Search

As a result of the development of intensive-care medicine and organ transplantation, an increasing number of neurologists and other physicians are being confronted with problems of cerebral death and relevant diagnostics. Subsequent to a survey of the, after all, rather uniform pathogenesis, and of the anatomic findings, the clinical syndrome is described in detail with the object of helping to avoid a diagnostic misinterpretation of individual neurologic findings. The diagnostic aids or methods which can be applied at present, are judged with regard to the problems involved and their diagnostic value (experiences with the computer-tomogram have been omitted, since too few observations have been made to date). The paper concludes with a few pointers as to how these guidelines can be utilized when dealing with the concrete everyday situation of diagnosing cerebral death.

During a period of 823 days (from 1st October 1971 to 31st December 1973), attacks of migraine, non-migraine vascular cephalea and cephalea due to other neighbouring disturbances strong enough to affect working capacity were studied in 4 subjects. 2152 pieces of data were collected. 2) Frequency was at a minimum in summer and peaked in spring and autumn. 3) Comparison with meteorological conditions points to a highly significant recrudescence of disturbances in cold, damp weather, and meteorological periodicity independent of biological (circadian) rhythms.

Using the biometeorologic system proposed by Brezowsky, the chronological distribution of migraine attacks was analysed in 4 patients over a 5-year period. A correlation of complaints with physical indices (atmospheric pressure, temperature, humidity and ionisation) could not be established. However, a significantly high incidence of headache symptoms was shown in the biometeorologic phase 6Z (although other investigators have reported such an increase in weather phases 3 and 4). The important common denominator of these weather phases seems to be a disturbed circadian rhythm which interferes with endogenous biorhythms and triggers attacks of headache.

A re-evaluation of EEGs of more than 1,000 applicants for flying training is presented. All EEG abnormalities were reevaluated by three EEG specialists. Out of 1,630 EEG records, 5.4% were classified as abnormal and, of these, 24 were found to have a bearing on flying qualification. SW-variants and paroxysms were cause for elimination in any case. This study led to the adoption of the following policy: Any subject showing EEG abnormalities, possibly requiring a permanent elimination, will undergo a second EEG by another examiner. In cases with EEG anomalies, a followup EEG is done with a concurrent sensory-motor performance test. This is supplemented by an evaluation of collateral cerebral circulation, using uni-and bilateral compression of the vertebral and carotid arteries. In cases without noticeable performance deficiencies another EEG is done a year later in order to exclude a progression of the EEG anomalies.