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Accepted 15 December 1987 Case reports Case 1 A 26 year old right handed Sudanese was admitted with a day's history of headache, vomiting, drowsiness, confusion and fever. He had experienced intermittent bifrontal headache with no special features for 8 months. During this period he had recurrent fever, was anorexic and had lost weight. Four months prior to admission he had been having episodes of weakness in the right limbs associated with difficulties in choosing the correct words although he could understand what was said to him. Most of these episodes lasted about 10 minutes and none lasted more than an hour. He often drank unpasteurised goat and camel milk.On examination he looked ill, was wasted and had a temperature of 39°C. He was drowsy and confused but easily rousable. He had neck stiffness, positive Kernig's sign and mild left hemiparesis. Clinical and CSF findings (table 1) were compatible with tuberculosis and he was started on streptomycin, rifampicin, INH and ethambutol while awaiting further laboratory results including tests for brucellosis. The following day he was fully alert, orientated and apryexial. Brucella species were later isolated from the CSF and brucella agglutination titres were raised in both serum and CSF (Table 1). Detailed investigations for stroke risk factors such as echocardiography, electrocardiography, haemoglobin electrophoresis, serum lipid analysis and serological tests for collagen disorders were normal.The antituberculosis drugs, except rifampicin, were discontinued and replaced by trimethoprim-sulfamethoxazole (TMP-SMZ). The patient continued to improve clinically and his antibody titres declined. He was discharged symptom free 5 weeks later. When reviewed 9 months after discharge he was well without any recurrence clinically and the brucella agglutination titres were 1/ 160 for both abortus and melitensis respectively. However, minimal pyramidal tract signs (pathologically brisk tendon jerks) were still present in the left limbs. Case 2 A 60 year old Saudi female was admitted with recurrent vertigo, nausea, vomiting, anorexia and weight loss for 3 months. The vertigo was worsened by exercise or change of position of the head. There was no history of headache, tinnitus, loss of hearing or visual disturbance. Six

The mean heart weight as a measure of arterial hypertension of patients who died from spontaneous intracerebraj hemorrhage (primary intracerebral hemorrhage or PIH) was compared with that of controls from the same autopsy population. All patients with valvular or congenital heart disease or disease processes associated with myocardial infiltration were excluded. In 206 cases of PIH, hypertension was diagnosed if heart weight a the mean heart weight of autopsy controls for either sex, plus 1.5 SD. Only 94 (46%) of all cases of PIH were hypertensive by this criterion. However, hypertension was five times more frequent in the cases than in the controls. The site of hemorrhage was clearly defined in 183 cases (88.8%) only. Of these, 80 (43.7%) had lobar hemorrhage and 69 (37.7%) bled in the basal ganglia. Only 26 cases (12.6%) had evidence of previous cerebral or myocardial infarction and there was no instance of previous intracerebral hemorrhage. These data show that arterial hypertension was present in about half the cases of PIH and suggest that other as yet unidentified risk factors for PIH may be more common than is realized. Patients who died from PIH had been healthy all their lives with no evidence of cardiovascular or cerebrovascular disease, and the PIH was their first evidence of disease. (Stroke 1987;18:531-536) A RTERIAL hypertension as the major risk factor / \ for primary intracerebral hemorrhage (PIH) is A. \ -well recognized.1 However, the frequency of hypertension varies widely from study to study.2 " 5 This is partly due to different diagnostic criteria for hypertension, the strictness with which such criteria are applied, and selection biases inherent in specialist hospital admission or referral. Preictal blood pressure level may not be available, and the postictal blood pressure recordings do not accurately reflect the presence of arterial hypertension before the stroke.Evidence of prior sustained arterial hypertension in patients without congenital or valvular heart disease can be obtained at autopsy from consideration of heart weight. 67 The choice of the maximum heart weight in some studies was arbitrary 2 -3 and the fact that men have heavier hearts than women was usually overlooked.The aims of this study were to define sustained arterial hypertension by analyzing heart weights for men and women separately, comparing their means with those of controls, and to determine the frequency of hypertension deduced from heart weight in the PIH group and the controls. Heart weight was preferred to left ventricular wall thickness because the latter may be subject to greater interobserver error.

During an 8-year period, Guillain-Barré syndrome (GBS) was diagnosed in 54 Kenyans. Overall, the outcome was poor. Only 26 patients (48%) walked unaided within 3 month of the height of their paralysis. Five patients (9%) died from respiratory failure and 14 (26%) remained severely disabled from bilateral foot drop by the end of 16 months. Paralysis of lower cranial nerves and sphincter dysfunction were frequently associated with respiratory failure. Whether these features can predict the likelihood of respiratory failure developing requires further evaluation.

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