Clinical Neuroscience

[Spinal lipomas and their surgery]

PARAVICZ Ervin, TÓTH Katalin, TORMA Albert

JULY 20, 1993

Clinical Neuroscience - 1993;46(07-08)

[18 intraspinal lipomas were operated, mostly in childhood. Surgery seems to be indicated unavoidably in view of preoperative clinical progression and postoperative improvement. Prior MR investigation was indispensable to the surgical procedure.]

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Clinical Neuroscience

Pathology of the vestibular system

GOSZTONYI György, ZILL Edith

The vestibular end organ, in spite of its small size, has extremely rich interconnections with other parts of the nervous system. The vestibular system can be damaged at the end organ, along the vestibular nerve, in its brain stem representations and in its cerebellar projections. The nature of the pathological process damaging the vestibular system is manifold: neoplastic, inflammatory, vascular, nutritional and degenerative. Neural complications of AIDS may also involve the vestibular system. The lesions may be focal, multifocal and diffuse. While in the past the results of neurootological examinations could only be correlated with post mortem findings, NMI opens new horizons for neurootological and topoanatomical correlative studies.

Clinical Neuroscience

[Vascular surgery in the prevention of stroke]

MOGÁN István, NEMES Atilla, NAGY Zoltán

[In Hungary the prevalence of cerebrovascular disorders has increased so that each year vascular reconstruction surgery is needed in 2800 cases. However, only a quarter of these eligible patients are operated. After a thorough examination if all the indications for carotid surgery are met, more and more patients will end up in vascular reconstruction units. Angiography and surgery are recommended if the carotid artery stenosis is asymptomatic and is more than 90%. Also, under special conditions an asymptomatic carotid stenosis may caused by indicate surgery (before coronary by-pass operation, etc.). Another indication is a transient ischemic attack, if carotid artery lesion and the stenosis is above 70%. Ulcerated plaques also need surgery because they are a likely source of emboli. After stroke surgery may be necessary if the angiologic status is unstable and further ischemic events, that may lead to disability are expected. An acute stroke rarely calls for surgery. In contrast to this, immediate surgery is needed after repeated, TIA, or crescendo TIA because the risk of stroke is very high in these cases. Finally, sometimes surgery is indicated because of the occlusion of internal and common carotid artery. With vertebrobasilar vascular reconstruction, we do not have enough experience. Cerebrovascular syndromes due to supraaortic vascular lesions are other indications for reconstruction surgery. However, surgery is never a satisfactory substitute for pharmacological treatment.]

Clinical Neuroscience

[Transcranial doppler detection of cerebral vasospasm following aneurysmal subarachnoid haemorrhage]

BARZÓ Pál, BORDA Lóránt, VÖRÖS Erika, KISS Mariann, BODOSI Mihály, DÓCZI Tamás

[In 22 patients with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms serial neurological evaluations, transcranial Doppler examinations and computer tomographic scans were performed. Transcranial Doppler flow velocities were significantly elevated for the group with vasospasm on posthemorrhage day 2. The maximum blood flow velocities were recorded between days 9 and 18, with normalization occurring within the following 3 weeks. Increase in velocity preceded clinical symptoms and could therefore be used as a prognostic factor for the management of patients with subarachnoid hemorrhage. The data also indicated that the extent and location of blood in the subarachnoid space determine the severity and location of vasospasm.]

Clinical Neuroscience

[Elective extra-intracranial arterial bypass in the treatment of giant aneurysms of the carotid artery]

BODOSI Mihály, DÓCZI Tamás, BARZÓ Pál

[Clinical details are presented of 5 patients with a giant carotid aneurysm in whom both the occlusion of the aneurysm and the parent internal carotid artery were performed with an extra-intracranial arterial bypass. In the first case ligature of the giant carotid-ophthalmic aneurysm narrowed the parent artery critically and hemiplegia developed. The bypass operation did not improve the clinical outcome. In the second case the occlusion of the aneurysm was performed after an extra-intracranial anastomosis and in spite of the severely narrowed carotid artery the postoperative course was uneventful. In three cases of giant intracavernous aneurysm the occlusion of the carotid artery on the neck and just proximal to the ophthalmic artery was performed in the presence of an arterial bypass. All of the anastomoses were patent and no ischemic event developed during the follow up period. On the basis of these experiences the authors suggest that, if the preoperative tests (TCD, EEG, SPECT) reveal impending ischemic lesion after carotid compression, surgery should be performed with the combination of extra-intracranial bypass.]

Clinical Neuroscience

[Experimental and clinical methods for the measurement of cerebral blood volume]

BERECZKI Dániel, LING Wei, TADAHIRO Otsuka, VIRGIS Acuff, KURT Gruber, CLIFFORD Patlak, JOSEPH Fenstermacher

[A review is given of the methods utilized in evaluating of regional cerebral blood content, both in animal experiments of and the clinical studies with emphasis on the importance and methodological problems of these measurements. A new, double radiolabel method is presented, which is suitable to determine blood content in tissue chunks of 10–30 mg. Red cells are labeled in vivo by 55Fe. The labelled donor” red cells are mixed with 1251-labelled serum albumin and injected intravenously to experimental rats. Red cell and plasma distribution spaces are measured after 3 min circulation time. Regional blood volumes range from 7-30 ul/g, with lowest values in the white matter. Tissue (microvascular) hematocrit is 25-30% lower than large vessel hematocrit.]

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Clinical Neuroscience

Combination of severe facial and cervical vascular malformation with obstructive sleep apnea syndrome: diagnostic and therapeutic approaches

FALUDI Béla, IMRE Marianna, BÜKI András, KOMOLY Sámuel, LUJBER László

The combination of obstructive sleep apnea syndrome and vascular malformation within the head and neck region is a rare condition, and interestingly, only a few cases have recently been published. Propagation of the vascular mass to the larynx and pharynx can cause breathing and swallowing difficulties. Due to these sypmtoms, examination and initiation of appropriate therapy for such patients are indeed challenging. We reviewed the literature available and present our case of a 64 year old woman emphasizing the complaints of sleep apnea syndrome and vascular malformation of the face and neck region. Polygraphic examination detected severe obstructive sleep apnea syndrome. The MR examination of the neck revealed extensive vascular mass narrowing the pharyngo-laryngeal region, thereby causing temporal bone destruction on the right side with intracranial propagation. ENT examination demonstrated significant narrowing of the pharyngeal lumen and the laryngeal aditus caused by multiple hemangiomas. CPAP titration showed the minimalization of the apnea-hypopnea index on the effective pressure level. Regular CPAP usage resulted in diminishing a majority of the patient’s complaints. Our examination clearly demonstrates, obstructive sleep apnea syndrome coupled with significantly obstructing vascular malformation in the head and neck region can be effectively treated safely with a CPAP device, if surgical therapy is not possible. We summarized our findings and the data available in the literature to set up recommendations for the appropriate examination and therapy (including mask fit, etc.) of vascular malformations and hemangiomas causing pharyngo-laryngeal obstruction.

Clinical Neuroscience

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KENÉZ József, BARSI Péter

[In the article digital imaging methods are presented with special emphasis on the use on diagnostics of cerebral circulation studies. Recently, fundamental changes have happened in this field, concerning especially the MR investigations. These changes have influenced the therapeutic strategies of ischaemic stroke. Authors give the theoretical background on the diffusion and perfusion MR imaging, emphasising the importance of their “mismatch” and its impact in the estimation of the outcome of ischaemic events. More recently, new, controversial facts arose, regarding the reasons of the introduction of the theory of so called “negative” and “positive” mismatches. As a consequence, a level of uncertainty took place in the judgement of prognostics. The leading institutions are searching the way to solve the problem which seems to be the quantitative evaluation of the diffusion, perfusion and mismatch data. The advent of the multislice spiral CT with very fast imaging and the importance of CT investigations increased. With this new kind of equipment, even perfusion studies can be performed using iodinated contrast medium.]