Biomedical subjects
Publications and source records attributed to M Pryszmont.
The authors describe a case of a 74-year-old patient with orthostatic hypotension syndrome. They discuss the possible symptomatic or idiopathic mechanisms of the aetiology of this syndrome, taking into account their possible coincident.
The aim of the study was to evaluate the relation between heart diseases and ischemic cerebral stroke. In addition to routine tests, echocardiographic examinations were performed in 70 patients with ischemic cerebral stroke and in 30 persons constituting the control group. It was found that heart diseases occurred in 70% of the patients in the group studied i.e. three times more frequently than in the control group. Heart disease confirmed by echocardiography and electrocardiography occurred more frequently in patients with cerebral infarct than in those with RIND. In the majority of cases cardiac valve diseases and/or atrial fibrillation were noted. It was found that in 14.3% of the patients studied, the results of the echocardiography indicated the need for modification of the treatment applied.
At the age of 23 the patient showed the first signs of dryness syndrome. Those symptoms developed progressively and during a few years primary Sjögren syndrome was noted. In the 37th year of life suddenly the patient developed very severe Gullian-Barré syndrome with involvement of the peripheral and central nervous system and with a considerable autonomic component. After treatment the patient improved, however mild symptoms of central and peripheral nervous system destruction remained. Those symptoms are still present and the patient is under the care of the Neurology and Rheumatology Clinic.
An analysis of 617 cases of cerebral strokes was done, including 534 acute and 83 past ones treated in the years 1966-1972. The patients were divided into 4 groups: I -- cerebral haemorrhage, II -- cerebral embolism, III -- cerebral arterial thrombosis, IV -- failure of cerebral circulation. The classification was based on clinical criteria and in dying patients also on autopsy findings. ECG changes were analysed in all patients. In the acute period of stroke the greatest proportion of cases were cerebral arterial thrombosis (197 cases --37%) and in this group acute myocardial infarctions were most frequent. This group was followed by cases of acute cerebral circulatory failure (191 cases -- 35%). The electrocardiographic correlate of the cerebral changes were in this group signs of myocardial ischaemia (84 cases -- 15%). Cerebral embolism (134 cases -- 24%) was associated with arrhythmia (109 cases --19) of various origin. In the group of cerebral haemorrhages (95 cases -- 17%) no unequivocal ECG changes were observed. In all patients with myocardial infarction during cerebral stroke atheromatous changes of coronary arteries were present. No correlation was observed between the location of the cerebral focus and the type of electrocardiographic changes.
In a material of 14 cases of funicular myelosis the authors demonstrated frequent presence of peripheral signs, psychic changes and rare occurrence of such infrequent syndromes as transverse myelitis, cerebellar syndrome, optic nerve atrophy. Diagnostic difficulties are discussed in cases of pernicious anaemia without blood changes, without gastric achylia, or in patients with vitamin B12 deficiency, malabsorption syndromes and other more infrequent pathological conditions. The importance of such investigations as Schilling's test in atypical cases and the necessity of regular, long-term substitutive treatment with B12 are stressed.
The authors describe two cases of Shy-Drager Syndrome in the aspect of diagnostic difficulties. The simple tests for evaluation of automatic system function, especially orthostatic test are stressed.
Rheoencephalography was made in 105 patients with ischaemic brain stroke during the first phase after the onset of the disease and 10 days later. It was found that the presence of an ischaemic focus in the area of the internal carotid artery induced blood supply alterations within the areas of adjacent++ arteries, i.e. contralateral carotid artery and vertebral arteries. In some cases it became visible in the reg records under the form of reduced or enhanced pulsation of blood flow followed by weaker reactions of changed vascular tonus. Most distinct changes were observed at the onset of the brain stroke. Ten days later these changes became less expressed.
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Rheoencephalographic investigations in different head positions were carried out in 62 subjects, including 22 healthy ones and 40 patients with vertebrobasilar arterial failure comparing the results with degenerative changes in the cervical spine. In patients with advanced changes in this spine the blood flow in the cerebral vessels was lower and their tonus was greater than in the remaining patients. Rheoencephalographic investigations may be particularly useful in patients in whom vertebral angiography is contraindicated.
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The rheoencephalographic method was applied for evaluating the common carotid artery compression test in 87 cases, including 49 patients with ischaemic strokes and 38 healthy subjects. In all 174 tests were done. No complications were observed. The investigation confirmed the usefulness of the test for the diagnosis of carotid artery occlusion. The test should be used routinely in rheoencephalographic investigations in patients with ischaemic cerebral strokes.
The method of rheoencephalography (reg) was applied for assessing brain circulation in 40 healthy subjects divided into two age group. The age in the first group was from 20 to 45 years (mean 34.3), in the second group from 46 to 73 years (mean 52.3). Reg records were assessed visually calculating the pertinent indices and arithmetical means of 10 waves on each side. The obtained results point to reduced elasticity of blood vessels in the older age group.
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Dynamic rheoencephalographic investigations with nitroglycerin test were carried out in 32 patients with ischaemic strokes in the carotid vascularization area during the first two weeks after disease onset. No complications were observed. As a rule, nitroglycerin reduced the tonus of intracranial vessels and improved the blood flow to the studied areas taking place parallelly during the first two weeks of the disease. Vascular tonus was decreased after nitroglycerin more in the cases in which this tonus was more increased initially. The dynamic investigations with the nitroglycerin test may be useful for selection of an optimal treatment.
The authors present a clinical description of three cases of occlusion of the left posterior cerebral artery. The pathogenesis of the syndrome of alexia without agraphia is discussed, together with other coexistent symptoms and signs such as hemianopsia, colour anomia, disturbances of recent memory. The discussion is based on own observations and a review of the pertinent literature.
Ten patients are presented with normotensive hydrocephalus treated by implantation of the ventriculo-atrial valve. The follow-up was from 1 to 5 years. The usefulness of the test of cerebrospinal fluid removal (Fisher's test) for qualification for this surgical treatment is stressed.
Dynamic rheoencephalographic investigations were carried out in 52 subjects including 20 healthy ones and 32 patients with ischaemic brain strokes in the first 14 days after disease onset. The investigations demonstrated changes of the mean values of the reg index, most evident in the initial stage on the disease. The author discusses the problem whether the fluctuations of the reg index in certain patients could be due to the lately described syndromes of excessive brain perfusion and intracranial steal syndromes.