Romanian journal of neurology and psychiatry = Revue roumaine de neurologie et psychiatrie最新文献

A 48-year-old male patient, a surgeon, displayed a right temporo-occipital cerebral haematoma (5 x 7 cm). He had a history of chronic left occipital migraine-like cephalalgia from the age of 16 and hypertension was diagnosed when he was 42 years old. As therapy, he used ACE inhibitors, nifedipine and clonidine for hypertension and for cephalalgia a combination of aspirin, phenacetin and caffeine. During the last 2-3 months before the detection of cerebral haematoma, injections with piritramide were made when severe headaches were unbearable. The patient was operated on the 7th day since the onset of cerebral haematoma after a "wait and see" period of repeated clinical and CT-scan assessment. The initial option of the patient was surgical. We consider that the patient's profession (medical/surgical profile) may have played a positive motivation for the surgical option.

A retro- and prospective study was carried out in 150 patients who underwent surgery for benign (grade I) intracranial meningiomas (ICM). The mean duration of the follow-up was of 4 years. The subjects were divided into 4 groups according to the intervals of follow-up examination. The following variables were analysed: preoperative (clinical and paraclinical diagnosis), operative (macroscopic investigation) and postoperative (complications, sequelae, recurrences). The data were statistically processed. Conclusions are drawn concerning early results as well as predictors of long-term prognosis. Immediate improvement of the neurological and mental status was noted in 51% of patients. Late favourable outcome was found in only 35% of patients, demonstrating a tendency of late worsening. Postoperative morbidity includes complications (21%), sequelae (32%) and recurrence (22%). Predictor criteria in operated ICM patients are: onset type of illness, preoperative score, tumor location, edema and excessive vascularization of the brain as inspected at operation, early and late sequelae. Histological predictors for recurrence are: nuclear pleiomorphism, cellular mitoses, cell agglomerations. The frequency of recurrence, regardless of the operative technique, demonstrates the tendency toward malignancy of many of these tumors.

The present study was carried out in 31 neurosurgical patients with unaffected consciousness and concerned by the severity of their condition. The severity of stress was established by the comparison between the pre- and postoperative peripheral blood lymphocyte populations and subpopulations (B, T, Th lymphocytes, serum complement and circulating immune complexes). The peripheral blood lymphocyte populations and subpopulations were determined by the technique of sheep red blood cell rosette. Circulating immune complexes were determined by precipitation of polyethylene glycol (PEG, M = 6000) whereas the serum complement by the usual 50% hemolytic method. Our data show that the decrease in Th cells and the consecutive diminution of antibody production is a cause of lower resistance against cancer and infections.

A previously healthy 9-month-old girl, obese (12,500 gm) with sudden onset of hyperthermia (40 degrees C), generalized tonic-clonic seizures, followed by focal seizures, drowsiness, left facial nerve palsy, left lagophthalmos and mydriasis is presented. CT-scan and MRI suggested temporal-parietal infarction due to Sylvian artery occlusion in a 9-month-old infant with familial hypercholesterolemia (type 2 A dyslipidemia). The possibility of a cerebral abscess or herpetic encephalitis was considered. Negative clinic and serologic results excluded this diagnosis. The management of the symptomatology was made with parenteral antibiotics, anticonvulsive and antioedematous cerebral therapy. Favourable evolution with residual left hemiparesis after 30 days, when the child was discharged. CT-scan reevaluation (after 5 months of evolution) showed a hypodense temporal-parietal area abnormality due to a right ischemic infarction.

Previous and recent studies stress the importance of small intracerebral vessel lesions in the pathogeny of some forms of dementia. The observations on this subject and included in our study refer to adult patients (32-86 years) selected only on the criterion of clinical diagnosis of dementia. To diagnose most of the cases, clinical experimental data and clinico-psychomotor tests were used. Classical neuropathological techniques were performed for the morphological study of their brains. All types of cerebral vessels were affected in various percentages by the different types of lesions. Vessel wall sclerosis of all types of intracerebral vessels was noticed in 50% of the cases, the thickening of the arteriolar wall with or without sclerosis in 25% of cases and exclusively capillary fibrosis in 21.4% of cases. Other types of vascular changes were present in a small number of cases. No correlation could be made between a certain type of vascular lesion and the age or diagnosis of the patient. Nevertheless, we could observe that wall sclerosis was more frequently found in groups with the oldest patients with vascular diseases (VD, MD), the thickening of the arteriolar wall in patients aged 60-74 years with vascular diseases, and capillary changes in older patients with dementia of Alzheimer type. No preferential location of the vascular lesions could be observed in our group of patients.

The reasons for not treating hypertension could be the risk of reducing cerebral blood flow (CBF) which may induce additional cerebral damage in the so-called ischaemic "penumbra". Hypertensive patients have altered autoregulation. A severe hypertension (over 230/120 mmHg) may lead to further damage by cerebral edema which asks for antihypertensive therapy. An antihypertensive therapy was applied in 81 patients within the 72 hours interval from acute ischaemic stroke (AIS) onset. In 42 patients, the antihypertensive treatment was discontinued after the 72-hour interval (the therapy with nifedipine in daily doses of 10-20 mg was not considered as hypotensive). We compared as end points: the survival, death, modified Rankin Scale (mRS). There were no statistically significant differences between end points of patients who discontinued (group C) and those who maintained (group T) the antihypertensive therapy. The mean value of blood pressure was higher in patients who maintained antihypertensive therapy (p < 0.001 for systolic blood pressure (BP); p = 0.001593 for diastolic blood pressure). The mean value of age in patients in whom antihypertensive therapy was discontinued was higher than that found in patients who maintained antihypertensive therapy (p < 0.05).

The case of a 35-year-old patient is reported. After a two-week interval following an ORL puncture in the frontal sinuses, the patient showed a suppuration on the right hemisphere and was admitted in the territorial neurosurgical clinic. Due to a progressive neurological impairment (loss of consciousness and left hemiplegia) the patient was transferred to the Neurological Clinic of "G. Marinescu" Hospital, in Bucharest. CT-scanning carried out in 1989, showed multiple empyemas (intrahemispheric, basal, etc.) excluding any surgical treatment. A conservative treatment was administered during a long period including antibiotics, notably cephalosporines (the third generation). Repetition of CT-scanning evidenced a progressive diminution of a total disappearance of septic intracranial collection, hence, an obvious improvement of the patient. After a year of treatment, the patient was considered to be recovered even if he still accused rare epileptic seizures, partially controlled by drug therapy.

One hundred and twenty-nine cases with depression were submitted to a comparative therapeutic study, using a flexible treatment administration: mianserin 30-60 mg and imipramine 50-150 mg. The mean dosages were 43.6 mg of mianserin and 62 mg/day of imipramine. Twenty-nine patients were excluded from the study, the rest constituting 2 equal groups of 50 cases each. The study covered a period of 4 weeks. After this period, almost 40% of the cases were discharged due to their obvious improvement. The significant benefits of mianserin were evident in the 7th and in the 21st day of the study on HDRS for the total score and in the 7th day on HDRS for the anxiety-somatization score. The superiority of mianserin was also obvious due to the total score on Lipmann-Rickels' scale as well as for the general neurotic symptoms. No statistically significant differences between mianserin and imipramine for the antidepressive efficacy were observed by the end of the study. A greater number of secondary effects was noticed in the group treated with imipramine. It seems that mianserin was a better therapy for this category of psychic patients, especially for older cases, probably due to the anxiolytic influence and to a lower incidence of side-effects.