Hemorheological disturbances in patients with chronic cerebrovascular diseases.

Hemorheological disturbances may occur in more than 40% of patients with ischemic cerebrovascular diseases. In this study the changes of rheological factors--hematocrit, plasma fibrinogen concentration, whole blood and plasma viscosity, red blood cell aggregation and deformability were investigated in 297 patients (173 males, 124 females, mean age 60 +/- 11 years) with transient ischemic attack or chronic phase (> 3 months after onset) ischemic stroke, and in 73 healthy volunteers (35 males, 38 females, mean age 38 +/- 7 years). Hematocrit, plasma and whole blood viscosity were significantly (p < 0.0001) elevated in cerebrovascular patients compared to controls. Plasma fibrinogen concentration (p < 0.001), red blood cell aggregation (p < 0.05) and deformability (p < 0.01) were also impaired in stroke patients. Hemorheological disturbances were dominant in stroke patients with diabetes, hyperlipidemia and smoking habits. Hematocrit, plasma viscosity and red blood cell aggregation showed a significant (p < 0.025-0.001) correlation with the severity of carotid artery stenosis. We could not find any characteristic distribution of rheological parameters among the three subtypes of brain ischemia. Our results show that all of the measured rheological parameters are significantly impaired in chronic ischemic cerebrovascular disorders, especially in diabetic, smoking and alcoholic patients. They correlate with the severity of the carotid artery stenosis, but there is no association with the type of ischemic stroke.

[Familial brain abscess as a complication of hereditary hemorrhagic telangiectasia]. / Hereditaer haemorrhagiás teleangiectasia szövódményeként kialakult agytályog családi halmozódása.

The hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) is an inherited autosomal dominant disease with angiodysplasia of the skin, mucosa, parenchymal organs, and it can affect the central nervous system. In 40% of the cases neurological complications, most frequently intracerebral abscesses occur. In this study, the case history of a patient with central nervous system manifestation of hereditary hemorrhagic telangiectasia showing familiar aggregation of brain abscess will be presented. A young male patient was admitted to Neurological Department because of his first epileptic seizure and progressive right hemispheric symptoms. His examinations showed frontal abscess, which was surgically removed. The frequent nose-bleeding of the patient and recurrent brain abscess in his brother's history provided the possibility of hereditary hemorrhagic telangiectasia. The background of brain abscess were multiple pulmonary arteriovenous malformation, which were embolized by repeated angiography. Familiar brain abscess is very rare. However, in the case of brain abscess especially with familiarity diagnosis of the Rendu-Osler-Weber disease should be considered.

[Ischemic stroke in young adults]. / Fiatalkori ischaemiás stroke.

Ischemic strokes appear infrequently in young adults before age of 45. It is important to find the etiologic factors and treatment them adequately for preventing the recurrence. Between 1988-1998 eighty-four stroke patients were observed in the authors' clinic. Smoking and hyperlipidemia were the most frequent risk factors. These were different from other studies and they can related to the national eating habits. Atherosclerosis (33.3%), prothrombotic states (15.5%) and cardiogenic embolism (9.5%) were found in the background, but the etiology remained unclear in 17.7% of patients. Neurological signs improved in 77.4% of patients, but deterioration was found in 3.6% and 7% of patients died in spite of appropriate therapy. The frequency of the stroke in young adults and distribution of etiological factors were similar to the other studies. The occurrence of above mentioned risk factors--mainly the frequently observed hyperlipidemia--reflects local feeding features. Because of the limited diagnostic tools some cases remained unclear.