James S. Teal

Longitudinal evaluation of patients with untreated prolactin-secreting pituitary adenomas

A group of 43 patients with galactorrhea, hyperprolactinemia, and radiographic evidence of pituitary adenomas were followed from 3 to 20 years. Initial polytomography and computerized tomographic (CT) scans revealed no evidence of extrasellar extension. Serum levels of prolactin (PRL) were measured at 6 month intervals, and visual fields were assessed annually. Polytomograms and CT scans were repeated every 9 to 36 months. During the period of follow-up, CT scans (but not polytomograms) indicated tumor enlargement in two patients, both of whom underwent selective transsphenoidal removal of the tumor. Polytomograms and CT scans did not show any change in the other 41 patients, and three of them have resumed normal menses, are no longer lactating, and have normal PRL levels. The initial results of this ongoing study indicate that most patients with small pituitary adenomas can be followed with annual CT scans with or without medical therapy, and that surgical treatment should be reserved for those patients with large tumors, those with visual-field loss, and those who show signs of enlargement of the tumor.

Anomalous Branches of the Internal Cartoid Artery

Anomalous branches of the internal carotid artery are rarely demonstrated angiographically. Cases of the ascending pharyngeal, occipital, Vidian (pterygoid canal), and posterior inferior cerebellar arteries arising from the internal carotid artery are presented. A case of anomalous origin of the anterior cerebral artery from the internal carotid artery at the level of origin of the ophthalmic artery is also described. Brief embryological explanations of the vascular anomalies are given.

Cerebral Vascular Changes Secondary to Amphetamine Abuse in the Experimental Animal

Five adult Rhesus monkeys were given intravenous methamphetamine during a two-week period and then sacrificed. Immediately following injection, 3 animals showed decreased caliber of some of the small cerebral arteries with slow flow or absence of flow in some vessels. In 2 animals severe generalized arterial spasm developed during the two-week period. All 5 animals at necropsy demonstrated extensive brain damage. There were focal areas of ischemia and infarction and generalized areas of cerebral edema and ischemic nerve cell changes. The drug dose was in the range followed by some addicts.

Angiographic Demonstration of Fenestrations of the Intradural Intracranial Arteries

Fenestration or partial duplication of intracranial arteries is noted occasionally during anatomical dissection. Since the phenomenon is rarely described in the literature, the authors present 5 recently observed cases, with a brief explanation of the proposed embryology and potential clinical significance.

Computed tomography of posterior fossa trauma.

Abstract A group of 1,700 cases of head trauma were reviewed to determine the incidence of posterior fossa injuries and to assess the value of computed tomography (CT) in their diagnosis and management. In 57 cases (3.3%), the most significant and primary injuries were within the posterior fossa. These included epidural hematoma (EDH), acute and chronic subdural hematoma (SDH), and parenchymal hemorrhage and contusion of the cerebellum and brainstem. The prognosis varies with the location and severity of the injury. Brainstem injuries are associated with a high mortality rate. Computed tomography proves particularly useful in the early recognition of brainstem injury. The demonstration by CT of obliteration of the cisterns surrounding the brainstem is a reliable sign of a grave prognosis in brainstem injury. Contrast enhancement is useful in demonstrating whether the dural sinuses are displaced, thus differentiating EDH from SDH. Except in the rare case of vascular injury unassociated with EDH, CT correlated with the neurological examination is an accurate method of determining the nature, location, and extent of significant posterior fossa injury. Scans of high quality are mandatory, and frequent supplementary contrast studies are recommended.

Persistent Carotid-Superior Cerebellar Artery Anastomosis: A Variant of Persistent Trigeminal Artery

Abstract The embryology and anatomy of the trigeminal artery are reviewed, and one case of persistent carotid-superior cerebellar artery anastomosis without an interposed segment of basilar artery is demonstrated angiographically. This anomaly apparently has not been reported previously, either angiographically or anatomically. An embryological explanation for this anomalous anastomosis is proposed. Two more typical presentations of persistent trigeminal artery are also included.

Diagnostic and prognostic implications of computed tomography of head trauma.

A total of 210 cases of head trauma were examined using noncontrast enhanced and contrast enhanced computed tomography scans. Evidence of contrast enhancement was seen in 97 cases (46%). Subdural hematoma and focal contusion were the most frequent entities demonstrating contrast enhancement. This finding was also frequently seen in patients with intraventricular hemorrhage (IVH) (5 of 17). Every one of the five patients in this series with IVH whose scans showed enhancement died, whereas out of the 12 whose scans showed no enhancement, five survived. Illustrative cases are presented. The authors feel that contrast enhanced scans are valuable in the evaluation of the full extent of head trauma.

Cerebral microvascular injury in experimental drug abuse.

An experimental drug abuse research project is reported, in which monkeys and rats were placed on various I.V. amphetamine (Desoxyn) and I.V. barbiturate (Seconal) regimes. The monkeys were studied by serial cerebral angiography. At the end of the study all animals were sacrificed for histological examination. I.V. methamphetamine produced relatively severe cerebral vascular injury and brain damage in most animals. At least part of the damage seemed to be the result of direct vascular injury, arterial and venous. The misuse of Seconal and Ritalin also appeared to be hazardous, but these studies are incomplete, and the degree of hazard has not been fully evaluated.

Lateral position of the external carotid artery: a rare anomaly?

Lateral position of the external carotid artery has been infrequently reported and thus has been considered by many to represent a rare anomaly. In a series of 587 angiograms, this anomaly represents a common finding, with an incidence dependent upon the side of the body and the age of the patient. There was a greater incidence of this finding in patients over 40 years of age, and it was more commonly seen on the right than on the left.

Ventricular Opacification During Carotid Angiography Secondary to Rupture of Intracranial Aneurysm: Case Report

Rupture of intracranial aneurysms during cerebral angiography is a rare occurrence. A case of such a rupture with extravasation of contrast material into the cerebral ventricular system and onto the floor of the middle cranial fossa is presented. The role of angiography as a possible causative factor is discussed.