Faculty Bibliography

Recently, the benign nature of aneurysms of the cavernous carotid artery has been questioned. In a review of cases evaluated from 1980 to 1990 with this developmental aneurysm, the authors found 70 patients with 79 cavernous carotid artery aneurysms. As expected, the great majority (59 patients) had ophthalmoplegia as the initial problem. Retro-orbital pain (three cases) and a carotid-cavernous fistula (five cases) were infrequently the sole manifestation. Mirror-image asymptomatic aneurysms were found in nine patients and asymptomatic cavernous aneurysms were found in three additional patients. Thirty-four patients not surgically treated were followed for a mean of 2.8 years, and 36 surgical patients were followed for a mean of 4.1 years prior to treatment. Of the 79 aneurysms, one (1.3%) ruptured into the subarachnoid space during this period. Other than optic neuropathy or cranial neuropathy, no patient had a permanent neurological deficit; the 12 asymptomatic aneurysms remained asymptomatic. It is concluded that an aneurysm of the cavernous carotid artery is rarely associated with life-threatening complications, and treatment should be considered principally for patients with intolerable pain or problems related to vision

Intramedullary spinal cord abscesses are relatively uncommon. We report the first case of an intramedullary spinal cord abscess in a preexisting spinal cord ependymoma. The clinical features and pathogenesis are discussed. Salient features of the management of intramedullary spinal cord abscesses are outlined

In an attempt to find safe and effective methods of treating giant intracranial aneurysms, we have developed a one-step construction of giant experimental aneurysms in dogs with a yield of 100% patency of the parent artery and the experimental aneurysm without intraaneurysmal thrombus. Giant aneurysms were produced in the right thrombus. Giant aneurysms were produced in the right common carotid artery of nine mongrel dogs. Key features concerning the procedure were: (1) proximal placement of the aneurysmal neck, (2) 1 cm length as the aneurysmal ostea, and (3) postoperative aspirin therapy. This one-step construction of giant experimental aneurysms in dogs should prove helpful in evaluating a wide variety of treatment modalities of giant aneurysms in the laboratory. It also may be of additional value in investigative studies relative to catheters, balloons, and other similar techniques

A patient harboring a cerebral arteriovenous malformation (AVM) underwent angiography in an attempt to embolize the AVM. During catheterization (and prior to embolization) he became hemiplegic and aphasic. Angiography revealed a complete middle cerebral artery (MCA) occlusion by an embolus. The patient was treated with recombinant tissue plasminogen activator (t-PA), a thrombolytic agent. Restoration of MCA flow was achieved, and the patient recovered. Immediately after MCA embolus, t-PA infusion may lead to thrombolysis and neurological recovery. The decision-making process as well as the risks associated with the use of t-PA are discussed

Platelet deposition in the microcirculation may play a role in focal cerebral ischemia. We investigated platelet deposition in selected parts of the cat brain after temporary middle cerebral artery occlusion. Ten anesthesized cats were given autologous indium-111-labeled platelets and chromium-51-labeled erythrocytes. The right middle cerebral artery was occluded with miniature aneurysm clips for 3 hours via a transorbital approach; blood pressure was reduced concomitantly to decrease the collateral circulation. Removal of the clips initiated a 45-minute period of normotensive reperfusion. After sacrifice, the brain was removed and sectioned for comparison of right- versus left-hemisphere platelet deposition. Platelets were selectively deposited in the territory of the occluded right middle cerebral artery. Significant deposition was found in the caudate nucleus, internal capsule, parietal cortex, and the centrum semiovale. Our findings support the evidence that platelets are deposited in the microvasculature during temporary severe focal cerebral ischemia

In a patient with multiple intracranial aneurysms, the clinical examination, computed tomographic brain scan, and cerebral angiogram failed to disclose which of five aneurysms had ruptured. Magnetic resonance imaging (MRI) revealed high signal intensity compatible with hemorrhage in the lower portion of one cerebellar tonsil, and a corresponding posterior inferior cerebellar artery aneurysm was successfully obliterated. We would add MRI to the list of useful adjuncts in identifying which of multiple aneurysms bled

A young Mexican female developed neurocysticercosis presenting as a lymphocytic meningoencephalitis with eosinophilia. Parasitic cysts in the fourth ventricle and pre-pontine cistern were well visualized by magnetic resonance imaging but not by computerized tomography. The meningoencephalitis recurred despite treatment with praziquantel and dexamethasone, and obstructive hydrocephalus eventually developed. The patient remains well one year after excision of the intraventricular cyst. This case emphasizes the distinct advantages of magnetic resonance imaging in the diagnosis of intraventricular neurocysticercosis, and the potential need for surgical rather than medical intervention in this condition