Transient global amnesia: a clinical and sonographic study

BACKGROUND: The aetiology of transient global amnesia (TGA) is still unknown. The aim of this study was to identify potential risk factors for TGA, vascular risk factors, the role of patent foramen ovale (PFO) and of retrograde jugular venous flow. METHODS: 138 subjects entered the study, including 48 patients with TGA, 42 age-matched patients with transient ischaemic attack (TIA) and 48 controls. PFO was studied by contrast transcranial duplex sonography. Retrograde jugular venous flow was tested with air contrast ultrasound venography (ACUV). RESULTS: TGA patients and controls showed a lower prevalence for vascular risk factors than TIA patients. No statistical difference was found between the 3 groups with regard to PFO. ACUV detected jugular valve incompetence in 72.9% TGA, 35.7% TIA and 39.5% controls (TGA vs. TIA and TGA vs. controls p < 0.01). CONCLUSIONS: TGA patients have fewer vascular risk factors than TIA patients. Paradoxical embolism due to PFO as a cause of TGA is not confirmed in our study. Cerebral venous hypertension due to incompetence of the internal jugular valve may play a role in the pathogenesis of TGA.     

Neuropsychological assessment in multiple sclerosis: a follow-up study with magnetic resonance imaging

Summary Nineteen moderately impaired patients with clinically definite multiple sclerosis and an initially relapsing-remitting course were included in a neuropsychological and magnetic resonance imaging (MRI) follow-up study. The average test/re-test interval was about 2 years. The neuropsychological findings were indicative of a very mild overall impairment; the patients, as a group, showed no evidence of cognitive deterioration in the follow-up period. A numerical estimation of the severity of cerebral demyelination shown by MRI did not indicate a significant change. No correlation between cognitive performance variations and MRI changes was found.     

Isolated accessory nerve palsy of unusual cause

We report the case of a 23 year old male patient who presented for an isolated left accessory nerve palsy which had appeared one year before. Neuroradiological investigations showed that the causative pathology was a giant saccular aneurism of the intracranial left vertebral artery. Three months after diagnosis, signs of bulbar palsy rapidly developed. An emergency intra-arterial embolization was then attempted, which led to complete recovery except for the accessory nerve palsy which remained unchanged. We conclude that, in cases of apparently isolated accessory nerve palsy, neuroradiological investigations should include the posterior fossa.

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Sommario Descriviamo il caso di un giovane maschio, di 23 anni, che giunse alla nostra osservazione per una paralisi isolata del nervo accessorio spinale insorta da un anno. Gli accertamenti neuroradiologici dimostrarono che la eziologia era legata ad un aneurisma gigante dell' arteria vertebrale sinistra. Tre mesi dopo la diagnosi, il paziente sviluppò rapidamente i segni di una paralisi bulbare. Venne pertanto eseguita una embolizzazione intraarteriosa d'urgenza che permise un completo recupero, eccetto che per la paresi del nervo accessorio che rimase invariata. Noi concludiamo che nel caso di una paresi apparentemente isolate del nervo accessorio, le indagini neuroradiologiche dovrebbero includere lo studio accurato della fossa posteriore.

     

Neurological involvement in antiphospholipid syndrome: clinical and instrumental evaluation in 21 consecutive cases

Twenty-one consecutive women with the antiphospholipid syndrome were investigated with a full cardiological and neurological examination including a semi-structured interview. They were also systematically studied with magnetic resonance imaging (MRI), transcranial Doppler (TCD), duplex sonography of neck vessels and transesophágeal echocardiography (TEE). Nearly 67% of patients had signs or symptoms suggestive of CNS involvement Migraine-like headache, stroke, ocular disorders and epilepsy were the most frequent disturbances. MRI was abnormal in 65% of patients who underwent the examination and showed two distinct patterns of abnormality: either territorial infarctions or multiple subcortical spotty lesions. TCD showed in one case a stenosis affecting the main trunk of the middle cerebral artery. TEE demonstrated potentially emboligenic mitral vegetations in 72% of patients. These findings suggest that antiphospholipid syndrome is burdened with a high rate of complications affecting the CNS, which are likely to be mostly thromboembolic. It is possible that both cardiogenic embolism and in situ thrombosis of cerebral vessels occur. Given the relative absence of conventional vascular risk factors, antiphospholipid antibodies are likely to represent a true risk factor for cerebrovascular disease through the mechanism of an immunologically mediated hypercoagulable state.     

Predictive value of cervical bruit for the detection of obstructive lesions of the internal carotid artery. Data from 2000 patients

Between January 1982 and June 1985, 2000 patients with either symptoms of cerebrovascular insufficiency (1873) or asymptomatic cervical bruits (127) were studied at the Surgical Department of the University of Brescia (Italy). Of these, 441 presented a mono- or bilateral cervical bruit. The value of the bruit as indicator of an obstructive pathology of the extracranial carotid artery was evaluated in comparison with the findings of Doppler spectrum analysis. A stenosis or occlusion of the internal carotid artery was present in 51% of the patients with a bruit (homolateral to the bruit in 91% of the cases) and in 9% of those without a bruit. Stenoses of a medium-high degree were those more often associated with the bruit. Both in patients with bruit and in those without bruit the age and the severity of the presenting symptoms significantly influenced the rate of association with lesions of the internal carotid artery was present in 51% of the patients with a bruit (homolateral to the bruit in 91% of the cases) and in 9% of those without a bruit. Stenoses of a medium-high degree were those more often associated with the bruit. Both in patients with bruit and in those without bruit the age and the severity of the presenting symptoms significantly influenced the rate of association with lesions of the internal carotid artery.

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Sommario Presso la Clinica Chirurgica dell'Università di Brescia (Italia) dal gennaio 1982 al giugno 1985 sono stati studiati 2.000 pazienti che presentavano o sintomi di insufficienza cerebrovascolare (1.873) o soffi carotidei asintomatici (127). In totale 441 di questi pazienti presentavano soffi mono-o bilaterali in regione cervicale. Il valore di un soffio come indice di patologia ostruttiva della carotide extracranica è stato valutato utilizzando il Doppler con analisi spettrale come esame di riferimento. Nel 51% dei pazienti con un soffio era presente una lesione della carotide (nel 91% dei casi omolateralmente al soffio) la quale era presente, peraltro, anche nel 9% dei pazienti in cui non erano rilevabili soffi. Sia nei pazienti con soffi che in quelli senza, l'età e la gravità dei sintomi iniziali rappresentavano i principali fattori correlati con l'entità dell'ostruzione carotidea.