[Treatment of cerebral embolism and thrombosis with cervical sympathetic block: clinical contribution].
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We performed 123I-IMP SPECT in patients with cerebral infarction within 48 hours after onset, to investigate its usefulness in differentiating cerebral embolism from thrombosis. Clearcut wedge-shaped defect was seen on the SPECT image in all six cases of clinically suspected cerebral embolism in our series, while this pattern was not observed among the five cases of cerebral thrombosis.
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We assayed plasma concentrations of fibrinogen, fibrinopeptide A, plasmin-alpha 2 plasmin inhibitor complex, D dimer, and antithrombin III activity in 40 patients with cerebral thrombosis and nine patients with cerebral embolism during the acute (less than 7 days), subacute (7-27 days), and chronic (greater than or equal to 28 days) periods and compared these with 69 controls. In cerebral thrombosis, fibrinogen and fibrinopeptide A levels were elevated significantly in all stages (p less than 0.001), whereas plasmin-alpha 2 plasmin inhibitor complex and D dimer levels were elevated significantly in the subacute and chronic periods. The antithrombin III activity was significantly decreased in the acute stage. The elevation of fibrinogen and plasmin-alpha 2 plasmin inhibitor complex levels in the acute stage was significantly greater in patients with an infarct size greater than 10 mm2 compared to patients with an infarct size less than 10 mm2. We observed similar changes in patients with cerebral embolism. These results suggest that enhanced coagulation exists at all stages and endogenous fibrinolysis is activated in the subacute and chronic periods in a large proportion of patients with cerebral thrombosis and embolism.
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Eight instructive clinical case reports on younger women demonstrate the actual problem of severe adverse reactions (ADR) associated with oral contraceptives. Complications consisted of cerebral arterial thrombosis, peripheral arterial thrombosis, cerebral embolism, pelvic vein thrombosis, pulmonary embolism, thrombosis of the sinus sagittalis, recurrent pancreatitis and focal nodular hyperplasia of the liver. Contraindications of hormonal contraception (i.e. heavy smoking) were not always taken seriously by the prescribing physician. The data bank of the Medicines Commission of the German Medical Association contributed 648 cases to draw an ADR frequency profile, according to age, doses, duration of prescription and deaths. 25 deaths in close connection to oral contraception intake were reported, mostly caused by arterial or venous thromboembolism. Deaths predominantly were reported in women less than or equal to 30 years old, mostly following exposition to low-dose-preparations and after relatively short duration of intake (less than or equal to 3 years). These non-representative observations call for strict consideration of contraindications and use of low-dose-preparations, even in younger women.
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