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Peripheral Collateral Circulation Between Cerebral Arteries

A Demonstration by Angiography of the Meningeal Arterial Anastomoses

Harold Rosegay and Keasley Welch

walking; the gait was spastic. The left facial weakness was still present, the tendon reflexes were hyperactive on the left, and a left extensor plantar response was present. Movements of the left arm and hand were good, though paretic. On Nov. 19, 1953, the day of discharge, an evaluation of muscle function was as follows: “She walks well and bends the knee and ankle in the swinging phase. Hand function is good, and is better than shoulder function. Deltoid, biceps, and triceps are good. Thumb extension, flexion, abduction and opposition are only fair.” On Feb. 4

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Joseph A. Epstein, Robert Carras, Leroy S. Lavine and Bernard S. Epstein

with no evidence of new vertebral osteophytosis. The 5-year postoperative myelogram ( e ) discloses the spinal cord to be normal in transverse diameter with good filling of the lateral axillary regions. This patient made an excellent recovery with only minimal residual spasticity. An early return of sensation and improvement in ataxia and hand function were encouraging signs. Seven of the eight patients with “useless hands” improved significantly, six falling into the good result group. Stereoanesthesia subsided in all four patients with this deficit prior to

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Joseph A. Epstein, Robert Carras, Bernard S. Epstein and Leroy S. Levine

–5 0 arm atrophy hands, stereoanesthesia, mild spasticity, hyperreflexia good, employable, return of hand function 38 4 yrs upper cervical hyperlordosis, cervicodorsal kyphosis moderate C2–5 C6–7-T1 + arm old double athetosis, torticollis, atrophy hands, stereoanesthesia, hyperreflexia temporary, deterioration 2 months later 45 3 days (?) hyperlordosis slight C3–6 + arm and leg spastic gait, tetraparesis, hyperreflexia, recent CVA minimal improvement Long Tract Signs In all patients, long tract signs

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John A. Kusske and William A. Kelly

, progressive paresis of lt arm 43, lt hemiparesis, slurred speech, skull bruit, severe postictal paresis rt post. frontal, parietal, occipital, rt middle cerebral, rt post. cerebral, lt ant. cerebral one seizure every 2 mos, return of lt hand function neck wound infection, increased frequency of seizures early postop 10 18 F focal seizures intracerebral hemorrhage, lt hemiparesis, headaches 28, lt hemiparesis, intractable headaches rt frontal, rt middle cerebral no change 5 days of retinal ischemia O.D., normal vision now

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John I. Moseley and Robert W. Rand

fingers, and progressive bilateral weakness in hand function. This was accompanied with loss of sensation in both lower extremities and weakness in the left leg. She recently had episodes of acute urinary retention. A metrizamide myelogram disclosed cervical spinal cord widening at the C6–7 level, and spinal angiography demonstrated mild tumor vascularity. With the patient in the sitting position, laminectomy from C2–7 was performed to explore this intraspinal tumor, which later proved to be an ependymoma. The Jura was opened under view of the surgical microscope at

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David G. Kline, Joseph Kott, George Barnes and Lester Bryant

and the lower and middle trunks was done. At 4-year follow-up examination, this patient has a marked degree of improvement in hand function. Case 2 This 26-year-old man sustained a .38 caliber gunshot wound to the supraclavicular region in early July, 1974. The supraclavicular vessels had been explored on the day of injury by the General Surgery service and a subclavian vein injury was repaired without use of a graft. In addition, a severely comminuted fracture of the clavicle was resected. From the onset he had a severe loss of nerve activity in the

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George L. Bohmfalk and Jim L. Story

dexamethasone. Daily spinal taps were performed for removal of bloody CSF. After several days he responded to verbal stimuli with monosyllables, and followed some commands. On March 14, an angiogram revealed a small aneurysm of the left anterior cerebral artery ( Fig. 1 left ). By March 21, the patient was alert but confused, with excellent right hand function and no facial asymmetry. On March 24, he rapidly deteriorated, becoming unresponsive to pain, with semipurposeful movements and dense paresis of the right upper extremity. Lumbar puncture demonstrated clear CSF under

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Brachial plexus injury following axillary arteriography

Case report and review of the literature

Dennis M. O'Keefe

hematoma, active bleeding, axillary artery thrombosed normal 5 mos 12 Lyon, et al. , 1975 71, F 1 day median (c), ulnar (c), radial (c), axillary (c), musculocutaneous (p) 2 mos pseudoaneurysm paralysis all hand & forearm muscles, shoulder movement improved 22 mos 13 61, F 2 hrs median (c), ulnar (c), radial (c), musculocutaneous (p) 12 hrs hematoma partial return of forearm & hand function 26 mos 14 63, F 2 hrs median (p), ulnar (p), radial (p), musculocutaneous (p) 16 hrs hematoma slight diffuse loss

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Jacquelin Perry

proved more effective than the traditional methods in augmenting the use of emerging selective control. 8, 16 The effects of spasticity are reduced by contracture correction. 149 Outcome is proportional to the degree of selective control recovered. Usually residual deficits restrict the hand to the role of an assistant, with primary function being transferred to the other (non-paralytic) extremity, whether or not it previously was the dominant side. Hand function and comfort can be improved by selective surgical release of spastic or contracted muscles. 149 An

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Robert B. King and Gerald R. Schell

portion of the posterior bank of the gyrus was not contributing to the anatomical substrate essential to the sensory evoked potential or to sensory events demonstrable by careful clinical testing. We have explicitly avoided resection of the locus from which sensory evoked responses were recorded or the posterior wall of the motor cortex. In Case 9, a glioma infiltrated the anterior half of the precentral gyrus and was removed just ahead of the somatosensory hand area without inducing a demonstrable change in hand function. Similar questions may then be raised