RESUMEN
EEG recordings from 230 carotid endarterectomies performed with an automatic EEG monitoring system were reviewed with the purpose of establishing the exact relation between EEG changes and intraoperative stroke. Patients were selectively shunted, based on the EEG changes occurring after carotid cross-clamping. Transient EEG asymmetry was not associated with intraoperative stroke. Only persisting EEG asymmetry reflected intraoperative major stroke, expressed by a positive predictive value of 0.50, but also in terms of specificity (0.99), sensitivity (0.80) and diagnostic gain (47.8%) of the EEG; minor strokes could not be detected with EEG monitoring. Analysis of the time course of the persisting asymmetry confirmed the thrombo-embolic origin of the majority of the major strokes.
Asunto(s)
Arterias Carótidas/cirugía , Trastornos Cerebrovasculares/diagnóstico , Electroencefalografía , Endarterectomía , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/etiología , Humanos , Persona de Mediana Edad , Monitoreo Fisiológico , Tomografía Computarizada por Rayos XRESUMEN
We analyzed perioperative strokes in 658 carotid endarterectomies with the purpose of explaining the pathogenesis from the morphologic aspect of the infarct on cerebral computed tomograms. All endarterectomies were performed with continuous electroencephalographic monitoring. Of the 42 ischemic strokes (6.4% of all endarterectomies), 34 could be studied. Seven infarcts were hemodynamically induced (five watershed infarcts, two patients with bilateral ischemia); all seven occurred during surgery. Twenty-three of the remaining 27 infarcts were within the territory of the middle cerebral artery (20) or anterior cerebral artery (three) and were probably of thromboembolic origin; 13 of these 23 occurred during surgery (57%). If intraoperative stroke was heralded by permanent electroencephalographic changes, these were not related to the moment of cross-clamping. In four patients the computed tomogram was normal. We believe these facts favor the hypothesis that thromboembolism is the most important factor in the pathogenesis of perioperative stroke associated with carotid endarterectomy under conditions of optimal cerebral monitoring.
Asunto(s)
Arterias Carótidas/cirugía , Infarto Cerebral/etiología , Endarterectomía/efectos adversos , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/fisiopatología , Electroencefalografía , Humanos , Tomografía Computarizada por Rayos XRESUMEN
We describe the case history of an 83-year-old man with subacute parkinsonism. CT scanning of the head showed a bilateral frontal subdural hematoma. The hypokinetic syndrome almost completely disappeared after surgical removal of the hematoma. The pathogenesis is discussed, and the importance of CT scanning in subacute parkinsonism of unknown origin is stressed.
Asunto(s)
Hematoma Subdural/complicaciones , Enfermedad de Parkinson Secundaria/etiología , Anciano , Anciano de 80 o más Años , Traumatismos Craneocerebrales/complicaciones , Hematoma Subdural/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Des-tyr1-gamma-endorphin (DT gamma E) was administered intramuscularly in a dose of 1 mg/day for 10 days to 18 neuroleptic-free schizophrenic patients in a double-blind crossover design. Six patients showed either a slight or no antipsychotic response; seven patients showed a moderate antipsychotic response; and the remaining five patients showed a marked antipsychotic response. DT gamma E led to a decrease of plasma prolactin levels in patients treated with DT gamma E in the first period of experimental treatment as compared to those treated with placebo. Neither plasma levels of growth hormone and cortisol nor cerebrospinal fluid concentrations of homovanillic acid, 5-hydroxyindoleacetic acid, and 3-methoxy-4-hydroxyphenylglycol were affected by DT gamma E. Patients suffering from a hebephrenic or paranoid type of schizophrenia and those presenting relatively fewer negative symptoms were most susceptible to treatment with DT gamma E. These data confirm and extend previous findings that DT gamma E has antipsychotic properties in a number of schizophrenic patients.