William A. Weidner

Dural Arteriovenous Malformation in the Posterior Fossa

Arteriovenous malformations that involve the dura of the posterior fossa are rare, and they are therefore seldom considered in the differential diagnosis of posterior fossa lesions. Such malformations may involve the tentorium and the dura that covers the remainder of the posterior fossa. Their presence and extent can be evaluated accurately only by angiography. The purpose of this report is to present the clinical and angiographic features of 16 patients with dural arteriovenous malformations of the posterior fossa. These patients were studied either at the University of California Medical Center at San Francisco or Los Angeles or at the Karolinska Hospital in Stockholm, Sweden. Clinical Features The clinical features of the 9 males and 7 females are summarized in Table I. The ages ranged from one to sixty-eight years. In 11 patients a pulse-synchronous bruit was audible either at the vertex or over the mastoid region. Of these patients, 7 complained of hearing a pulsatile buzzing sound. Both the bruit a...

INTRACRANIAL COLLATERAL CIRCULATION VIA LEPTOMENINGEAL AND RETE MIRABILE ANASTOMOSES.

EMBOLIC OR THROMBOTIC occlusions of intracranial arteries are followed by adjustments in the distribution of blood through the circle of Willis, external-internal carotid communication by way of the opthalmic artery, leptomeningeal arterial anastomosis, and, occasionally, the rete mirable. Angiographic analyses of changes in flow through the circle of Willis as a result of intracranial arterial occlusive disease are well known. The purpose of this report is to discuss our technique of angiographic demonstration of leptomeningeal and rete mirabile arterial anastomosis with illustrative cases. Angiographic criteria for the diagnosis of intracranial arterial occlusion will be illustrated and discussed. The demonstration of these occlusions requires special radiological equipment, and the technique of selective carotid angiography simplifies the procedure. Selective internal carotid angiography by the catheter technique offers certain advantages in the diagnosis of intracranial arterial occlusions in the visualization of collateral circulation. Occlusions of large intracranial arteries rarely present any diagnostic problems, but, when a small branch is occluded, the diagnosis may be difficult. In these cases, overlapping branches of the external carotid may be very confusing, and, if complete filling of the peripheral branches of the intracranial arteries is not obtained, collateral circulation via leptomeningeal arteries may not be seen. Leptomeningeal arteries. There is an extensive arteriolar network over the surface of the cerebral cortex which is, in effect, a mantle in the pia mater supplied by the internal carotid and vertebral arteries. The conducting arteries connect with one another through this extensive arteriolar network via anastomotic vessels called leptomeningeal arteries. Heubner,l in 1874, first demonstrated these anastomotic vessels. Fay,z in 1925, injected metallic mercury via a cannula in the middle cerebral artery at autopsy and demonstrated anastoniotic arteries on stereoscopic roentgenograms. Cobb,3 in 1931, reported his studies of the anatomy of the cerebral circulation and stated that there are no end arteries in the brain. Vander Eecken and A d a r n ~ , ~ in 1935, described the anatomy of the meningeal arterial anastomoses in adults and children and discussed their functional significance. The leptomeningeal arteries lie in the depths of the sulci of the brain and vary from 180 to 610 p in diameter. Some of the arteries form loops to anastomose with others, while some may have oblique or branched configurations.4 Collateral circulation via these vessels has been demonstrated angiographically by a number of authors.5-7 Rete mirahle. The rete mirabile, or “wonderful net,” refers to anastomotic vessels joining the meningeal arteries from the external carotid artery with the leptomeningeal arteries on the surface of the brain.s-lo

Recurrent Pulmonary Emboli Secondary to Right Atrial Thrombus Around a Permanent Pacing Catheter: A Case Report and Review of the Literature

A case report and review of the literature.

The Complications of Cirrhosis of the Liver

Excerpt Dr. Marshall J. Orloff: This conference will review the natural history of cirrhosis of the liver and the treatment of the disease and its complications. A case to be presented by Dr. Lipma...

Roentgenographic Demonstration of Intrapulmonary and Pleural Lymphatics During Lymphanqioqraphy

The authors report the demonstration of intrapulmonary and pleural lymphatics during lymphangiography. In a case of bilateral chylothorax the etiology was shown by reflux from the thoracic duct retrograde to visceral pleural lymphatics. Valvular insufficiency in the mediastinal and pulmonary lymphatics was present, a manifestation of a mild form of congenital pulmonary lymphangiectasis. A similar mechanism of reflux into parietal pleural lymphatics occurred in the second case, one of lymphosarcoma.

Pheochromocytoma of the Prostate: An Unusual Location

We report a case of pheochromocytoma of the prostate. The clinical presentation, diagnostic evaluation, therapy and pathological findings are discussed.

Magnetic resonance imaging in leukodystrophies of childhood

Magnetic resonance imaging (MRI) is particularly valuable in the diagnosis of childhood brain disorders with abnormal myelination because MRI may identify lesions not always seen with x-ray CT scans. We report the clinical and magnetic resonance findings of six children with leukodystrophy. T2 weighted (spin-echo) images disclosed striking asymmetric involvement of cerebral white matter, particularly in periventricular white matter and visual radiations. Calculated T1 values were significantly elevated in the children with leukodystrophy.

Percutaneous transaxillary selective coronary angiography.

The basic premise of optimal angiography is to deliver the contrast material selectively to the arterial bed under investigation. This applies to the coronary arterial bed as well as other areas of the body. In 1959, Mason Sones reported his technic of selective catheterization of the coronary arteries with a specially designed catheter (9). The coronary angiograms Sones produced are of such excellence that all other methods must be compared and evaluated with reference to his results. We have modified his basic technic (7–9) by omitting the surgical exposure of the brachial artery and open arteriotomy and substituting instead the percutaneous transaxillary Seldinger approach (2, 6). Advantages of the percutaneous transaxillary approach include those of the Seldinger technic versus open arteriotomy: the ability to re-examine the patient via the same artery, if necessary, after review of the angiogram and on an annual basis to evaluate therapeutic programs. A technical advantage is the fact that the axilla...

Xanthogranulomatous pyelonephritis: angiographic considerations.

THE ANGIOGRAPHIC pattern elicited by focal parenchymal and vascular injury is distinctive in most cases of pyelonephritis. Xanthogranulomatous pyelonephritis is an unusual form of chronic pyelonephritis, often presenting as a dominantly proliferative mass, with few symptoms typical of acute or chronic infection. It may be confused, both clinically and radiographically, with other benign nephropathies as well as with carcinoma of the kidney (1, 2). The histologic appearance is characterized by replacement of renal parenchyma by lipidladen macrophages within areas of granulomatous reaction. Rios-Dalenz and Peacock (3) in 1966 recorded 67 cases in a search of the literature and described 4 of their own. In the same year Becker (4) included an angiographic description, reportedly the first, in his case presentation. An awareness of the condition is essential, particularly with the availability of selective angiography in evaluating renal lesions. This report includes two cases of xanthogranulomatous pyeloneph...

THE PNEUMOENCEPHALOGRAM IN HUNTINGTON'S CHOREA.

HUNTINGTON’S CHOREA classically consists of 5 characteristics. They are: (1) onset in middle life (average age 35 to 50 years); ( 2 ) choreiform movements or rigidity, or both; ( 3 ) mental deterioration; (4) progression of the movement and mental symptoms; and ( 5 ) a family history of the illness. The illness is quite protean in its onset. The age range is large and childhood cases have been rep0rted.l The movement or mental symptoms may manifest themselves first and one or the other may be the only manifestation initially. In Davenport and Muncy’s large series of 962 cases,2 even progression was found not to be universally true. The recent description of this disease in all races would suggest that Huntington’s chorea, though a genetic dominant, must have a fairly high rate of mutation. This factor is also suggested by the numerous spontaneous cases seen in most large clinics. Thus, even the family history may be lacking.3 The social and eugenic significance of this dominant hereditary disease is so important in the families of patients suspected of having Huntington’s chorea that a confirmatory diagnostic criteria was sought. Because of the dis-