Hypertension and cerebrovascular disease.

Cerebrovascular disease (CVD) is the third leading cause of death in United States and hypertension is a leading cause of both stroke and heart disease. It may cause headache, acute hypertensive encephalopathy, dementia and various types of strokes e.g., thrombotic, haemorrhagic, lacunar infarcts and transient ischaemic attacks. It remains the singlemost important treatable risk factor for stroke in all age groups and modern antihypertensive therapy has its documented prevention of stroke. Hypertension in acute phase of ischaemic stroke should not be treated. Hypertension in acute stroke should be treated. In advanced centres with specialised stroke units, the favoured drugs are short acting vasodilators e.g., sodium nitroprusside and labetalol. Nifedipine is the most popular drug followed by captopril, both sublingually and orally.

Subcutaneous emphysema as an uncommon presentation of child abuse.

A case of subcutaneous emphysema and pneumomediastinum as a result of child abuse is presented to add to the spectrum of findings associated with child maltreatment. This case is a reminder that although most cases of subcutaneous emphysema resolve uneventfully, there still needs to be an aggressive search for a cause. In addition, in the pediatric age group, the history given should be carefully verified as being plausible because of the possibility that child abuse may be the true etiology.

Appearing and disappearing CT scan abnormalities in epilepsy in India--an enigma.

In 230 consecutive cases of epilepsy, CT abnormalities were found in 51.7%. Out of these, 91 cases (39.5%) had non specific abnormalities consisting mostly of ring lesions, hyperdense disc lesions with surrounding oedema in enhanced scans and in a small percentage hypodense lesions, generalised brain oedema and calcifications. All these cases were treated with anticonvulsant drugs alone. A follow up scan was possible in 31 cases, 12 weeks or later, after the control of the seizures. Out of these 31 cases, 24 showed a complete or significant resolution and five remained unchanged. Two of these cases showed an increase in the lesions which resolved on treatment with antituberculous drugs. These lesions therefore may have an aetiology other than tuberculosis in the majority of cases and there is ample justification in treating them initially with anticonvulsant drugs only.

Familial hyperlipidemia in stroke in the young.

Serum cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL) and chylomicron levels were studied in 25 young patients (age 40 years or less) of non-embolic ischemic stroke of unknown aetiology. Fifteen patients were males and 10 were females. The prevalence of hyperlipidemia was found to be 60%. Frederickson's type IIb hyperlipoproteinemia was the commonest (32%) abnormal pattern observed, followed by type IIa (12%), type IV (12%) and type V (4%). Family studies were carried out in all the 25 index patients (15 hyperlipidemic and 10 normolipidemic). Familial hyperlipidemia (i.e. 2 or more hyperlipidemic members in the same family) was found in 9 of the 15 hyperlipidemic index patients and in none of the normolipidemic index patients. The common pattern was found to be that of familial combined hyperlipidemia. The study indicates that screening the family members of hyperlipidemic young patients of non-embolic ischemic stroke may delineate a group of high risk individuals for possible primary prevention before they develop the disease.

Stroke during pregnancy and puerperium in young females below the age of 40 years as a result of cerebral venous/venous sinus thrombosis.

One hundred and thirty-eight cases of cerebral venous/venous sinus thrombosis during the puerperium have been studied. Maximum number of cases (112 cases) occurred in the age below 30 years. Signs and symptoms appeared in most of the cases (72 cases) during the first 7 days of post partum period. One hundred and eleven cases were multipara. Commonest signs and symptoms were fever (85 cases); headache (66 cases), convulsions (64 cases), altered consciousness (57 cases), hemiplegia (60 cases), papilloedema (48 cases), etc. Carotid angiography done in 55 cases revealed block in middle part of superior sagittal sinus in 24, and localised, dilated and tortuous cortical veins in 5. A statistically significant rise in serum triglycerides, phospholipids, free fatty acids, blood platelet count, platelet adhesive index, and fall in blood fibrinolytic activity were found as compared with normals. These factors may be playing a role in the etiology of cerebral venous/venous sinus thrombosis during puerperium.

Serum lipids, platelets, and fibrinolytic activity in cerebrovascular disease.

Fifty patients with occlusive cerebrovascular disease (ischemic thrombotic cerebrovascular disease--ITCBVC) were studied for clinical features, angiographic findings, serum lipids, platelet functions and fibrinolytic activity. Angiograms were abnormal in 24 of 36 cases. Two-thirds of these had an abnormality of the internal carotid artery in the neck; one-third had occlusion of the middle and/or anterior cerebral arteries. A statistically significant rise of serum triglycerides, pre-beta lipoproteins, platelet adhesiveness and aggregation, and a decrease in fibrinolytic activity were noticed in these patients as compared to age and sex matched controls. The correlation coefficient did not show any intercorrelation between the platelet adhesiveness and raised lipid fractions. These factors could be responsible for the atheroma resulting in large vessel occlusion.

Serum lipids and uric acid relationship in ischemic thrombotic cerebrovascular disease.

Serum lipids and serum uric acid have been studied in 50 patients with ischemic thrombotic cerebrovascular disease. Patients having diseases known to predispose to hyperuricemia were excluded. Abnormalities of large vessels were present in 14 or 30 cases (46.6%) as a whole, and in 9 of 16 cases (56.5%) below 40 years of age. Thirty percent of the cases showed hyperuricemia. A statistically significant rise in serum triglycerides, pre-beta lipoproteins and serum uric acid was found in all 50 patients and in patients below 40 years of age. In patients above 40 years of age, only the rise in serum triglycerides and pre-beta lipoproteins was found to be statistically significant. A statistically significant rise in serum triglycerides, pre-beta lipoproteins, cholesterols and uric acid was found in patients with abnormal angiograms. A statistically significant correlation was observed between serum uric acid and serum triglycerides in all the groups, between serum uric acid and pre-beta lipoprotein in patients below 40 years of age, and between serum uric acid and serum phospholipids in patients with abnormal angiograms. These factors may be playing a role in the causation of ischemic thrombotic cerebrovascular disease in general and especially in patients below 40 years of age.