Disturbances Of Cerebral Circulation Research Articles

Electrographic reactivity to caloric vestibular stimulation in cerebral circulatory disturbances.

Vestibular stimulation (with a weak caloric stimulus) enhances in normals the photical evoked responses (ER) recorded in the posterior areas of the scalp. Especially the late components of the ER are enhanced. In patients with cerebral circulatory insufficiencies, even in vertebro-basilar insufficiencies, vestibular stimulation amplifies the ER. In a high proportion of patients with cerebral atherosclerosis vestibular stimulation depresses the ER. In patients with focal lesions (sequelae of infarction or hemorrhage) in the internal capsule or cortex, vestibular stimulation depresses the ER, especially when the ear homolateral to the lesions is stimulated. No relationships were established between alterations of the ER produced by the vestibular stimulus and the oculokinetic (nystagmus), EEG and autonomic changes induced by the same stimulus.

Tonal sensation as a criterion of vertebral artery insufficiency.

The introduction of surgical techniques improving blood flow through the extracranial blood vessels supplying the brain has turned attention toward the development of applicable methods of diagnosing disturbed cerebral circulation. There is an urgent need for more precise diagnostic tests, particularly those which may detect early and reversible central nervous systems (CNS) damage. Of equal importance to the surgeon is the need for the development of an objective method for assessing the results of surgical procedures directed towards improvement of central blood flow. Accurate evaluation of symptoms referable to organic disturbance of cerebral circulation may be difficult, because of the similarity to certain functional disorders. Quantitative objective methods of testing along with prolonged follow-up of these patients will permit the assessment of value of vertebral artery surgery. This article reports the results of a new test of the performance of the CNS, as it was used on 55 cases chosen

Studies of cerebral hemodynamics in subarachnoid hemorrhage.

Cerebral hemodvnamics and nwtaholism in 32 cases of subaraelmoid hemor-rhage were investigated by the nitrous oxide method. Cerebral circulation was highly disturbed in the acute stage of the disease, while it remained within the normal range in the remission stage. In patients with angiospasm visualized on the cerebral an giogram. cerebral circulatory disturbances were severer than those without angiospastic patterns. Between the pressure of cerebrospinal fluid at lumbar puncture and cerebral blood flow, there was a negative correlation., whereas a roughly positive correlation was found between cerebral vascular resistance and the pressure. In cases in which surgical clipping of aneurysm was done, remarkable improvement of the cerebral circulatory disturbances was generally noticed immediately after the operation. Cerebral vascular responses to 50, carbon dioxide inhalation and hyperventilation were examined in 9 cases. In the acute stage, poor responsive-ness to the vasodilatative stimulus was observed, while patients in the remission stage showed a normal response. Furthermore, cerebral vasoconstriction by hyperventilation is more remarkable in the acute stage than in the remission stage.

Klinische Erfahrungen und biochemische Aspekte bei der Behandlung des Alkoholismus mit Calciumcarbimid (DIPSAN)

The substance calcium carbimide (DIPSAN) which produces alcohol intolerance was tested on 72 alcoholics aged 23—66 years. Unlike the well-known disulfiram (ANTABUS), which obviously inhibits a large number of ferments, calcium carbimide appears to act selectively on acetaldehyde dehydrogenase. The results of an alcohol—dipsan reaction are therefore easier to check, more constant, and lack unpredictable complications. In the foreground is facial flushing, and to a lesser degree of other parts of the skin. Trunk and extremities may be affected in patches. If the contraindications are kept in mind (patients with hypertony, decompensated heart disease, cerebral circulatory disturbance, bronchial asthma, kidney disease, stomach and intestinal ulcers, and pregnancy) massive undesirable side effects and complications are seldom to be feared. Our investigations of blood chemistry show the following differences from disfuliram: 1. The fasting levels of acetaldehyde rose after the administration of disulfiram even without alcohol being consumed. This seems to be connected to the fact that as a rule the administration of disulfiram will produce mild symptoms such as headache and dizziness. The rise is much smaller in the case of calcium carbimide so that without alcohol it is well tolerated even over longer a period, and virtually without discomfort. 2. After the consumption of alcohol the acetaldehyde levels in patients treated with calcium carbimide are much higher than in those on disulfiram. There appears to be a direct relationship between the level of acetaldehyde and the degree of the reaction to alcohol with calcium carbimide. These findings are related to the selective inhibition of acetaldehyde hydrogenase. 3. 1 or 2 hours after the first dose of calcium carbimide a complete alcohol reaction is achieved, which means that preparative treatment as with disulfiram is not necessary. 4. In contrast to patients treated with disülfiram, in whom the cumulative effect can still produce a marked intolerance of alcohol even 7—10 days after completion of treatment, those taking calcium carbimide, even for prolonged periods, show only negligible signs of intolerance 48 hours after the last dose.

Clinical monopolar rheoencephalography

Sixty patients with symptomatic cerebral vascular disease were studied clinically, angiographically, and by the monopolar REG in an effort to evaluate the degree of correlation between the REG and anatomically localized disturbances in cerebral circulation. There was unequivocal evidence of reduction of impedance in the clinically and angiographically appropriate area of the brain in 40 patients. In 9 additional patients the REG abnormality correlated with the location of the cerebral lesion as denoted by either clinical or arteriographic abnormality. In 11 patients no correlation could be demonstrated, and possible explanations for this are offered. The degree of correlation between abnormalities in the REG and the area of clinical defect is roughly proportional to the size of the lesion. The REG abnormality appears to be more closely correlated to the hemodynamic factors of cerebral perfusion than to the biophysical alterations of brain tissue which follow ischemia or infarction. The results of this study are sufficiently encouraging to warrant further correlative observations between the REG and measured cerebral hemisphere blood flow.

Unusual axons found in experimental brain edema of cats.

In a study of the experimental brain edema using the balloon-compression method, unusual axons characterized by numerous mitochondria, vesicles, dense bodies, amorphous material and neurofilaments were demonstrated by electron microscopy. According to their structural features which associated with the stages of the brain edema, the unusual axons were classified into eight types. It was suggested that type I and II might transform to type IV and V by way of type III. The unusual axons accorded in many structural respects with those of nerve degeneration reported in the past. Therefore it was suggested that the unusual axons were closely related to the nerve degeneration, which was supported by the results of the light microscopic observation in the present study.The appearance of the unusual axons may be attributed to the metabolic alterations of glial cells induced by the brain hypoxia or cerebral circulatory disturbance following the compression by which the nourishment of nerve cell may be disturbed.

Changes in the oxygen tension in the cerebral cortex and mechanisms of development of oxygen lack in the brain in association with open pneumothorax and lung injury

As shown in experiments on rabbits, traumatization of the lungs and pleura in conditions of open pneumothorax is accompanied by a drop of oxygen tension in the cerebral cortex, reduction of phosphorus, adenosintriphosphoric acid and creatinphosphate content in the brain with a simultaneous rise of inorganic phosphorus and lactic acid concentration, pointing to the development of acute hypoxia in the brain. At the early states of pneurnothorax the leading role in the appearance of cerebral hypoxia is played by respiratory insufficiency and the CNS exitation. Soon disturbances of cerebral circulation, and then the general vascular insufficiency, supervene.

EEG STUDIES ON CEREBRAL CIRCULATORY DISTUR‐BANCES IN MAN

SummaryCarotid compression was applied to 84 cases and EEG record thereof was taken. At the same time, the changes of the instantaenous values and integrated values were traced with the use of 2‐channel simultaneous automatic frequency analyser. In addition, a polygraphic observation was made by means of plethy‐smogram, cardiogram, cardio‐tachogram, pneumatogram, electro‐myogram, and eye‐ball movement. Of 84 cases, 53 had clinically diagnosed to have cerebral circulatory disorders, 21 without it, and as to the other 11 cases, no diagnostic determination was possible. Further, there was normal control group consisted of 10 persons.Under the carotid compression test, in the EEG of 21 out of 53 cases with cerebral circulatory disturbance, the slow waves of 1.5–5 c/s and 50–100 μV appeared, while no such phenomenon was observable in the group without the said abnormality. The result of EEG‐analysis shows that during the appearance of the slow waves, α‐band diminished and both θ‐and δ‐bands extended. Variance was seen between the normal control group and the group with the disturbance with reference to the transition of these three bands. In general, the blood pressure was lowered and the pulsation slowed down. Upon the cessation of the pressure application, all recovered the normal state.

Direct common carotid injection of radioisotopes for the evaluation of cerebral circulatory disturbances

Direct common carotid injection of radioisotopes for the evaluation of cerebral circulatory disturbances

Cerebral Circulation and Metabolism in Brain Stem Injury

A brain stem injury was produced in dog by injection of Indian ink, blood or Metaacryl-ethyl-ester into the pons or the medulla. The cerebral circulation and metabolism were investigated by N2O method in acute and chronic stages of the injury. In the acute stage, cerebral blood flow was reduced significantly in the majority of cases due to vasomotor reflex and local organic changes. With this and respiratory disturbance, cerabral gas and glucose metabolism were impaired remarkably. In the chronic stage, the disturbance of cerebral circulation remained in the similar degree to the acute stage due probably to progressive organic changes, whereas the metabolism revealed some improvement because of the better respiratory condition. Observations were also made from clinical and pathological aspect, but no significant relations were disclosed between these findings and cerebral hemodynamics.

Common neurological diseases seen in general practice.

The commonest neurological condition seen by the clinician results from the various manifestations of cerebrovascular disease, which is due generally to some type of vascular anomaly, usually congenital, or to the complications of arteriosclerosis, with or without hypertension or heart disease, or to syphilis. Cerebral embolism is included in this group because the symptoms are due to some disturbance of cerebral circulation, because it has to be differentiated from other cerebral vascular lesions, and because the treatment is essentially the same as for cerebral thrombosis. CEREBROVASCULAR ACCIDENTS Intracranial but Extracerebral Hemorrhage.— Hemorrhage occurring in the cranium but outside of the cerebrum is usually due to a congenital vascular anomaly but may be due to trauma or to rupture of a superficial sclerotic artery. The usual congenital anomaly is an aneurysm due to malformation in the arterial wall at the bifurcation of one of the vessels comprising the circle of Willis.

DIABETES INSIPIDUS OF OVER TWENTY YEARS’ STANDING IMPROVED FOLLOWING A SUBARACHNOID HEMORRHAGE

THE CAUSE of diabetes insipidus is still a matter of speculation. Among the etiologic factors those most prominently mentioned are heredity ar}d tumors, or other lesions such as gumma or other syphilitic lesions, tuberculosis, en-cephalitis lethargica or trauma at the base of the skull, causing pressure, inflammation, or degeneration involving the posterior lobe of the pituitary gland or the hypothalanv ic region adjacent to it. Other factors mentioned are blood dyscrasias, cerebral circulatory disturbances and psychic influences. In some cases no actual or apparent cause is discoverable. Cushing (3), Frank (4), and others reported cases of diabetes insipidus which showed a tumor at the base of the brain near the hypothalamus, probably interfering with posterior lobe function. Futcher (5) reported a case of diabetes insipidus due to an alveolar carcinoma of the hypothalamus secondary to primary carcinoma of the lungs, without involvement of the pituitary.