There have been no reports of studies on nocturnal sleep or quantitative studies of sleep spindle density in Huntington's disease, whereas sleep in Parkinson's disease has been extensively reported. We therefore examined nocturnal sleep changes in patients with Parkinson's and Huntington's disease and compared them with a control group. The previously reported decrease in sleep spindle density was observed in patients with Parkinson's disease. The patients with Huntington's disease, however, had a significant increase in sleep spindle density, the nocturnal sleep pattern being normal in other respects when compared with the control group. This observation may provide a further diagnostic criterion in Huntington's disease.

To determine the significance of hypertension in the pathogenesis of berry aneurysms, 113 patients with subarachnoid haemorrhage (SAH) and verified aneurysm and 63 patients with SAH without aneurysm were compared. Of those patients with angiographically verified aneurysms, 61.9% were found to have elevated blood pressure (greater than 160/95 mmHg) and 19.5% showed electrocardiographic signs of left ventricular hypertrophy (SV1 + RV5 (6) greater than 3.5 mV). The percentages for patients without aneurysm were 36.5% and 6.4% respectively. A significant correlation was found between anterior aneurysms and left ventricular hypertrophy (P less than 0.01). The mean Sokolow index values were also significantly elevated in cases of aneurysm (P less than 0.01). There was a complementary relationship between the extent of left ventricular hypertrophy and the percentage of females with regard to localization of an aneurysm and age group. The predominance of females in the total aneurysm population, in the 50- to 59-year-old age group, and among patients with internal carotid aneurysms indicates that a sex-specific hormonal factor may also play a role in the pathogenesis of aneurysms in addition to hypertension. The collagen wasting commonly observed in bone and skin in the post-menopausal period due to decreased oestrogen levels could possibly be responsible for the formation of aneurysms in the proximal segments of the cerebral arteries, as occurs in various connective tissue diseases.

In addition to the neurological findings, the functional capacity of 12 patients with Huntington's disease was evaluated quantitatively according to the Shoulson and Fahn scale [1]. This parameter was related to the following computed tomographic measurements: the greatest distance between the frontal horns (FH), the shortest distance between the heads of the caudate nuclei (bicaudate diameter, CC) and the quotient FH/CC. The ratio of the bicaudate diameter and the external diameter of the skull across the narrowest point of the heads of the caudate nuclei (CC/OTcc) was also used as well as the bicaudate diameter and the maximum internal diameter of the skull (CC/ITmax). The best correlation was found between the bicaudate diameter and functional capacity (r = -0.64, P less than 0.05). All the quotients containing the bicaudate diameter likewise showed a correlation with functional capacity, though to a less marked degree. Thus the bicaudate diameter appears to be the most specific and simple computed tomographic parameter for the differentiation of Huntington's disease from normal states or choreatic syndromes of different origin.

In this prospective study 52 patients with spontaneous subarachnoid haemorrhage were examined with respect to cardiac arrhythmias and their relationship to cerebral lesions. A continuous ECG was registered over an average of five days. Sinus tachycardia was the most frequently recorded arrhythmia, followed by multifocal ventricular extrasystoles, couplets, frequent supraventricular extrasystoles, non-sustained ventricular tachycardia, asystolia and sinus arrhythmia. A significant correlation was found between the clinical manifestation of a midbrain syndrome and sinus arrhythmia, and multifocal ventricular extrasystoles. This correlation points to the autonomic cardiovascular centres as the structures involved.

Neurogenically caused cardiac arrhythmias and their correlation to lesions within the central nervous system were examined prospectively in 54 patients with spontaneous intracerebral hemorrhage. All patients were examined neurologically dally for 3 weeks, with special attention given to signs of brainstem compression resulting from transtentorial herniation. Electrocardiograms were continuously recorded over an average of 5 days. A significant correlation was established between the clinical manifestations of brainstem compression and sinus arrhythmias, multifocal premature ventricular contractions, couplets, and ventricular tachycardias. An explanation for this correlation may be found in the localization of the autonomous cardiovascular centers in the hypothalamus and brainstem. Transtentorial herniation frequently leads to a bilateral lesion of these structures. However, the cardiac arrhythmias are only a partial phenomenon within a complex cardiovascular reaction. (Stroke 1988;19:688-692) A lthough disturbances in cardiovascular regulation are a well-recognized complication of intracerebral hemorrhage, there are only a few reports on the incidence of cardiac arrhythmias. This is because most studies were not based on continuous electrocardiographic (ECG) recordings.l~* We report on extensive ECG recording in intracerebral hemorrhage, placing particular emphasis on previous cardiac diseases, neurologic complications, and localization of the hemorrhage. Subjects and MethodsWe included 54 patients (mean age 55.7 ±12.4 years) with spontaneous intracerebral hemorrhage in our prospective study. Table 1 shows localization of the hemorrhage, neurologic complications, risk factors, and previous cardiac disease. In 90% of the cases, a motor or sensory hemisyndrome was present. Two thirds of the patients were hospitalized on the day of the hemorrhage, one sixth on the subsequent day, and the remainder on the second or third day after the event. We excluded any patients admitted later. The day on which the hemorrhage occurred was defined as Day 0, the subsequent day as Day 1, etc.The diagnosis was always confirmed by computed tomography. Angiography was performed when the patient's age, localization of the hematoma, and absence of hypertension suggested an angioma or aneurysm as a possible cause of the hemorrhage. Patients with bleeding into an infarction or tumor were excluded. All patients were examined neurologicalry dairy, with special attention being given to the level of Received May 27, 1987; accepted December 28, 1987. consciousness and midbrain symptoms. According to McNeary and Plum, 3 disturbances in ocular motUity such as absence of bulbar movements, divergent and/or conjugated and nonconjugated floating eyes, respiratory disturbances in the sense of Cheyne-Stokes respiration, periodic breathing, rhythmic hyperventilation or apnea, flexion and stretch mechanisms as well as a general increase in muscular tonus were assessed as indications for a transtentorial herniation. Although differences in pupil size ...