The shift in the "paradigm" of the pharmacology of hypertension.

Until recently elevated blood pressure was considered as a hemodynamic entity representing an increase in workload for the heart and the arterial tree. Control of hypertension meant hemodynamic unloading, through inhibition of vasoconstrictor pathways, principally renin-angiotensin system and sympathetic system. In recent years however a new pharmacological approach has evolved as a result of (i) the dissociation of endothelial dysfunction and vascular pathology from increased blood pressure; (ii) the recognition that endothelial dysfunction regards not only the vascular reactivity, but also promotes atherosclerosis and thrombosis; and (iii) an improved understanding of the complexity of local-tissue renin angiotensin system and of the vasodilatory and cytoprotective role of natriuretic peptides.

Cerebral blood flow in patients with a subarachnoid haemorrhage during treatment with tranexamic acid.

Many clinicians currently use antifibrinolytic therapy (AFT) routinely in the management of subarachnoid haemorrhage (SAH). Many others do not, either because they remain unconvinced that AFT reduces the risk of rebleeding, or that the medication itself causes serious complications and in particular cerebral ischaemia. Nineteen randomly selected patients were studied, 9 receiving tranexamic acid (9 g a day) and the remaining 10 placebo, with SAH confirmed by CT scanning and by lumbar puncture.

Alcohol consumption--a risk factor for hemorrhagic and non-hemorrhagic stroke.

Purpose: The risks of alcohol consumption and its association with stroke were studied in 621 patients with stroke and 573 control subjects using case-control methods.

Patients And Methods: Patients with stroke were subdivided into 193 with subarachnoid hemorrhage, 91 with intracerebral hemorrhage, and 337 with cerebral infarction. Data on recent alcohol consumption were obtained by questionnaire in patients with stroke and compared with data from an occupational screening survey in control subjects.

Spontaneous subarachnoid haemorrhage occurring in association with a platelet function disorder.

A case of spontaneous subarachnoid haemorrhage occurring in association with a disorder of platelet function is described and the features of the disorder of platelet function were consistent with a storage pool deficiency. There has been no previous report of subarachnoid haemorrhage with platelet dysfunction.

Seasonal variation of cerebrovascular diseases.

The seasonal variation in all admissions of all types of cerebrovascular disease within the West Midlands Region was examined between the years 1973-1980. There was a fluctuation for both sexes with a peak in winter, between the months of October and April; a trough was observed in late summer, in July and August. Multivariate analysis of the meteorological factors showed an association between hours of sunshine and intracerebral haemorrhage.

Benefits and risks of antifibrinolytic therapy in the management of ruptured intracranial aneurysms. A double-blind placebo-controlled study.

One hundred patients with a verified subarachnoid haemorrhage were studied in a double blind, placebo-controlled trial at a single centre to determine the value and relative risks of tranexamic acid (TXA) in the management of ruptured intracranial aneurysms. The incidence of recurrent haemorrhage between active and placebo groups was identical (12%) and the mortality from recurrent haemorrhage was 7% and 5%, respectively. The overall incidence of cerebral infarction before surgery, at discharge and at 6 months follow-up was greater in the TXA group (27%) than in the control group (11%).

Fibrinolytic activity after subarachnoid haemorrhage and the effect of tranexamic acid.

Seventy-four patients with recent subarachnoid haemorrhage were randomly allocated to placebo or tranexamic acid treatment. Fibrinolytic activity in the blood and cerebrospinal fluid was assessed before treatment, one week later and two weeks later. The natural history of fibrinolysis following subarachnoid haemorrhage was obtained from analysis of the placebo group.

Cigarette smoking. A risk factor for hemorrhagic and nonhemorrhagic stroke.

Cigarette smoking habit was studied in 621 patients with stroke and in 573 control subjects using case control methods. There was an excess of smokers among the stroke group when compared with control subjects. Relative risks of cigarette smokers compared with nonsmokers, after adjustment for the possible confounding variables for subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction, were 4.

Reduced platelet function in subarachnoid hemorrhage.

The hypothesis that abnormalities of platelet function may relate to the occurrence or recurrence of subarachnoid hemorrhage (SAH) has been examined. Seventy patients with SAH and 65 control individuals were studied. The adenosine diphosphate (ADP) threshold for secondary platelet aggregation was significantly higher in the SAH group than in the controls.

Pituitary apoplexy.

Three patients with symptomatic haemorrhagic necrosis and infarction of the pituitary gland are described. They showed a range of clinical presentation, diagnostic pitfalls and diversity of treatment.

Oligoclonal immunoglobulin G in acute subarachnoid hemorrhage and stroke.

Oligoclonal Ig bands were found in serum and CSF of 13 of 83 patients (16%) with verified subarachnoid hemorrhage (SAH). Serum Ig bands were more common in patients with SAH than in those with cerebral ischemia. The reverse was true with oligoclonal Ig bands in CSF.

Comparative studies of the diagnostic value of cerebrospinal fluid spectrophotometry and computed tomographic scanning in subarachnoid hemorrhage.

Serial spectrophotometric scans of cerebrospinal fluid (CSF) and computed tomographic (CT) scans of 99 patients with a subarachnoid hemorrhage (SAH) were examined. The xanthochromic index (i.e.

Diurnal variation of and activity during the onset of stroke.

The diurnal variation in the onset of stroke was examined in 557 consecutive patients aged over 70 years. These included 194 patients with subarachnoid hemorrhage, 118 with intracerebral hemorrhage, and 245 with thromboembolic cerebral infarction. All three types of strokes exhibited a peak incidence between 1000 and 1200 hours.

Determination of plasma tranexamic acid using cation-exchange high-performance liquid chromatography with fluorescence detection.

A procedure is described for the determination of plasma tranexamic acid concentrations using cation exchange high-performance liquid chromatography with fluorescence detection following post-column derivatisation with omicron-phthalaldehyde. The chromatographic conditions were optimised with respect to detector performance and the method applied to measuring the plasma tranexamic acid levels of patients in a double-blind trial.

The spoon test: a simple bedside test for assessing sudomotor autonomic failure.

The efficacy of a new dual simple bedside test--the spoon test--in demonstrating sudomotor skin derangements was assessed. The results were compared with those defined by the quinizarine sweat test. The advantages and disadvantages of these two above and other known similar tests are discussed.

Surgical management of intracerebral hematomas.

Traditional and recent developments in the management of spontaneous intracranial hematomas are reviewed. A comprehensive account of the epidemiological characteristics worldwide with an etiological analysis including prevention and prophylaxis introduce the size and clinical significance of this neurological problem. The usefulness and limitations of the available diagnostic methods are described.

Outcome from "rescue clipping" of ruptured intracranial aneurysms during induction anaesthesia and endotracheal intubation.

Eight patients with ruptured aneurysms during induction anaesthesia and endotracheal intubation underwent an emergency "rescue clipping" of their lesion. Three patients died. Of the five survivors three made a good final recovery, one patient was moderately disabled and one remained in coma.

Ophthalmological signs and prognosis in patients with a subarachnoid haemorrhage.

In cases of subarachnoid haemorrhage from various causes, ophthalmological signs can be a feature. In the clinical examination they can be of assistance in determining the site of the aneurysm or other responsible lesion, and they can also be of prognostic value. In a series of 48 cases the significance of these ocular signs is evaluated and discussed.

Rupture of intracranial vascular lesions during arteriography.

Four cases with ruptured intracranial vascular lesions during angiography and confirmed radiologically are presented to emphasise a dangerous complication of the procedure.

Emission and transmission tomography of the brain in cerebrovascular disease.

Transmission and emission computed tomography (T-CT and E-CT, respectively) scans of the brain in 149 patients with cerebrovascular disease were compared to establish the diagnostic accuracy of the two methods. The T-CT scan yielded an overall rate of true-positive results of 80.75% in major infarcts, 80% in intracerebral hematomas, and 75.

Short- and long-term prognosis of patients with a subarachnoid haemorrhage in relation to intra-operative period of hypotension.

112 patients operated on for an intracranial aneurysm were surveyed. The immediate (up to 3 days from surgery) and late (from 3 days onwards and up to 2 years) outcome was examined in relation to the level and duration of per-operative hypotension as well as technical difficulties. The risk of both immediate and late post-operative neurological deficit was increased when the systolic blood pressure was pharmacologically reduced below the level of 60 mm Hg.

The effect of decerebrate rigidity on intracranial pressure in man and animals.

Unlabelled: Patients with decerebrate rigidity frequently show intracranial hypertension. The factors responsible for this effect and their inter-relationships were explored in cats and in patients with head injuries.

Animals: The factors examined, separately and in combination, were elevation of central venous, intrathoracic, intra-abdominal and systemic arterial pressures.