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Agnita J. W. Boon, Joseph T. J. Tans, Ernst J. Delwel, Saskia M. Egeler-Peerdeman, Patrick W. Hanlo, Hans A. L. Wurzer and Jo Hermans

, 13, 17, 22, 38 The lack of correlation between Rcsf, baseline CSF pressure, and ventricular size also indicates that increased Rcsf is not the only causative factor. 4, 5, 21, 39 Several authors have drawn attention to the association between cerebrovascular disease and idiopathic NPH. Risk factors for cerebrovascular disease were found significantly more often among patients with NPH than among controls. 10, 16, 24 Evidence of cerebrovascular disease such as white matter hypodense lesions on computerized tomography (CT) scanning was also more common among

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Hajime Touho, Jun Karasawa, Hisashi Shishido, Toshitaka Morisako, Keisuke Yamada and Keiji Shibamoto

detrimental. 40 In severely burned children, relief from metabolic deficits reverses many of the immunological abnormalities and reduces the incidence of mortality from sepsis. 1 To date, the metabolic response to hemorrhagic cerebrovascular diseases has not been fully studied. 48 An understanding of the factors influencing the general metabolic state in patients with subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm and hypertensive intracerebral hemorrhage would help in planning attempts to meet the metabolic demands. In this study, energy expenditure

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Humbert G. Sullivan, Theodore B. Kingsbury IV, Mary E. Morgan, Ronnie D. Jeffcoat, Jerry D. Allison, Jamie J. Goode and Dennis E. McDonnell

would improve the diagnostic accuracy of this procedure in determining when rCBF is impaired by an occlusive lesion. The rCBF norms over a wide age range for both resting and Diamox-activated states are presented, and the use of these norms in evaluating patients with cerebrovascular occlusions is reported. Subjects and Methods Measurement of rCBF and Protocol for rCBF Studies A 20-detector xenon-133 ( 133 Xe) inhalation system 26 was employed to measure rCBF in the gray matter in 55 normal subjects and 20 patients with presumed cerebrovascular disease

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William J. Powers, Robert L. Grubb Jr. and Marcus E. Raichle

T he importance of hemodynamic factors in the pathogenesis of ischemic cerebrovascular disease remains unclear. Clarifying this issue is of clinical importance since thromboinhibitory drugs, no matter how effective, can do little to prevent cerebral infarction produced by decreases in regional cerebral perfusion pressure (rCPP) distal to occlusive disease of the carotid or vertebral arterial systems. Surgical revascularization procedures have the potential to improve rCPP and regional cerebral blood flow (rCBF) to such areas and to prevent hemodynamic

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Robert E. Harbaugh, Daniel S. Schlusselberg, Robert Jeffery, Shawn Hayden, Laurence D. Cromwell and Daniel Pluta

vasculature and the surrounding structures. We present our early experience with the use of three-dimensional CT angiography in 20 patients with known or suspected cerebrovascular disease. Clinical Material and Methods In this procedure, CT * is performed usually with the patient in the supine position, with the orbitomeatal line perpendicular to the floor. No gantry angulation is used. The angle of the head is, however, not critical as long as the CT scan slices cover the entire field of interest. A scout view of the head and upper cervical spine is obtained. A No

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Sepideh Amin-Hanjani, William E. Butler, Christopher S. Ogilvy, Bob S. Carter and Fred G. Barker II

E xtracranial—intracranial bypass surgery was widely used during the 1970s and early 1980s to treat occlusive cerebrovascular disease that was not amenable to carotid endarterectomy. 23, 98, 103 After 1985, when the randomized multicenter EC—IC Bypass Study failed to demonstrate efficacy for the operation, 33, 34 the number of EC—IC bypass operations performed annually fell sharply. Some groups have recently attempted to define a subgroup of patients who, following CA occlusion, are at high risk for symptomatic ischemic events and might benefit from an EC

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Ramachandra P. Tummala, Ray M. Chu and Eric S. Nussbaum

Object

The role of cerebral revascularization remains unclear in symptomatic occlusive cerebrovascular disease refractory to medical therapy. Despite the disappointing findings of the Cooperative Study on Extracranial–Intracranial Bypass, a subpopulation of patients with ischemic cerebrovascular disease and poor hemodynamic reserve may benefit from extracranial–intracranial (EC–IC) bypass. The authors reviewed the records of 65 patients who underwent 71 EC–IC bypass procedures at their institution over the past 6 years.

Methods

All patients except one presented with repeated transient ischemic attacks (TIAs) that were referable to the involved vascular region. Eight patients underwent EC–IC bypass urgently for “crescendo” TIAs refractory to anti-platelet and anticoagulation therapy. Indications for surgery included cervical internal carotid artery (ICA) occlusion in 28, supraclinoid ICA stenosis in two, middle cerebral artery stenosis or occlusion in 14, moyamoya disease in 18, and ICA dissection in three. Cerebral angiography demonstrated poor collateral flow to the involved region in each case. There were no postoperative strokes or deaths in this series. Following EC–IC bypass, the vast majority (95.4%) of patients experienced cessation of their ischemic events and stabilization of preexisting neurological dysfunction. Of the eight patients who underwent EC–IC bypass urgently for crescendo TIAs, two awoke with increased neurological deficits that improved rapidly within 24 hours of surgery.

Conclusions

Although the Cooperative Study failed to show benefit from this treatment modality, the authors have continued to perform EC–IC bypass in certain cases. Carefully selected individuals with occlusive cerebrovascular disease and persistent ischemic symptoms refractory to maximal medical therapy appear to benefit from cerebral revascularization.

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H. F. W. Pribram

T he role of the extracranial vessels in cerebrovascular disease was suspected as long ago as the end of the nineteenth century but it remained for Hutchinson and Yates 4, 5, 10 to define the incidence and segmental nature of arteriosclerosis in these vessels. Eastcott et al. 3 reported the first successful attempt of carotid surgery in 1954 and later concluded that the best results were obtained in cases of partial occlusion. 8 The importance of early diagnosis thus becomes manifest. Many well known clinical findings have, however, proved unreliable and

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Frederick W. Pitts, Marvin E. Haskin, Helena E. Riggs and Robert A. Groff

. Scarcella , G. Encephalomalacia simulating the clinical and radiological aspects of brain tumor. A report of 6 cases . J. Neurosurg. , 1956 , 13 : 366 – 380 . Scarcella , G. Encephalomalacia simulating the clinical and radiological aspects of brain tumor. A report of 6 cases. J. Neurosurg. , 1956, 13: 366–380. 8. Smiley , G. L. Occlusive cerebrovascular disease simulating brain tumor. Angiographic differentiation . Arch. Neurol. Psychiat., Chicago , 1952 , 67 : 633 – 640 . Smiley , G. L. Occlusive

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Shunsuke Nomura, Koji Yamaguchi, Tatsuya Ishikawa, Akitsugu Kawashima, Yoshikazu Okada and Takakazu Kawamata

T he discussion on the effectiveness of extracranial-intracranial (ECIC) bypass for chronic steno-occlusive cerebrovascular disease continues worldwide, even after the Carotid Occlusion Surgery Study (COSS) in the United States. 1 , 9 Although some studies such as the COSS have disproved the superior efficacy of the ECIC bypass over medical therapy, 9 the Japanese EC-IC Bypass Trial (JET) revealed the procedure’s effectiveness in a selected population with hemodynamic instability (data from the JET have not been reported in print, peer-reviewed, English