[Cerebral infarct and the immune response]. / Mozogový infarkt a imunitná odpoved organizm.

There are only few data available regarding the immunological mechanisms for cerebral infarction. The aim of this study was to find out the humoral and cell-mediated immunity under the conditions of focal brain ischemia (CI). As a method for humoral immunity, the complement consumption test against a panel of 8 antigens, quantitative analysis of immunoglobins and fractionized sedimentation of erythrocytes were used in the group of pts with CI, and the group of atherosclerotics (AS) and hypertonics (VH), potential victims of focal brain ischemia. It was found that the occurrence of antibodies against the whole panel of antigens in the group of CI is significantly higher as compared with the healthy controls, but it is lower than that in the group of AS and VH. The occurrence of antibodies exclusively against only brain antigens and that in CSF is similar. No correlation to the location of ischemic lesion and the degree of neurological deficit score was found. These findings didn't change in 2 and 4 weeks as well as in 1 year after the onset of CI. The quantitative analysis of immunoglobins revealed statistically higher levels of IgA and lower levels of IgM in comparison with the controls. IgG were higher, but without statistical significance. Statistically significant higher levels of all immunoglobins in CSF were found. As similar trend of changes found also in the group of AS and VH. These results of humoral immunity confirmed by the results of fractionized sedimentation of erythrocytes with EP. The results can be interpreted as a possible change or disorder of central regulation of immunizing processes due to the latent (in AS and VH) of manifest (in CI) lesions of the brain. But the quality and quantity of this response might have been affected by the entire case history of the patients who survived cerebral infarction. The changes in immunity response of the organism in CI was shown also in cell-mediated immunity. The results a statistically significant increase in stimulatory (SI) as well as in immunoregulatory (IRI) indices in stroke patients under the age of 40. These findings didn't change 2 and 4 weeks after the onset of CL. An increase in IRI was due to the increase in Th lymphocytes. In the immune response of the organism in CI, the antiphospholipid antibodies (aPLs = anticardiolipin antibodies (aCL) and lupus anticoagulant--LA) play an important role. aCLs were present in 9.8% of the first stroke pts when compared to 4.3% in controls. The most common isotype of the antibodies we IgG. Of all first-stroke pts who were aCL positive only 8% had no other stroke risk factors (atrial fibrillation, diabetes, hypertension and other). aCLs are an important risk factor for the first stroke, mainly in the young, but also in the elderly. The presence of aCLs increases the risk for recurrent strokes. aPLs are not necessarily associated with the specific location of clinical stroke syndrome but they are in significant correlation to the occurrence of multiple strokes on CT (30:18%). None of the initially aCL-negative patients became aCL-positive during the time course of CI. These data support the idea that aCLs play a causal role in stroke (PROPTER HOC changes) rather than vice versa (POST HOC changes). From the therapeutic point of view, currently there do not exist any good treatment guidelines for preventing the second stroke. The analysis of HLA. antigen showed an increase in some HLA (A2, A28 etc.) and a decrease in others (A3, A9 etc.) in comparison with the controls. This might refer to the participation of genetic factors in the onset of CI.

[The heart and the brain. Aspects of their interrelations]. / Srdce a mozog. Niektoré aspekty vzájomných vzt'ahov.

The objective of the investigation was an attempt to analyze some aspects of the heart-brain relationship. The group was formed by 626 patients with the diagnosis of focal cerebral ischaemia (CI) and 191 patients with the diagnosis of subarachnoidal haemorrhage (SAH). It was revealed that the CI group comprised 77.3% patients with a pathological finding on the heart. Analysis revealed moreover that in the group of patients with "congestive heart failure" there was a significantly higher percentage of patients with a severe neurological deficit as compared to the group with a "normal" ECG (p < 0.001). Atrial fibrillation causes a fivefold increase of the risk of cerebral infarction. The incidence of ECG abnormalities of various types was significantly higher in the group of patients with CI during long-term ECG monitoring, as compared to the results of conventional ECG examination (p < 0.001). The value of long-term ECG monitoring was confirmed also in an investigation of these changes in a group of patients with arterial hypertension, quari potential candidates of cerebral infarction. The relationship between cardiac and cerebral function was tested also in an investigation focused on the incidence of ectopic activity and changes of the QT interval. It was revealed that while the percentage rate of ectopic activity assessed by conventional ECG examination was in the group of "improved" patients 18.0%, long-term monitoring revealed a rate as high as 48.0%, the difference being statistically significant. Similar significant differences were observed also on analysis of the QT interval: in the group of patients with neurological "improvement" the QT interval was significantly shorter, as compared with the group with neurological "deterioration". It was assumed that the prolonged QT interval could be the cause of sudden death. A cardio-cerebral relationship was found also on analysis of changes of the cerebral circulation (CBF) in different forms of cardiac insufficiency. It was revealed that isolated ventricular extrasystoles reduced the CBF by 8.0%, isolated atrial extrasystoles by 12% and in atrio-ventricular tachyarrhythmia the CBF is reduced by as much as 25.0%. The cerebro-cardiac relationship was tested in a group of patients with SAH. ECG abnormalities of a varying type were found in 30.7% of the patients with SAH. They are described in as many as 100% of patients and were detected also other in cerebral disorders, such as contusion of the brain, intraoerebral haemorrhage and cerebral tumours.

[The spinal canal, dural sac and spinal cord on cervical myelograms. Possibilities of quantification using a computer]. / Spinálny kanál, durálny vak a miecha na cervikálnych myelogramoch. Moznosti kvantifikácie pomocou pocítaca.

The objective of the presented work was to investigate anatomical structures of the cervial spine and their interrelations on cervical myelograms in a neutral position and in retroflexion. Cervical myelograms were made in 34 patients from a lateral approach between the first and second vertebra. In a neutral position and in retroflexion the relations of the dural sac and spinal canal were investigated in 26 subjects with a normal antero-posterior diameter of the spinal canal and in eight patients with congenital stenosis of the spinal canal. Quantification by means of a computer revealed that in retroflexion the antero-posterior diameters of the dural sac diminishes significantly in subjects with a normal antero-posterior diameter of the spinal canal as well as in subjects with congenital stenosis of the spinal canal. Moreover, the authors provided evidence that the area of the dural sac diminishes significantly in retroflexion, as compared with the neutral position in subjects with a normal spinal canal as well as in subjects with congenital stenosis of the spinal canal.

Electrophysiological characterization of central sensory and motor pathway function in patients with moderate hemiparesis. II. Clinical results.

The central sensory and motor pathway function in patients with moderate hemiparesis and in healthy persons was selectively characterized by evaluation of latencies of short (R1) and long (R2) latency EMG responses as well as simultaneously recorded sensorimotor potentials (N19, N26) evoked by electrical stimulation of median and peroneal nerve (additionally, calculation of peripheral and central sensory/motor conduction times). This investigation procedure permits a noninvasive quantification of disturbed central sensory and motor pathway function in hemiparetic patients. The results found are in agreement to clinical, CT and other examination findings.

Electrophysiological characterization of central sensory and motor pathway function in patients with moderate hemiparesis. I. Methodical approach.

The central sensory and motor pathway function in healthy persons and patients with several neurological disorders was selectively characterized by evaluation of latencies of short (R1) and long (R2) latency EMG responses as well as simultaneously recorded somatosensory potentials (N19, N26) evoked by electrical stimulation of N.medianus and N.peroneus. On the basis of these latencies the peripheral and central sensory/motor conduction times were calculated. By using this investigation procedure a selective quantification of central pathway functions is possible.

[Specific aspects of mobility and changes in the shape of the dural sac in functional lumbosacral myelography]. / Niektoré specifiká pohyblivosti a zmien tvaru durálneho vaku pri funkcnej lumbosakrálnej myelografii.

The purpose of the work was an analysis of lateral myelograms of the lumbosacral spine in the neutral position, in anteflexion and retroflexion from the aspect of the mobility of the dural sac and its relationship to the spinal canal. The group comprised 50 patients with clinically obvious discopathies and other vertebrogenic syndromes. The areas of the dural sac were measured planimetrically and evaluated by means of a computer. It was revealed: 1. The Soinal canal and dural sac are not static variables but dynamic ones. By movements of the lumbosacral spine the size of the dural sac changes and so does its shape. These phenomena can be evaluated not only qualitatively but also quantitatively. 2. The anteroposterior diameter of the dural sac on the myelograms in anteflexion and in retroflexion changes significantly, as compared with the neutral position, it increases during anteflexion and diminishes during retroflexion. 3. The area of the dural sac increases during anteflexion and diminishes in retroflexion, as compared with the neutral position. 4. Changes in the shape of the dorsal portion of the dural sac revealed in the segment of the discopathy are considered to be due to hypertrophy of the yellow ligaments.

[Intracerebral hemorrhage in hypertensives: diagnosis, therapy and prognosis]. / Intracerebrálne krvácanie u hypertonikov: diagnóza, liecba a prognóza.

The authors analyzed 98 cases of intracerebral haemorrhage in hypertonic subjects from the aspect of the clinical course, CT findings and therapeutic results. Thirty-seven patients were treated by surgery and 61 had medicamentous treatment. The acute mortality rate in operated patients was 57% in non-operated ones 30%. The patients with haemorrhage in the putamen formed the majority of the group and had a higher mortality rate than patients with other sites of haemorrhage. The state of consciousness on admission and the size of haematomas influenced in a significant way the acute mortality rate of patients. Fifty-nine patients were followed up for an average period of 34 months. Of those 19% died and 54% attained a fair restoration of the clinical condition. Only 5% returned to work.

[An unusual CT image of an ischemic focus]. / Neobvyklý CT obraz ischemického loziska.

In a 39-year-old man with focal cerebral ischaemia an uncommon CT picture of an ischaemic focus is described. The first CT examination was made two weeks after the development of the disease. After administration of the contrast substance an increased density along the fronte-parietal gyrification was detected. The finding was not typical for an ischaemic lesion. Two weeks after the first CT examination the examination was repeated. After administration of the contrast substance only at some sites the original increased density along the gyrification was found.

[Venous angiomas of the brain. Retrospective study of angiograms and clinical material]. / Venózne angiómy mozgu. Retrospektívna stúdia angiogramov a klinického materiálu.

The aim of the investigation was to reveal the existence of venous angiomas of the brain by serioangiography in selected neurological diseases and to test the possible connection between the angiographic finding of a VA and neurological symptomatology. The material was formed by 386 serioangiograms in patients with subarachnoid haemorrhage, intracerebral haemorrhage, focal epilepsy and unilateral headache. It was revealed that from the total number of mentioned diagnoses there were 18 venous angiomas, i.e. 4.66%. Intracerebral haemorrhage and unilateral headache were most frequent (7.3% and 9%). No difference was found between the right and left hemisphere and between different brain areas. Cerebral angiography remains an important method in the diagnosis of venous angiomas of the brain, provided a satisfactory programme and high quality material are used. Examination by computed tomography without a contrast is of little diagnostic value, the use of contrast in computer tomography can improve the diagnosis.

[The new hemorheologic drug VULM 957 improves cerebral circulation]. / Nové hemoreologikum VULM 957 zlepsuje mozgovú cirkuláciu.

The authors investigated the effect of a newly synthetized haemorheological drug VULM 957 for basic haemorheological parameters in vitro and on the cerebral flow in vivo. It was revealed that substance VULM 957 inhibits in a dose-dependent and time-dependent way the platelet aggregation, reduces the viscosity of blood, increases the deformability of red blood cells and increases the cerebral blood flow. Analysis of possible mechanisms of action of VULM 957 indicates that the observed positive haemorheological effects are due to the influence on the fluidity of the platelet and red cell membrane. The increased cerebral blood flow after administration of VULM 957 depends obviously on the reduced viscosity of the blood and the inhibited formation of platelet microaggregates. The presented results justify the assumption that VULM is a perspective substance in the therapy of cerebrovascular diseases.

[Optimism or pessimism in the treatment of cerebral infarct]. / Optimizmus ci pesimizmus v liecbe mozgového infarktu.

The aim of the study was to analyse the effects of drug and rehabilitation treatment of cerebral stroke. Material consists of 2,500 patients with focal brain ischemia. About three-fourths (68.7%) of patients with cerebral stroke improved receiving complex drug treatment, rehabilitation and psychological care. 54.9% of the whole group of patients had a neurological deficit score below 150, i.e. more than one half of the whole group (n = 2,500) left the hospital practically in good health capable of carrying on in their original occupation. Only 11.9% of patients died, but 48.9%, i.e. practically one half of them showed an extracerebral cause of death. The results of treatment are dependent on age. In the higher age group, the number of deteriorated cases as well as the number of death increases. The results of treatment are dependent on an early initiation of treatment after the onset of brain ischemia. In the 2nd time-period, the results of treatment are better in comparison to the 1st period due to new strategies of treatment, i.e. due to drugs that improve heart failure, rheological properties of the blood and brain metabolism and due to intensive rehabilitation care. The results have shown the improvement not only in movement possibilities of the patients, but also the improvement in majority of the psychological parameters (IQ, emotionality, sociability scale etc.).

[Is the effect of naloxone on cerebral circulation mediated by blood platelets?]. / Je úcinok naloxonu na cerebrálnu cirkuláciu sprostredkovaný krvnými dostickami?

In an attempt to elucidate the mechanism of action of the opiate antagonist, naloxone, on the cerebral circulation the authors investigated changes of thrombocyte aggregation in whole blood (impedance aggregometry) and in the regional cerebral blood flow (hydrogen "wash-out" method) after a single dose of naloxone (1 mg/kg) to intact gerbils and gerbils with hemispheric cerebral ischemia. Under physiological conditions naloxone significantly reduced the cerebral blood flow and at the same time increased platelet aggregation. Under conditions of hemispheric cerebral ischemia naloxone increased the blood flow but did not affect the platelets activated by ischemia. The authors assume that naloxone induced hyperaggregation of platelets is at least partly responsible for the reduced cerebral blood flow after naloxone administration to intact animals. The favourable effect of naloxone on the ischemic cerebral circulation is, however, certainly not mediated by the effect on the platelet activity.

[Changes in carbohydrate metabolism before and after the development of focal cerebral ischemia. III. Function of the diencephalon]. / Zmeny glycidového metabolizmu pred a po vzniku loziskovej ischémie mozgu. III. cast. Funkcia diencefala.

The purpose of the investigation was to assess whether the mechanism of reduced glucose tolerance in focal ischaemia of the brain can be considered a functional disorder of the regulatory brain centres or a manifestation of inadequate glucose utilization due to impaired insulin secretion. The function of centres regulating metabolic processes was tested by the i.v. administration of Pyrifer. It was revealed that after Pyrifer administration a parallel rise of the investigated values does not occur (i.e. number of leucocytes, body temperature, pulse, systolic and diastolic pressure, blood sugar level), the maximum values do not reach the levels of the control group, their rise is retarded, persists twice as long as in the control group and does not return to baseline values in the appropriate time. A pathological constellation of responses was recorded in 85.71% of the cases. A similar trend of changes was found also in a group of arteriosclerotic and hypertonic patients although in a lower percentage. The results confirmed the assumption that in the mechanism of reduced glucose tolerance in the periphery an important part is played by the impaired function of regulating centres in the diencephalon.

[Vascular headache. Changes in visual evoked potentials]. / Vaskulárna cefalea. Zmeny zrakových evokovaných potenciálov.

The authors examined visual evoked potentials using the method of the visual full field stimulation hemi-field, using a check-board patterned structural stimulus in 69 patients with the diagnosis of vascular headache. The peak latencies of the waves did not differ significantly in the group of patients with vascular cephalea, as compared with the control group; this applies to both ways of stimulation. The es amplitudes of waves (P1 = P100 and N2) were significantly higher in the group with vascular cephalea after stimulation by the visual field. Of half the visual field stimulation did not reveal statistically significant differences in the latencies waves. The results may indicate an increased electrophysiological activity of the visual system in the interparoxysmal period in patients with vascular cephalea.