[Phlebothrombosis and thrombophlebitis during the second half of pregnancy and puerperium].

Fhlebothrombosis and thrombophlebitis of the cerebral veins and sinuses develop relatively rare, but they affect young people and have poor prognosis. Pregnancy and puerperium are et risk due to hormonal and homeostatic changes in the organism. This report exhibits the most frequent etiologic factor, early symptoms, clinical manifestation, diagnostic value of the different methods, treatment principals and the factors that determine the outcome of thrombofphlebitis and phlebothrombosis during pregnancy and puerperium. In the acute phase a treatment with direct anticoagulants (intravenous heparin or low molecular mass heparins) and symptomatic treatment with anticonvulsants and drugs against oedema. After the acute phase the treatment continues with oral indirect anticoagulant as long as the severity of the disease requires.

Cerebral hemodynamic response induced by the Tower of Hanoi puzzle and the Wisconsin Card Sorting test.

Transcranial Doppler sonography (TCD) was applied in normal subjects to investigate the effect of prefrontal functions like the Tower of Hanoi (TOH) task and the Wisconsin Card Sorting test (WCST) on cerebral hemodynamics. In 20 healthy volunteers, left and right middle cerebral artery (MCA) and anterior cerebral artery (ACA) were insonated. The TOH task and the WCST were administered while cerebral blood flow velocity (CBFV) was registered. Each test was repeated once per artery pair. There was a visuomotor test to control the motor and visual stimulations. Three phases of CBFV time course were detected: an initial peak within 5 s, a following decrease within 25 s and a steady state beginning at 40 s. The TOH task, WCST and visuomotor tests had different mean CBFV during the initial peak (MCA: P<0.05; ACA: P<0.05) as well as for the decrease (ACA: P<0.01) and the steady state (MCA: P<0.01; ACA: P<0.01). The TOH showed an increased mean CBFV as compared with the WCST during the steady state (MCA: P<0.01; ACA: P<0.05). However, temporal modulation of mean CBFV during category shift of the WCST resulted in significantly increased values after category shift (MCA: P<0.001; ACA: P<0.01) as compared with CBFV before the category shift. These findings showed a different CBFV pattern during the TOH task and WCST than during the visuomotor test. In conclusion, TCD was able to assess CBFV in prefrontal functions, using a high resolution in time.

Comparison of the ECST, CC, and NASCET grading methods and ultrasound for assessing carotid stenosis. European Carotid Surgery Trial. North American Symptomatic Carotid Endarterectomy Trial.

We compared three angiographic methods for grading of carotid stenosis and examined the correlation between angiographic and ultrasound findings. Two observers independently measured 111 carotid stenoses on arteriographic films of 84 patients. The stenoses were graded according to the European Carotid Surgery Trial (ECST), North American Symptomatic Carotid Endarterectomy Trial (NASCET), and Common Carotid (CC) methods. The results obtained by these methods were compared, and the interobserver reproducibility of the measurements was calculated. In addition, all angiographic results were compared to ultrasound findings obtained before angiography. Measurements using the CC method were the most reproducible and those using the NASCET method the least. The NASCET method underestimated the degree of stenosis compared to the other methods. The ECST and CC methods yielded almost identical results (97% agreement). Ultrasound provided an accuracy of 94% compared to ECST and CC methods and 84% compared to the NASCET method. Interobserver reproducibility of angiographic quantification of carotid stenoses was best for the CC and ECST methods and least for the NASCET method. Ultrasound demonstrated better accuracy than the ECST and CC methods.

The site of atheromatosis in the subclavian and vertebral arteries and its implication for angioplasty.

We analysed the site of plaques and stenoses in the subclavian and vertebral arteries, to improve the safety of percutaneous transluminal angioplasty (PTA) in high-risk patients. These lesions were assessed on arteriograms of 35 patients with stenoses and occlusions of the subclavian and vertebral arteries; the degree of stenoses was measured. Of 19 subclavian artery stenoses 17 (89%) were in the segment proximal to the vertebral artery; 30 (79%) of 38 vertebral artery stenoses were on the medial wall. With this knowledge, a double-balloon technique using a simultaneous transbrachial and transfemoral approach for angioplasty of high-risk subclavian or combined subclavian and vertebral artery stenoses and occlusions was used successfully in seven patients. This new technique may broaden the endovascular therapeutic possibilities in the rare but dangerous situation where plaque extends directly from the stenotic subclavian artery into the origin of the vertebral artery.

Hemiplegia vegetativa alterna (ipsilateral Horner's syndrome and contralateral hemihyperhidrosis) following proximal posterior cerebral artery occlusion.

BACKGROUND: Posterior cerebral artery (PCA) occlusive disease usually produces homonymous visual field defects, hemisensory loss, and neuropsychological deficits. Conversely, the combination of hemiparesis, Horner's syndrome, and contralateral hemihyperhidrosis has never been reported before. CASE DESCRIPTION: A patient with infarction in the superficial and deep territories of the right PCA presented with a unique clinical picture, which included contralateral hemiparesis, hemihyperhidrosis, and ipsilateral Horner's syndrome. Magnetic resonance imaging disclosed infarcts in the right anterolateral midbrain, ventroposterolateral thalamic-subthalamic area, and temporo-occipital lobes. CONCLUSIONS: The alternating vegetative syndrome (hemiplegia vegetativa alterna) observed in this patient supports the hypothesis of the existence of an uncrossed excitatory and a crossed inhibitory hypothalamospinal sympathetic pathway.