Epileptic seizures after subarachnoid hemorrhage.

We studied predictive factors for the occurrence of epilepsy in 381 consecutive patients admitted within 72 hours after they had a subarachnoid hemorrhage from a ruptured intracranial aneurysm. Fits occurring in the presence of hyponatremia or within 12 hours after the initial bleed, rebleeding, or aneurysm surgery were classified as associated with these acute events and we did not regard these fits subsequent epileptic seizures. Thirty-five patients (9%) had one or more epileptic seizures, 12 hours to 1,761 days after the initial bleed (median value, 18 days). The following variables were included in the analysis: sex, age, history of hypertension, history of cardiovascular disease, loss of consciousness at ictus, sum score on the Glasgow Coma Scale on admission, sum score for the amount of cisternal blood and presence of intraventricular blood based on the initial computed tomography (CT) scan, occurrence of ictal seizures (seizures occurring within 12 hours after the onset), acute hydrocephalus, rebleeding, delayed cerebral ischemia, fluid intake, treatment with tranexamic acid, ventricular drainage, and aneurysm surgery. After multivariate analysis by means of Cox proportional hazards model with stepwise forward selection of the variables, a high cisternal blood score and rebleeding proved to be significantly related to epilepsy (hazard ratio = 2.06, p = 0.040; and hazard ratio = 3.02, p = 0.016), even after the exclusion of 28 patients who received perioperative prophylactic anticonvulsant therapy (hazard ratio = 2.31, p = 0.022; and hazard ratio = 3.65, p = 0.006, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach.

Discrepancies were examined in diagnostic outcome between a monodisciplinary approach and a multidisciplinary, criteria-based approach in patients referred to a university memory clinic. Of 278 patients not fulfilling dementia criteria, 19 had been previously diagnosed as demented (specificity: 0.93). In 60 of 152 demented patients, dementia had not been diagnosed before (sensitivity: 0.61). Underreporting was frequent for mildly demented patients and for patients with coexisting depressive symptoms. In patients referred by psychiatrists, sensitivity rates for dementia and Alzheimer's disease were low; in patients referred by neurologists, depression often went unreported. Results underscore the need for more frequent use of integrated multidisciplinary services for cognitively disturbed patients.

Timing of autopsy-confirmed hemorrhagic infarction with reference to cardioembolic stroke.

We studied the temporal profile of hemorrhagic transformation in 34 cases with autopsy-confirmed hemorrhagic infarction who died within 15 days following a supratentorial brain infarct, provided they had undergone computed tomography. It appeared that within 4 days, at least 76% (95% confidence interval 39-100%) of 21 cardioembolic strokes had become hemorrhagic. We conclude that if anticoagulation is considered in cardioembolic stroke, such treatment should not be started sooner than at least 4 days after the onset of stroke, provided that computed tomography at that time shows no hemorrhagic infarction.

Hemorrhagic infarction on CT in cardioembolic stroke.

CT-scans of 103 patients anticoagulated following cardioembolic stroke were evaluated. Data were taken from a prospective registry on the risk of early anticoagulant treatment in patients with cardioembolic stroke. Ninety-three patients had CT within 24 hours after stroke onset. Sixty-six of 103 CT-scans showed infarction. On initial CT five hemorrhagic infarcts were found (5%). Of 35 follow-up CT-scans randomly performed during anticoagulant treatment, six (= 17%) showed hemorrhagic infarction without clinical worsening. It is argued that a cardioembolic cause of stroke cannot be infered by the presence of HI on CT. In patients with a cardioembolic stroke the value of CT lies in minimizing the risk of early anticoagulant treatment.

Risk of early anticoagulation in patients with small deep infarcts possibly caused by cardiogenic emboli.

From a prospective registry of 103 stroke patients on early anticoagulation for cardiac embolus we selected 23 patients with a small deep infarct. We studied the incidence of hemorrhagic infarction on CT, and the risk of early anticoagulation. We found no hemorrhagic infarction on CT in any case, and no bleeding complications during the three week observation period. Obviously, early anticoagulation can be started safely in patients with a small deep infarct possibly caused by cardiac embolism.

Epilepsy and alcohol: the influence of social alcohol intake on seizures and treatment in epilepsy.

People suffering from epileptic seizures are often confronted with restrictions resulting from their attacks, such as exclusion from several professions and from some sports, not being allowed to drive a car, and prohibition of alcohol. Consultation of manuals to trace the literature studies on which this last prohibition was based was unsuccessful since there was no mention of the original research from which it appeared that alcohol was provocative of seizures. To be able to give a well-founded judgment on the influence of social alcohol intake on epilepsy, research was undertaken with epileptic patients who had never before or very sporadically used alcohol. During 16 weeks, twice a week, in a clinical setting, 1-3 glasses of an alcoholic beverage were consumed within a period of 2 h. The examination could be carried out double-blind since the drink that was chosen, vodka, is odorless and cannot be tasted when mixed with orangeade. We concluded the following. (a) No influence of social alcohol use on tonic-clonic convulsions or partial complex seizures is demonstrable. (b) Blood levels of carbamazepine, phenobarbital, and phenytoin are not influenced by alcohol intake. The valproic acid concentration is possibly slightly increased. However, this needs further examination before judgment can be made. (c) Both in frequency bands and in the amount of epileptic activity, no change is produced by alcohol use.

Computed tomography in acute cerebral multiple sclerosis. A report of two cases.

In two cases of acute cerebral multiple sclerosis, computed tomographic (CT) scans with contrast disclosed several enhanced foci, mainly situated in the periventricular white matter and, in one patient, in the cerebellum. Administration of dexamethasone sodium phosphate in one patient and prednisone with cyclophosphamide in the other was followed by considerable clinical improvement. Successive CT scans with contrast enhancement showed a close correlation between improvement of symptoms and the subsidence of contrast-enhanced foci during treatment. Perhaps clinical improvement reflected restoration of the impaired blood-brain barrier.

The symptomatology of megadolicho basilar artery.

Cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa are presumed to be related to a megadolicho basilar artery, if present. Since there are no large series of patients with such vascular anomaly, a bias in relating symptoms with the presence of a megadolicho basilar artery is not excluded. We therefore studied retrospectively the incidence of megadolicho and dolicho basilar artery on cranial CT-scan of 3332 patients of 50 years and older. Patient records were reviewed for the above mentioned symptoms. 12 out of 22 patients with a megadolicho basilar artery and 2 patients out of 40 with a dolicho basilar artery had one or two of these symptoms. It is concluded that a megadolicho basilar artery can cause cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa.

Evaluation of the risk of immediate anticoagulant treatment in patients with embolic stroke of cardiac origin.

We evaluated immediate anticoagulation of embolic stroke. Of 39 patients suffering a focal cerebral ischemia caused by a cardiac embolus, 38 were submitted to CT within 24 hours after onset. Twenty-one patients received direct full anticoagulation and, in 10 patients, treatment was delayed because of hemorrhagic infarction on initial CT (3 cases), cardiac cause 24 hours or more after stroke onset, or treatment delay without specific reason (6 cases). Eight patients with severe deficit were not anticoagulated because of hemorrhagic signs on initial CT, impaired consciousness, or general contra-indications to such treatment. Twenty-one follow-up CT-scans were performed under full anti-coagulation, and in only 2 cases hemorrhagic infarction was noticed without clinical deterioration. No clinical worsening attributable to anticoagulant treatment was observed during the three week observation period. It is concluded that direct anticoagulation therapy does neither induce hemorrhagic infarction nor cerebral hemorrhage in patients with embolic stroke nor does it cause clinical deterioration.

Megadolicho vascular malformation of the intracranial arteries.

A patient is presented suffering a hemiparesis. Megadolicho-vascular malformation of the intracranial part of the internal carotid arteries and some of its branches and of the basilar artery was suggested by CT and confirmed by angiography. The value of CT compared with angiography in relation to intracranial megadolicho vascular malformations is discussed.

Clinical significance of basal ganglia calcifications detected by ct (a retrospective study of 33 cases).

In a retrospective study 2015 CT scans were studied for the presence of basal ganglia calcifications. These were discovered in 33 cases. No abnormalities in serum calcium or phosphate levels or any other specific clinical symptoms related to these calcifications were found. It is concluded that basal ganglia calcifications casually detected by CT generally have no clinical significance.

Spinal cord compression by extramedullary hemopoietic tissue in pyruvate-kinase-deficiency-caused hemolytic anemia.

Spinal cord compression by extramedullary hemopoietic tissue is a rare complication of hemolytic anemias. This is the first report of this complication in hemolytic anemia caused by pyruvate-kinase deficiency. Indium scan, computed tomography (CT) scan, and myelography were helpful in diagnosis. Surgery and radiotherapy were followed by complete recovery during a follow-up period of 12 months.

Is an application form useful to select patients with epilepsy who may drive?

Of 1,268 persons who claimed to have epilepsy and were therefore disqualified for military service, 55% had a driving license 5 years later. Only 58% had applied for a driving license. Of those 14% who had answered truthfully the question "have you had fits, epilepsy etc." in the application form, 63% received a license. Fewer persons with epilepsy had a driving license after about 5 years (55%) than did age-matched controls (73%). The application form is of no use in preventing persons with epilepsy from obtaining a driving license. Adequate instruction of the patient and of his physician is to be preferred to the use of an application form.

Traffic accidents caused by epilepsy.

During a 10-year period, 203 traffic accidents were suspected of being caused by epilepsy; 155 of them definitely caused by seizures were selected for study. The seizures of 75% were psychomotor; in 12% the seizure was the first, and only 4% of the rest had reported that they had epilepsy when they applied for a license. Traffic accidents due to epilepsy were less serious than the "average accident". They involved another vehicle much less often, and they occurred more often outside rather than inside built-up areas. Accidents caused by epilepsy were rare--1/10,000 in the 10-year period. The characteristic features of the traffic accident due to epilepsy may be due to the "random" occurrence of seizures in traffic, and to the seizure-suppressing effect of increased vigilance in city traffic.