摘要:

A patient died after therapeutic bucrylate embolization and resection of a right occipital arteriovenous malformation, which received significant blood supply from the right posterior cerebral artery. At autopsy, there was marked diffuse neuron loss and gliosis in all cell layers of the right hippocampus—pathology which we hypothesize was secondary to a ‘Steal’ of blood from this structure into the malformation. This report represents pathologic evidence for a phenomenon believed to be of major clinical importance in the symptomatology of many AVMs.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Two patients with osteopetrosis were studied in whom severe stenosis of one or both internal carotid arteries was demonstrated. One patient had autosomal dominant osteopetrosis and the other patient had the autosomal recessive form of the disease. In one patient, probable occlusion of one internal jugular vein and retrograde thrombosis of the contributing dural venous sinuses was present. Venous drainage of parts of the brain occurred through dilated emissary and scalp veins. It appears that major extracranial vessels may be impinged upon by dysplastic bone in osteopetrosis, although this is the first report of such an occurrence. A posterior fossa aneurysm was present in one case, and may have been related to abnormal intracranial hemodynamics.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The main complication of anticoagulant therapy is bleeding. Although the use of long‐term oral anticoagulants in patients with transient cerebral ischemia and/or minor stroke is controversial, anticoagulants are still used in some instances. We have carried out a literature review of the risk of hemorrhage during long‐term oral anticoagulant therapy in patients with cerebrovascular disease to determine the rate of bleeding and the clinical and laboratory risk factors which predispose patients to bleeding. The risk of bleeding was substantial with major bleeding episodes ranging from 2% to 22% per year and fatal bleeds from 2% to 9% per year. Only hypertension emerged as an identifiable risk factor and its presence increased the relative risk of bleeding to more than two fold. Major bleeding was almost always intracranial, possibly because of associated hypertension or because of cerebrovascular disease per se. We could not detect a relationship between bleeding and the intensity of anticoagulant therapy, although major bleeding occurred frequently even with only moderately intense anticoagulant therapy. The net gain or loss in efficacy rate of treating patients with minor stroke with long‐term oral anticoagulant therapy was examined and it was concluded that in order for such treatment to be beneficial, a risk reduction of more than 50% in stroke rate, and a major bleeding rate of less than 2% per year are required. Since the risk reduction for stroke and death with anticoagulant therapy is unlikely to be 50% and the risk of major bleeding likely to be more than 2%, the present evidence does not support the use of anticoagulant therapy in minor stroke.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Moyamoya disease presents clinically as chronic progressive ischemia in the young brain. The brain is surrounded by concentric collateral networks but all of these networks are not available as collaterals in the early stage of cerebral ischemia. The anatomical characteristics precluding their early use include the presence of the watery layer of subarachnoid fluid between the cortical and dural vessels and of a closed bony box intervening between the dural and scalp arterial networks. These barriers isolate the brain from the abundant blood flow of the external carotid system as if they were the moat (the subarachnoid fluid layer) and the walls (the skull) of a castle.Based on these concepts, we have developed a surgical procedure, the encephalo‐duro‐arterio‐synangiosis to treat moyamoya disease in children. This operation surmounts the above mentioned two obstacles to collateral formation to the brain by perforating the castle wall and bridging the moat by granulation tissue, without injuring the collaterals which are already formed.This procedure was performed on 70 sides in 38 pediatric moyamoya patients. Revascularisation of the brain was obtained in 100 percent of the cases with varying improvement in the symptoms.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID