Charles R. Simmons

Occlusion of the intradural vertebrobasilar artery

SummaryThe diagnosis of occlusion of the intradural vertebrobasilar artery (OIDVBA) was made by means of cerebral angiography in 22 patients. The clinical presentation, course and followup were studied in conjunction with the angiographic findings in each case and the following conclusions made. OIDVBA is not rare. It occurs one-fourth as often as occlusion of the carotid artery. The correct diagnosis is not made clinically before angiography in the majority of patients. Complete visualization of the neck and intracranial vasculature is necessary to document the occlusion. Atherosclerotic thrombosis is the most common type of occlusive lesion. The most common predisposing factors are atherosclerosis, hypertensive cardiovascular disease, diabetes mellitus, and developmental vertebrobasilar hypoplasia. Most patients with occlusion are in the 7th and 8th decades of life and transient attacks of vertebrobasilar ischemia precede the occlusion in one-half of the cases. Emboli usually lodge in the terminal portion of the basilar artery whereas thrombotic occlusions tend not to be located in a characteristic segment. A majority of patients diagnosed angiographically survive their OIDVBA, but most distal occlusions result in death, often following several weeks of coma. In the surviving majority, disturbance of gait, impairment of vision, and symptoms of transient vertebrobasilar ischemia are the most common sequelae.

Polymyalgia Arteritica with Bilateral Subclavian Artery Occlusive Disease: A Case Report

A brief description of polymyalgia arteritica is given. A case summary is included to demonstrate the less commonly appreciated manifestations of the illness, i.e., peripheral arterial occlusions. Angiography may play an important role in diagnosing those cases involving manifestations of arteritis.

Loculated Intracranial Aneurysms: Angiography and Possible Etiology

Four-vessel femorocerebral angiography on 51 patients revealed 60 aneurysm of the circle of Willis or its major branches. Of these, 20 were multichambered or loculated and 10 had more than two chambers. Subarachnoid bleeding did not always occur, suggesting that loculations may represent areas of localized weakness on a parent aneurysm. Dye indicator studies on model aneurysms showed delayed dye retention beneath the aneurysm dome with turbulent flow, increased flow velocity, thicker aneurysm walls, increased pulse frequency, and smaller “necks.” Certain hemodynamic conditions could predispose to abrupt flow changes, resulting in aneurysm wall hypoxia, wall weakness, and regional loculation.

Selective visceral angiography in the diagnosis and treatment of gastrointestinal hemorrhage

Abstract Visceral angiography has been proved to be a valuable addition to the diagnostic armamentarium for acute and chronic gastrointestinal bleeding. Selective visceral arterial infusion of Pitressin is helpful in the control of acute gastrointestinal bleeding. In those patients who received Pitressin, 67 per cent had control of bleeding and in nine of eighteen (50 per cent) surgery was avoided. In patients whose bleeding was controlled by Pitressin there were no deaths resulting from recurrent bleeding of the original lesion. The use of Pitressin seems especially indicated in the management of acute gastrointestinal bleeding in a patient who is a poor surgical risk because of systemic disease, abdominal wall or intraperitoneal sepsis, stress ulcer syndrome, hemorrhagic gastritis, esophagogastric varices, and colonic lesions such as diverticulosis.