European neurology
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21 patients (aged 28-81 years) with recent subarachnoid hemorrhage (10 saccular aneurysms, 3 arteriovenous angiomas, 8 normal angiograms) were continuously infused with tranexamic acid at a dosage of 5 g daily for up to 14 days. Therapy was surveyed by daily measurement of the available plasminogen activity (aPl) with the chromogenic substrate S-2251 and by a modified bioassay, whereby the concentration of tranexamic acid was determined thrombelastographically and expressed as antifibrinolytic equivalent. ⋯ Intra- and interindividual changes were relatively small for aPl, when compared with the antifibrinolytic equivalent measured by the bioassay. In 2 elderly patients tranexamic acid infusion had to be terminated because of clinical and laboratory signs of disseminated intravascular coagulation, whereby aPl fell below the therapeutic range, elucidating that this method is a sensitive indicator for a hypercoagulable state and useful for the surveillance of therapy with antifibrinoltic agents.
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3 cases of dissecting aneurysm of the aorta and paraparesis are presented. 1 patient had an ascending dissection of acute onset with paraplegia but without pain. He was treated conservatively but the patient died. At autopsy a large coronary infarction was also found in the area of the right coronary artery, which was compressed at the starting point of the dissection. ⋯ A descending dissection was found in aortic angiography and an operation was performed. During the operation the aorta was occluded for 57 min, which was too long for the medullary circulation and permanent paraplegia was the result. Modern diagnostic and therapeutic possibilities are discussed.
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Clinical electrophysiological and neuroradiological examination of a case of unilateral intention and action myoclonus is reported. Brachial arteriography revealed an angioma located mainly in the lateral portion of the right posterior thalamus. ⋯ Our case, together with some cases previously described, raises the possibility that volitional myoclonus may be related to a relatively circumscribed damage of some diencephalic and/or mesencephalic structures. The rare occurrence of a hyperkinetic syndrome as principal symptom of a cerebral vascular malformation should be borne in mind in view of the potential risk of a stereotactic surgical procedure designated to alleviate the involuntary movements.
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In a group of 60 patients of which 30 were affected by myasthenia, we used the regional curare test. The results were evaluated from a critical point of view and were then compared with the results obtained by the repetitive stimulation of the circumflex nerve, deriving from deltoid muscle. We considered too the specificity of the regional curare test for the evaluation of ocular myasthenia.