[The clinical picture and pathogenesis of "nocturnal" cerebral strokes]

The authors studied 274 patients with ischemic and hemmorrhagical accidents which developed at night during sleep and awakening. A hypersensitivity of the carotid sinus was much more frequently seen in patients with ischemic accidents and was encountered not only in an extrasinus (massage), but in an intrasinus irritation (Walsalwa test) as well. The study also demonstrated significant cardio-inhibitive and vaso-depressive reactions, with an expressed asystolia and a drop in the arterial pressure. The authors express their opinion regarding the role of a developing bradycardia, asystolia, hypertension and a decrease in the postural tone in the genesis of ischemic accidents which may be due to a compression of the hypertensive carotid sinus. It is stressed that such accidents usually develop during parodoxal sleep. It is also assumed that there may be an embolization as a result of a compression of arteriosclerotically changed vessels in the area of the carotid sinus.