J. Matias-Guiu

Ischemic stroke in young adults I. Analysis of the etiological subgroups

ABSTRACT‐ An ischemic stroke (IS) group including 386 patients under 50 years old is analysed taking into account different etiological subgroups and comparing risk factors against a control group of 100 people. The series points out the presence of 66.1% patients included in the inconclusive‐atherothrombosis group, of which 22.7% had defined criteria of atheromatosis, while 11.6% were diagnosed of lacunar infarct. 13.5% of cases were considered as cardiac origin embolisms, and 14.1% were affected of mitral valve prolapse. The migraine group includes 4.9% of the patients while 17.6% belong to the miscellaneous group. The comparison of each of these groups with the control group showed significant differences for family history of stroke, personal history of peripheral arteriopathy, tobacco, arterial hypertension and previous IS.

Occurrence of Transient Ischemic Attacks in Alcoi: Descriptive Epidemiology

A door-to-door survey of transient ischemic attack (TIA) and stroke was conducted in 3 towns of the Alcoi health area. The prevalence ratios found for TIA and stroke were 13/1,000 people (95% CI 8.8-17.9) and 21.5/1,000 (95% CI 15.8-27.2), respectively. The crude incidence rates for both TIA and stroke were 2.8/1,000 (95% CI 0.7-4.9). Methodological differences in the ascertainment of the cases may explain the variations in the rates between the present work and other studies in the literature.

Ischemic stroke in young adults. II. Analysis of risk factors in the etiological subgroups

A prospective study on 386 consecutive patients affected of ischemic stroke (IS) has been analysed in relation to etiologies, comparing them with a control group of 100 people. The atherotrombotic etiology subgroups are associated with family history of stroke, risk factors, atheromatosis, occlusive peripheral arteriopathy, previous of stroke, high levels of hematocrit and hemoglobin, impaired lipid fractions and high levels of uric acid. The cardiac embolism etiology subgroups are associated with the presence of personal history of stroke, just as the mitral valva prolapse (MVP) patients group. The migraine group is significantly related with the intake of oral contraceptives.

Incidence of transient global amnesia in a Alcoi (Spain)

The April 1990 issue of Acta Neurol Scand contains a very interesting paper by Koski & Marttilla about the frequency of transient global amnesia (TGA) in Turku. The authors found an annual TGA incidence rate of 10 per 100,000 population and 32 per 100,000 among those aged 50 years old (1). The rates found are clearly higher than those previously reported by others (2). To evaluate the incidence of first-ever TGA in the sanitary area of Alcoi (Community of Valencia), we have done an analysis of the TGA patients included in the archives of our hospital between June 1986 and June 1990. The area investigated comprised 133,915 people. A more complete description of the whole population of the health area or geographic, climatic, economic and other characteristics have been described elsewhere (3). The criteria for the diagnosis of TGA were previously described (4) and were: 1) transient amnestic attack with no direct relation to cranial trauma or whiplash; 2) evidence given by a witness to the inability to form new memories; 3) repetitive queries; 4) apparently normal behaviour and orientation; 5 ) evidence given by the witness of normal long-term memory; 6) presence of retrograde amnesia at least during the episode; and 7) absence of other neurological signs and symptoms during the event. During the period, 8 men and 8 women fulfilled all the described diagnostic criteria with a mean age of 62.1 years (standard deviation 10.8). TGA incidence data are shown in the table. The duration of the episodes lasted 5 to 30 min in 1 patient, 1 to 2 h in 2, and 2 to 24 h in 13 cases. Cranial CT scan was normal in 8 patients. Abnormalities included cere-

Cardiovascular reflexes in Parkinson disease.

We have investigated the autonomic function of 95 patients with Parkinson disease (PD) by testing their cardiovascular reflexes and compared the results with those of 53 healthy volunteers. 51.1% of the patients were on antiparkinsonian therapy. The patients showed a smaller heart rate response to deep breathing with a mean exhalation-inspiration difference of 87.73±7 (p: 0.0005), a smaller heart rate response to standing with a mean 30 ∶ 15 index of 1.18±0.25 (p∶ 0.01), and a smaller blood pressure rise to handgrip with a mean rise of 9.53±8.76 mmHG (p∶ 0.005). We found a higher percentage of patients with established sympathetic lesion (41% vs 34%) or atypical patterns of global autonomic function involvement (33% vs 26%), but the percentage of subjects with parasympathetic lesion was similar in both, patients and controls (16% vs 15%). We found no significant difference on cardiovascular performance between treated and untreated patients. The patients with autonomic impairment were older than the patients with normal autonomic function. Our findings suggest that patients with PD have a true autonomic dysfunction.SommarioAbbiamo studiato la funzionalità del Sistema Nervoso Autonomo in 95 pazienti affetti da Malattia di Parkinson (PD), valutando i riflessi cardiovascolari e confrontando i risultati con quelli ottenuti da 53 volontari sani.Il 51.1% dei pazienti Parkinsoniani era in trattamento farmacologico. I pazienti hanno mostrato una ridotta risposta della frequenza cardiaca alla ventilazione profonda, alla stazione eretta e un ridotto aumento pressorio dopo esercizio isometrico. È stata riscontrata una più alta percentuale di pazienti con lesioni simpatiche stabilite (41% vs 34%) e con quadro atipico di coinvolgimento globale della funzione autonomica (33% vs 26%), ma la percentuale di soggetti con lesioni parasimpatiche era simile nei pazienti e nei soggetti di controllo (16% vs 15%). Non è stata riscontrata una significativa differenza alle performance cardiovascolari tra pazienti in trattamento farmacologico e non trattati. I pazienti con disturbi autonomici erano più anziani di quelli con normale funzione autonomica. I dati suggeriscono la presenza di una vera disfunzione autonomica nei pazienti affetti da PD.