results of an epidemiological and clinical study, both prospective and interdisciplinary, performed on a sample of 374 inpatients suffering from stroke, hospitalized in the Neurology Ist Clinic of Iasi, during the period June 2001-June 2004. The characteristics of the studied sample: age--78.8% over 51 years old, sex--53.7% male; residence--51.4% urban; provenance: rural--70.0% (p<0.001); studies: higher education--7.7% ; pensioners--76.2%; passive finding--96.8%; previous hospitalizations for cardiovascular diseases and/or diabetes mellitus: 48.2%; blood groups: OI and AII--86.61%. RESULTS: Risk factors for stroke: 56.6%--BMI > 25; "A" behavior type (Bortner's test)--63.8%; stress: familial--74.1% and occupational--25.9%; excess consumption: alcohol--11.4%; salt--32.8%; tobacco--24.9%; passive smoking--10.8%. Releasing and aggravating risk factors: arterial hypertension (AHT)--55.4% (p<0.001); obesity--12.9%; diabetes mellitus--12.5%. Hereditary antecedents: AHT--46.8%; ischemic cardiopathy and myocardial infarction--15.6%; obesity and dyslipidemia--15.0%; stroke--10.8%. CONCLUSIONS: In this study, the multifactorial and associative etiology of stroke is confirmed once more, and the estimate costs of 1.21 milliard lei, only for the 10-day average hospitalization, for each of the 374 inpatients.

[Absence seizure--recent physiopathologic data]. / Absentele epileptice--actualitati în fiziopatologie.

The progresses in clarifying the normal and pathologic cellular and molecular mechanisms are reflected in the elucidation of the way some of the most common forms of generalized seizure--absence seizures--occur and are produced. Intrinsic properties of the thalamic neurons that give them the ability to release or preserve oscillatory, low-frequency neuronal discharges, and the thalamo-cortical feedback mechanism seem to explain the pathogenesis of absence seizures. The involvement of GABA receptors in the regulation of membrane calcium channels, as well as their genetically-induced changes are new pieces in the pathogenic puzzle.