James I. Ausman

Acute cerebral revascularization after regional cerebral ischemia in the dog. Part 2: Clinicopathological correlation.

The efficacy of cerebral revascularization by anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA), performed 4 and 24 hours after a regional MCA infarction had been produced by combined occlusion of the MCA and internal carotid artery, was tested in 12 dogs. To control possible intercurrent variables, seven other dogs remained untreated and five had a sham operation. Clinical and pathological changes were recorded and analyzed. An incidence of 85% infarction was obtained in the untreated control group. The severity of the clinical deficits and pathological changes for the anastomosed groups were greater than those seen in the untreated control group. The extent of the infarction was significantly greater (p less than 0.05) in the anastomosed groups than in the sham-operated and control groups. Hemorrhagic infarcts occurred in most of the dogs in the anastomosed groups, but were not present in either control group (p less than 0.05). Two dogs in the 4-hour and one in the 24-hour group improved more than any control dog, but the difference was not statistically significant (p greater than 0.05). In two dogs with occluded anastomosis the clinical deficits and the pathological changes were less than those seen in animals with patent anastomosis. The severity of the pathological and clinical changes correlated well with the reestablishment of flow in the MCA territory. It is proposed that cerebral revascularization at 4 and 24 hours following a regional MCA infarct in the dog is followed by an exacerbation of the microcirculatory obstruction, cerebral edema, and infarction. From improvement noted in three animals the authors suggest that under special conditions the revascularization could benefit some cases following acute cerebral infarction.

Intraparenchymal embolization for obliteration of an intramedullary AVM of the spinal cord: Technical note

A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used.

New Developments in Anticonvulsant Therapy

As we learn more about the anticonvulsant drugs, we find it easier to understand the apparent failure of these agents to control epilepsy in about one of four patients and also the apparent toxicity of usual dosages in certain patients. Most of the new information in this area concerns the drugs diphenylhydantoin and phenobarbital. A practical approach to management of epileptics is outlined.

Intraparenchymal embolization for obliteration of an intramedullary AVM of the spinal cord. Technical note

A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used.