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Delayed Cerebral Ischemia Is Not Influenced by the Timing of Aneurysm Surgery

PS-08-01 Dexamethasone-Suppression Test in Stroke Patients-The Relation of DST to CSF Monoamine Metabolites and Poststroke Mood Disorders M. Kawakami, S. Maehara, T. Murashige, H. Kotoh, T. Satoh, S. Tochigi, and T. Itoh. Third Department of Internal Medicine, St. Marianna University, Kawasaki, Japan. We have performed the dexamethasone-suppression test (DST) in 38 stroke patients to elucidate the relation between the DST and cerebrospinal fluid (CSF) monoamine metabolite levels and clinical features, in especially poststroke mood disorders. Plasma samples for cortisol values were obtained at 8:00 AM and 4:00 PM on the next day of administration of dexamethasone (1 mg). Nonsuppression (NS) was defined if one of the two cortisol values was more than 5 mmg/dl in the postdexamethasone samples. Furthermore, lumbar puncture was performed within 1 week after DST to collect 7 ml CSF, and monoamine metabolites in the CSF were measured by high-performance liquid chromatography. The following results were obtained. Twelve (31.6%) patients showed NS. No significant difference was observed between suppression (S) and NS groups regarding sex, age, body weight, and duration after onset. From the total of 18 poststrokedepressed patients, only five (27.8%) had abnormal responses to DST. There were no relations between abnormal DST and the severity of depression, the location, and the lesion volume on computed tomography. However, a trend of high NS occurrence rates was found in patients with dementia and poor clinical outcome. CSF 5-hydroxyindoleacetic acid and 3methoxy-4-hydroxyphenylethyleneglycol levels showed no significant changes between NS and S groups. On the other hand, CSF homovanillic acid levels showed significantly low values in the NS group compared with the S group. These findings suggest that abnormal DST is in some way related to central dopaminergic dysfunction and possible clinical recovery but not necessarily to mood disorders in stroke patients. PS-08-02 A Comparison Between Habituation Index (HI) of Blink Reflex (BR) and Monoamine Metabolite Concentration in Patients With Cerebrovascular Accident (CVA) S. Tochigi, H. Watanabe, M. Kawakami, T. Sato, T. Murashige, and I. Ito. Tokyo Metropolitan College of Allied Medical Sciences, Tokyo Women's Medical College, and St. Marianna University, Kawasaki, Japan. 1-74 Supplement I Stroke Vol 21, No 8, August 1990 Quantitative electrophysiological study of the blink reflex (BR) and biochemical measurements of homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5 HIAA), and 3-methoxy4-hydroxyphenylethyleneglycol (MHPG) were undertaken in 28 patients with multi-infarct dementia (MID) and compared with those from 34 patients with unilateral hemispheric cerebrovascular accident and normal control subjects. The habituation index (HI) was measured by a modification of the method described by Penders and Delwaide (1971). The results obtained from the three groups were 1.8±0.2,1.9±0.2, 10.8±0.1, (mean±SDHz), respectively. Statistically significant difference was recognized between patients with stroke and normal control subjects. The monoamine metabolites were measured by high-pressure liquid chromatography with electrochemical detection. A significant decrease of HVA and MHPG in cerebrospinal fluid (CSF) was confirmed in patients with stroke in comparison with the results in normal control subjects, as determined by statistical analysis with Student's f test. The correlation between significantly elevated HI and decreased concentration of HVA with MHPG may play a pathophysiological role in patients with MID and unilateral hemispheric cerebrovascular accident.