J. Keith Campbell

Computed Tomography and Radionuclide Imaging in the Evaluation of Ischemic Stroke

One hundred forty-one patients with cerebral or cerebellar infarction were examined by computed tomography (CT) as soon after the ictus as possible. The examination was repeated in 7 days, and a radionuclide brain scan was performed. The overall detection rate for ischemic infarction was approximately equal for both techniques, ranging from 58% for radionuclide scanning to 66% for the delayed CT. Almost half of the supratentorial infarcts examined by CT on the day of the ictus were demonstrated. Mass effect was observed as early as the first day and as late as the 25th day.

Early experience with the EMI scanner for study of the brain.

Computed tomography of the head is highly accurate new radiologic technique for the evaluation of neurologic disease. Analysis of early cases indicates that the appearance produced by CT in some conditions is unique and that increasing experience allows the neuroradiologist to predict the position and nature of disease processes with greater accuracy.

An Overview of the Diagnosis and Pharmacologie Treatment of Migraine

Migraine, an episodic headache disorder, is one of the most common complaints encountered by primary-care physicians and neurologists. Nevertheless, it remains underdiagnosed and undertreated. Rational migraine treatment necessitates an accurate diagnosis, identification and removal of potential triggering factors, and, frequently, pharmacologic intervention. Effective management also includes establishing realistic expectations, patient reassurance, and education. The choice of medication (abortive, symptomatic) for an acute attack depends on such factors as the severity of the attack, presence or absence of vomiting, time of onset to peak pain, rate of bioavailability of the drug, comorbid medical conditions, and side-effect profile. Effective agents for acute attacks include simple or combination analgesics, nonsteroidal anti-inflammatory drugs, ergot derivatives, selective serotonin agonists, and antiemetics. Opioid analgesics are unnecessary for most patients. The choice of preventive (prophylactic, interval) medication depends primarily on comorbid medical conditions and side-effect profile. Useful preventive agents include beta-adrenergic blockers, calcium channel blockers, tricyclic antidepressants, anticonvulsant medications, and serotonin antagonists.

Diagnosis and treatment of cluster headache

Cluster headache (CH) is a rare form of headache occurring in both episodic and chronic forms. The painful attacks are short-lived, occur unilaterally, and are associated with signs and symptoms of autonomic involvement. Attacks frequently occur at night and can be precipitated by ingestion of alcohol. In the episodic form, attacks occur daily for some weeks followed by a period of remission. In the chronic form, attacks can continue for years. Inheritance is not a factor in CH. Treatment can be symptomatic or prophylactic. Agents used to treat individual attacks include inhalation of oxygen, rapidly acting forms of ergotamine and dihydroergotamine, and sumatriptan. Prophylactic treatment employs calcium-channel-blocking agents, methysergide, lithium, and corticosteroids. Surgical modalities, notably thermocoagulation of the gasserian ganglion, can provide relief in those who are resistant to medical management.

Neurovascular Complications of Dialysis and Transplantation

Dialysis and transplantation are now standard treatments for end-stage renal failure. Often, neurologists are consulted regarding the neurological complications of these therapeutic procedures. In addition to previously reported complications, neurovascular disease is being recognized as a cause of mortality and morbidity in these patients. We report two cases of apparent thromboembolic stroke in young patients with renal failure — one treated by dialysis and the other by renal transplantation. The risk factors of both dialysis and transplant are identified and data from the American College of Surgeons/National Institutes of Health Transplant Registry are reviewed.

Bypass and transluminal dilatation procedures for advanced occlusive disease of the posterior circulation

Differences in the patterns of occlusive vascular disease in the posterior circulation when contrasted with those in the anterior circulation make it necessary that different types of operative procedures be developed for the management of posterior circulation occlusive disease. The vast majority of patients with symptoms of ischaemia in the posterior circulation can be managed medically. The only indications for operation in this system are the progression or continuation of major symptoms in a patient who is on adequate medical therapy and who has angiographically proven major vessel occlusions or stenoses that produce a haemodynamically significant obstruction to flow. Patients who have been accepted for operation have fulfilled these criteria. Five basic procedures have been developed. The number of different procedures attempted emphasizes the difficulty in the management of these patients and obviously relates to the fact that we have found no single procedure that is applicable to all patients or which is totally reliable. These operations have included: 1) occipital to posterior inferior cerebellar artery bypass procedures, 2) superficial temporal artery to proximal superior cerebellar artery or anterior temporal branch of posterior cerebral artery bypass pedicle flaps for basilar artery stenosis, 3) transluminal angioplastic procedures for focal basilar artery stenosis, 4) interposition saphenous vein bypass grafts between the resected stump of the external carotid artery and the proximal posterior cerebral artery at the tentorial notch, and 5) intracranial transposition bypass procedures which have included side-to-side anastomosis between the posterior cerebral artery and superior cerebellar artery. In all 62 patients having been operated on (May, 1981) have been used the various techniques described above. The results and complications will be discussed in detail. Our experience indicates that each of the above operative procedures may have a role in the management of occlusive disease except those operations which use a superficial temporal artery as the donor pedicle.