Simultaneous monitoring of endothelin-1 and vasopressin plasma levels in migraine.

Vasopressin levels in plasma rise during migraine attacks. Vasopressin also induces endothelin-1 synthesis in endothelial cells, suggesting a role as a mediator of elevated plasma endothelin-1 in migraine. To explore a possible relationship between endothelin-1 and vasopressin in migraine, plasma concentrations of both peptides were monitored simultaneously throughout an attack and during two migraine-free intervals (control) in 20 patients. Endothelin-1 was elevated 6 h after the onset of an attack (3.3 +/- 0.3 pg/ml vs 2.7 +/- 0.2 pg/ml during migraine-free intervals; p = 0.12) whereas vasopressin was increased over control levels (2.8 +/- 0.3 pg/ml) by 3 h (3.6 +/- 0.4 pg/ml; p < 0.05) and remained elevated at 6 h (3.9 +/- 0.5 pg/ml; p < 0.01). These data suggest that vasopressin may act as a peripheral mediator of increased plasma endothelin-1 in migraine.

[Auditory evoked brain stem potentials, visual pattern evoked and somatosensory evoked potentials in transient ischemic attacks (TIA)]. / Auditorisch evozierte Hirnstammpotentiale, visuell musterevozierte und somatosensibel evozierte Potentiale bei transitorisch ischämischen Attacken (TIA).

Auditory-evoked brainstem potentials, visual pattern-evoked and somatosensory-evoked potentials in transitory ischemic attacks (TIA). Pathological findings in patients suffering from transitory ischemic attacks by means of using neuroradiological methods (CCT included) are a rare condition. The combination of visual checkerboard-evoked potentials (VEP), auditory brainstem-evoked (AEP) and somatosensory-evoked potentials (SSEP) can detect functional lesions in cerebral regions with different blood supply but without diagnostic risk. A delay of peak III of the AEP is possibly of specific value with regard to brainstem lesion caused by TIA in our patients.

Tumor-like amyloid formation (amyloidoma) in the brain.

An almost walnut-sized tumor was removed surgically from the left occipital lobe of a 46-year-old woman, who had suffered for 4 year from progressive visual loss with scotoma and finally from hemianopia, associated with attacks of headaches and recurrent episodes of depression each lasting for some weeks or months. Neuropathological examination, including polarization, thioflavine, fluorescence, immunofluorescence staining, and electron microscopy, revealed an amyloidoma, which consisted of broad appositionally grown amyloid deposits surrounded by some plasma cells, monocytic or foreign body cell types. The massive accumulations, often associated not only with blood vessels or perivascular collagenous fibers but also lying in the cerebral tissue not unlike senile plaques in the cortical gray matter corresponded to gradually growing masses as seen in the repeated CT scans. This unique lesion in the brain of a patient who did not show any evidence of systemic disorder, seems to confirm that the spontaneous tumor-like amyloid, which gave an immunofluorescent staining mainly with anti-IgM, is a special variant of primary amyloidosis (amyloid L) or of so-called paramyloid.

[Visual evoked potentials in cerebrovascular disorders. Method and results]. / Visuell evozierte potentiale bei zerebralem gefässprozess methodik und ergebnisse.

Investigation of visual evoked potentials (VEP) by means of checkerboard inversion gives values with good reproducibility and low standard deviation for the latencies and amplitudes of VEP. In patients with scanty symptoms of cerebrovascular disease and without visual field defects, we found either differences of VEP amplitudes from side to another of over 25% (in relation to the larger value) or very small absolute values of the amplitudes (smaller than 3 mu V) as pathological values compared to control subjects. The latencies were normal. The method of investigation described helps towards objective analysis of functional disturbances in patients with cerebrovascular diseases.

[Paralysis, organic brain syndrome, and cardiac dysrhythmias caused by chronic laxative abuse (author's transl)]. / Lähmungen, organisches Psychosyndrom und Herzrhythmusstörungen bei extremer Kaliumverarmung durch chronischen Laxantienabusus.

A 39-year-old woman developed generalised paralysis, reversible organic brain syndrome, and cardiac dysrhythmias after 15 years of laxative abuse. Under continuous and cautious administration of potassium the cardiac rhythm became normal within four days and two days later the paralysis and organic brain syndrome almost disappeared. The cause of the psychiatric symptoms is thought to be cerebral potassium deficiency and an abnormal sodium/potassium equilibrium. Other clinical signs and symptoms due to extreme potassium depletion are presented. The importance of Na+/K+-activated membrane ATP-ase in myocardium and CNS is discussed.

[Blood-CSF kinetics of penicillin G in neurosyphilis (author's transl)]. / Blut-Liquor-Kinetik von Penicillin-G bei Neurosyphilis

Measurements of the penicillin concentration in serum and cerebrospinal fluid patients with neurosyphilis showed that conventional therapy can attain effective treponemocidal levels for only a short time or not at all in the CSF and brain-tissue, the regions where the treponemas are found in this particular stage of disease. Intravenous infusions with high doses (0,5 mega unit penicillin-G/kg body weight in 24 hours) over more than one generation phase of the treponemas (35-43 hours) considerably improve the recovery. 16 patients were treated in this way and been followed over 2-3 years clinically and immunologically.

[Severe side-effects during peritoneal dialysis caused by sorbitol-containing dialysate (author's transl)]. / Sorbithaltige Spüllösung als Ursache schwerer Unverträglichkeitserscheinungen bei der Peritonealdialyse

In seven patients with chronic renal failure in an advanced stage 17 episodes of upper abdominal pain, hypertension, vomiting and (in some of them) coma occurred during peritoneal dialysis with sorbitol-containing dialysate. The signs recurred in some of the patients but did not when glucose-containing dialysate of otherwise identical composition was used. Very high levels of sorbitol in CSF and serum were measured in the comatose patients. The precipitating factor is probably a reduced metabolic breakdown of sorbitol in renal failure with preferential intracellular deposition of sorbitol and subsequent cellular oedema. To avoid this dangerous reaction it is necessary to use glucose instead of sorbitol in peritoneal dialysates, despite the technical problems of sterilisation. Where this is not possible, glucose should be added in order to reduce the sorbitol concentration in the dialysate to less than 15g/l.