Internal and external carotid vascular responses to vasoactive agents in the monkey.

Internal and external carotid blood flows in anesthetized monkeys were measured simultaneously using electromagnetic flowmeters. Complete dose-response relationships were established for the effects of intracarotid infusion of several humoral agents implicated in migraine. Both the internal and external carotid vasculatures were constricted by serotonin and prostaglandin F2alpha and dilated by bradykinin, histamine, and acetylcholine. Noradrenalin and adrenaline constricted the external carotid vasculature but had little direct effect in the internal carotid territory. Prostaglandin E1 dilated the external carotid vasculature. Low doses of prostaglandin E1 produced dilation in the internal carotid circulation, but with higher doses there was a paradoxical abolition of this effect.

Effects of methysergide, pizotifen and ergotamine in the monkey cranial circulation.

Internal and external carotid vascular resistances were measured, in anaesthetized monkeys, to asses the direct cranial vascular effects of i.v. methysergide, pizotifen and ergotamine, and their effects on the cranial vascular responses to the constrictors 5-hydroxytryptamine and noradrenaline and the dilators histamine, prostaglandin E1 and bradykinin. Methysergide reduced responses to 5-HT, and tended to potentiate the external carotid responses to noradrenaline. Pizotifen blocked responses to histamine; it tended to reduce internal carotid responses to 5-HT, but it potentiated external carotid 5-HT responses. Ergotamine reduced responses to 5-HT and noradrenaline, but this was probably related to its cranial vasoconstrictor effects, especially in the external carotid circulation. Methysergide induced weak transient cranial vasoconstriction and pizotifen had no direct effects. These findings may be relevant to the therapeutic actions of these drugs in migraine, since the doses used approximated to those used clinically.

Stroke in Indonesia: a first large prospective hospital-based study of acute stroke in 28 hospitals in Indonesia.

Stroke is an increasing cause of morbidity and mortality in Indonesia. Data on clinical patterns of hospitalized Indonesian stroke patients are still not available. This study is a part of ASNA (ASEAN Neurological Association) Stroke Epidemiological Stu dy aimed to investigate clinical profile of stroke in seven ASEAN countries with the same protocol. From 2065 acute stroke patients admitted to 28 hospitals all over Indonesia, the mean age was 58.8 (Standard Deviation [SD] 13.3) years (range: 18-95 year s). 12.9% were younger than 45 years, and 35.8% were older than 65 years. There were more men than women. Mean admission post-stroke time was 48.5 h (SD 98.8) (range: 1-968 h). Most of them arrived at hospital more than 6 h from stroke onset. The reasons for delayed admission were unawareness of stroke symptoms and long distance transportation. The most frequent stroke symptoms were motor disability. The most common risk factors were hypertension, heart disease, cigarette smoking and diabetes mellitus. Recurrent stroke was found in nearly 20% of patients. Ischemic stroke was the most frequent and the majority of the study subjects were discharged alive and improved.

Burden of stroke in Indonesia.

Stroke is the leading cause of death among Indonesians above five years of age, comprising 15.4% of all deaths, age-gender-standardised death rate 99/100 000, and age-gender-standardised disability-adjusted life years lost 685/100 000. Stroke prevalence is 0.0017% in rural Indonesia, 0.022% in urban Indonesia, 0.5% among urban Jakarta adults, and 0.8% overall. Frequent risk factors include hypertension, smoking and hypercholesterolaemia. The mean age of stroke patients is 58.8 years. Subarachnoid haemorrhage is found in 1.4% of patients, intracerebral haemorrhage in 18.5%, and ischaemic stroke in 42.9%. Only city hospitals have neurology, neurosurgery and neuroimaging services. Indonesia has 40 stroke units. Commonly used medications for stroke are easily available. Hospital-based rehabilitative services are available in large hospitals. Traditional medicine is widely practiced. Efforts to combat stroke include education, more stroke units and rehabilitative services especially in the rural areas.

Malignant disease of the nasopharynx presenting as pain in the head and neck.

Two patients with an unusual pattern of pain in the head and face, who presented a diagnostic problem for one and four years respectively, subsequently proved to have a carcinoma of nasopharyngeal origin. The neurological complications of this condition are described.