Cardio-respiratory arrest associated with cerebral anoxia and vigilant akinetic mutism. Dynamic clinical and polygraphic study of a case with electroclinical recovery.
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Biomedical subjects
Publications and source records attributed to C Sipoş.
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The intracranial cerebral circulation was studied in 6 patients with bilateral ischemic lesions due to lesions of the internal carotid artery in the extracranial segment (2 significant bilateral stenosis cases; 1 case with bilateral thrombosis and 3 cases of unilateral thrombosis and significant controlateral stenosis). All the patients were males their age ranging between the 5th and 8th decades of life. In a single case, the neurological examination showed secondary left hemiplegia and recent right paresis of remittent type whereas the other 5 patients had only transient ischemic attacks with hemiparesis or transient aphasia. The lesions were revealed by duplex system echotomography (Aloka-Hellige Model SSD-630) and spectral analysis of Doppler signal (Vasoscan-Sonicaid) and were later confirmed by bilateral carotid arteriography in all patients. The intracranial circulation was also watched by noninvasive methods using the spectral analysis of the Doppler signal with pulsed wave on TC-2 64-B apparatus. As for the modalities of blood flow compensatory mechanisms by the circle of Willis, it may be noted that in none of the patients investigated did the collateral supply observe a "mathematical model".
Carotid echotomography (CET) in the duplex system was made in 118 patients with atherosclerotic lesions of various degree (insignificant stenoses--ISS; significant stenoses--SS and thromboses) of the extracranial carotid axis. The atherosclerotic lesions were localized mainly at the level of the carotid bifurcation (CB) and/or at the level of the carotid sinus. The clinical form of the ischaemic attack was better correlated with the extension of atherosclerotic lesions in the extracranial carotid axis than with the severity of these lesions.
Using continuous-wave spectral analysis of Doppler signal (SADS) and/or pulsed-wave transcranial Doppler ultrasonography (TCD-US) we examined 263 patients with ischemic cerebrovascular diseases (ICVD) symptoms in the carotid and vertebrobasilar (V-B) systems. The degree of stenosis was established by taking into consideration the parameters of the spectrum of frequency (systolic peak velocity--SV; end-diastolic velocity--DV); the ratio between SV of internal carotid artery (ICA) and common carotid artery (CCA); the ratio between DV of ICA and CCA as well as the value of the spectral broadening (SB) index. The diminution of DV in CCA with increased values of Pourcelot's circulatory resistance index (RP) and spectral broadening index (SB) as compared with the controlateral part, but with apparent increase (over 3.5 kHz) of SV in ICA was constantly observed in significant stenoses of extracranial ICA. Our observations have pointed out that when proximal ICA occlusion is being formed slowly and progressively, ECA (whose increased circulatory resistance under normal conditions reflects diminished diastolic velocities) gradually takes over the hemodynamic characteristics of ICA which is expressed by increased DV, approximating DV and ICA. This situation may give rise to erroneous interpretations.
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This paper contains a clinical, classical electroencephalographic and computerized electroencephalographic (by original methods) study of 271 cases with vertebro-basilar strokes, all the cases being verified by transcranial Doppler ultrasound investigations and some of the patients by morphopathological studies. In the first part, the standard EEG modifications in relation with the clinical pictures and with the affected arterial field are presented. In the second part, the aspects of the computerized EEG recordings with the carrying out of the cortical EEG mappings which have brought important contributions in setting down the topography of the infarctions are discussed. The third part presents the results of the polysomnographic recordings of the 70 selected cases with ischaemic vertebro-basilar attacks without disorders of consciousness (32 cases), with attacks accompanied by symptomatic hypersomnias (13 cases), with ischaemic attacks accompanied by insomnia (5 cases) and with ischaemic attacks with disorders of consciousness (20 cases). The opinion of the authors on the possible relations between the disturbances of the vigilance, the perturbations of the polysomnographic organization of sleep-wakefulness cycles (with the realisation of some interesting competitive dysfunctions between the three states of vigilance) and the electrographic anomalies are discussed.
The velocimetric complexes of vertebral arteries were studied following up 4 parameters of the frequency spectrum: peak of systolic velocity-PSV; end systolic velocity-ESV; mean diastolic velocity MDV; end diastolic velocity EDV. According to this study, it seems that MDV related to PSV is more indicated than EDV to appreciate cerebrovascular resistance. The increase of MDV related to the systolic velocity is more constant and ample from segment V1 to segment V3, compared with the increase of EDV. Thus, to appreciate circulatory resistance at downgrade, instead of Pourcelot value, there can be used the relation MDV/PSV or their difference related to PSV because MDV follows the variations PSV more exactly than EDV.