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Intracranial Angiography

I. The Diagnosis of Vascular Lesions

Carl F. List and Fred J. Hodges

angiography in accuracy. Not only are the location and size of the aneurysm clearly shown, but sometimes multiple aneurysms are revealed. On the other hand, angiography has its limitations even in this field where it is so specifically indicated. For instance, the aneurysmal sac, as seen in angiograms, may be smaller than the aneurysm found at operation or autopsy, if it is partially obliterated by clot. If the aneurysm or its neck is very small, the pouch may not accept any of the contrast medium; this happened in one of our observations (verified by operation). In other

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G. Norlén and H. Olivecrona

Proximal part of ant. cer. art. 1 1 Ant. comm. art. 20 14 3 1 2 1 Distal part of ant. cer. art. 7 6 1 Middle cer. art. 15 11 4 Vertebral artery 1 1 Multiple aneurysms with different localization 3 3  Total 63 48 8 2 5 2 With regard to the results it should be mentioned that 1 of the 2 fatalities was caused by an extradural clot, which was diagnosed and reoperated on too late. The other patient who died came to the clinic in a semicomatose

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W. Eugene Stern

0 R 52/70 31/45 not injected 0 + R.H. Frontal tumor A.L. Birth injury epilepsy R 50/67 33/44 0 0 0 0 A.L. Birth injury epilepsy L 46/63 31/42 0 0 0 0 G.T. Cerebral thrombosis L 50/62 27/33 0 0 0 0 R.A. Multiple aneurysms R 33/64 20/36 0 + + + J.C. Carotid thrombosis R 40/53 no data 0 0 not injected J.C. Carotid thrombosis L 35/55 no data 0 0 not injected J.G. Subarachnoid hemorrhage L

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Gösta Norlén and Alec S. Barnum

practice surgery in these cases, it is a rather small risk to take compared to the vital information obtained. Firstly, the co-existence of multiple aneurysms is well known. Dandy 4 found multiplicity in 15 per cent of his 108 patients, although Ask-Upmark and Ingvar 1 have rightly stated that there is “usually” only one. We are aware that angiography does not always demonstrate the aneurysm or all of the aneurysms. However, the angiographic evidence of multiplicity will be a deciding factor in which procedure to employ or if any at all should be attempted. None of our

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Samuel P. W. Black and William J. German

bleeding. The other operative mortality (E.H.) was the only patient in the whole series to have multiple aneurysms, there being lesions of the right internal carotid and right middle cerebral arteries. Ligation in the neck was done first; a direct attack upon the middle cerebral lesion was to have been made subsequently. She died suddenly 12 days after the common carotid ligation. Autopsy revealed the middle cerebral lesion to have ruptured; there had been no bleeding from the internal carotid aneurysm. TABLE 3 Aneurysm of cerebral portion of internal carotid

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George Wilson, Helena E. Riggs and Charles Rupp

aneurysms (dotted numerals) and 39 unruptured aneurysms (solid numerals). The aneurysmal sac originated at arterial branchings, although not necessarily at a bifurcation, in 101 cases and by outpouchings from the vascular stem in 42. When the aneurysms involved the origin of an artery, particularly the anterior choroidal from the internal carotid, the distal portion of the vessel was frequently continuous with the fundus of the sac. Multiple Aneurysms . Multiple aneurysms were present in 27 patients, bilaterally placed in 13 and in the midline as well as on one

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Carl J. Graf

. There was softening of the ventral nucleus of the thalamus. The thalamoperforating branches of the middle cerebral artery had been occluded by clips. Two patients who had hematomas associated with the aneurysm expired. One of these patients had multiple aneurysms. In this particular situation the problem was an acute one of hematoma evacuation and the aneurysm was not treated. Five (20 per cent) of the patients in this group died. Middle Cerebral Aneurysms There were 6 patients with middle cerebral artery aneurysms, 5 of whom had associated intracerebral

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Dwight Parkinson

single clip placed on its neck with the circulation preserved beyond to the anterior cerebral branches. In 3 of the 4 cases in which surgical fatality occurred, the patients were operated upon while in coma and 2 in addition had multiple aneurysms ( Table 2 ). The other patient died apparently of inadequate anterior cerebral circulation. He regained consciousness and movement in all four extremities. His conversation was always spontaneous but not always appropriate. He became progressively spastic and drowsy, dying 44 days postoperatively. Autopsy revealed

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Lester A. Mount and Juan M. Taveras

patients, 35 had aneurysms on the internal carotid artery; 6, on the middle cerebral, 1 of whom also had an internal carotid aneurysm on the same side; 7, on the anterior communicating; 1, on the anterior cerebral; and 1, on the posterior cerebral ( Table 1 ). There were 4 patients who had multiple aneurysms: in 1 case both aneurysms were on one side of the brain, and in 3 cases they were on both sides. The 3 patients in whom the aneurysms were located bilaterally had no therapy directed to the aneurysms on the second side. Thirty-three patients had had subarachnoid

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Phillip Harris and George B. Udvarhelyi

21 Unplaced 4 — Total 152 Anterior cerebral artery and anterior communicating artery 87 Middle cerebral artery 73 Posterior cerebral artery 1 Basilar artery 9 Posterior inferior cerebellar artery 2 Vertebral artery 2 — Total 174 Spontaneous subarachnoid haemorrhage Negative angiography 98 Angiography not performed 85 — 183 Multiple aneurysms were found in 10 patients: bilateral internal carotid-posterior communicating artery in