Intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH. A preliminary report.

Nimodipine was given as an intracarotid slow bolus injection in six patients with subarachnoid hemorrhage (SAH) due to rupture of a cerebral aneurysm, with angiographically demonstrated vasospasm. The patients were followed by serial angiograms for demonstration of the effect of nimodipine on vasospasm. After angiography, all patients were treated with a constant venous infusion of this new calcium antagonist. Although the therapeutic regimen was started only a few hours after onset of vasospasm, there was no change in cerebral vessel caliber detectable on angiograms following the intracarotid injection. Three patients died, two patients finally recovered with neurological deficits due to cerebral ischemia, and one patient with asymptomatic vasospasm remained symptom-free. Although nimodipine may act to prevent cerebral vasospasm after SAH, the authors believe that the intracarotid application is not effective after vasospasm has occurred.

Prevention of symptomatic vasospasm after SAH by constant venous infusion of nimodipine.

Sixty-one patients with SAH due to rupture of a cerebral aneurysm, classified in Grades I to IV according to Hunt and Hess, received a constant venous infusion of Nimodipine in a dose of 2mg/h for at least 14 days, followed by an oral administration of 60 mg/6 h for at least 4 days. Patients admitted after the 6th day of SAH, patients with SAH but without aneurysm on the angiogram and patients in Grade V were excluded. Mortality in 30 patients of Grades I-II was 3.3%, in 31 patients of Grades III-IV 42%. In the latter group 1 patient died due to cerebral vasospasm. Transient vasospasm occurred in 2 patients of Grades I-II. Recovery was complete in both cases. Thus, incidence of cerebral vasospasm was 4.9%, the incidence of poor-outcome-vasospasm even only 1.6%. The syndrome of cerebral vasospasm seems to be more than only constriction of cerebral vessels. The deleterious effects of Ca2+ shift into vascular cells and into neural cells which causes irreversible damage are discussed. Early administration of a specific 'cerebral' calcium antagonist like Nimodipine after SAH will prevent the intracellular Ca2+ overloading, thus protecting the neural cells and preventing Ca2+-induced smooth-muscle contraction of cerebral vessels, which encourages ischaemic deficits after SAH. The preventive use of Nimodipine has markedly reduced the incidence of symptomatic vasospasm in our clinic.

[Complications of cervical discography (author's transl)]. / Komplikationen der zervikalen Diskographie

The report deals with 1,005 discographic examinations in 380 patients with a cervical syndrome. Three cases of a discitis were observed, of which two had to be regarded as complications of the examination. The aetiology, clinical features, diagnosis and differential diagnosis are described: therapeutic and prophylactic problems and possible complications are discussed. With a complication rate of 0.2%, the authors recommend contrast demonstration of the cervical disc as a supplementary radiological method for the investigation of the cervical syndrome.

[An unusual manifestation of a pineal tumour (author's transl)]. / Eine ungewöhnliche Manifestation eines Pinealistumors.

In the last two years, out of 186 cases of brain tumours we have treated 10 tumours in the pineal region. One of these patients had a pineocytoma. The patient was admitted to our clinic with generalized epilepsy. At the time of admission there were no neurological deficits. In the CT scan we found a tumour in the pineal region with cystic extension in the right temporo-occipital region. The tumour was totally excised and the patient did well postoperatively. The only neurological sequela was a left-sided homonymous hemianopia. He resumed his former profession and is working successfully up till now. It was necessary to radiate the patient, as no tumour recurrence was demonstrated in the CT scan.

[Complications of anterior cervical fusion operations]. / Komplikationen zervikaler ventraler Fusionsoperationen

The authors describe the technique of operation and then report about 15 intra- and post-operative complications in 360 anterior cervical fusions in 307 patients who suffered from cervical disc lesions. The complication rate was 4.16%. Apart from one case of complete but clinically reasonably well compensated recurrent paresis, all complications healed without permanent deficit. The differential diagnosis, prophylaxis and therapy of these specific operative complications are discussed.

[A traumatic aneurysm of the pericallosal artery (author's transl)]. / Uber ein traumatisches Aneurysma der Arteria pericallosa bei einem elfjährigen Jungen.

A case is reported of a traumatic pericallosal artery aneurysm in an eleven-year-old boy. A comparison is made with previously published cases of traumatic cerebral aneurysms. The need to consider such a diagnosis is urged in cases of delayed recovery after head injury.

[Radiation treatment of intracranial arteriovenous malformations--experiences with a semi-stereotactic technic]. / Die Strahlenbehandlung intrakranieller arteriovaskulärer Malformationen--Erfahrungen mit semi-stereotaktischer Technik.

Since 1982 79 patients with intracranial AVM's were irradiated at linear accelerator with 10 MV photons. Diagnosis, localization and therapy were done immobilizing the head for identical positioning. In a controlled study the therapy was done with fractionated irradiation up to 50 Gy in 25 fractions within 5 weeks or with 20 Gy in 4 fractions within 7 days. Complications, due to therapy, did not occur. Suffering from convulsion was not affected. Five patients have died, one patient got a hemorrhage 36 months later. The angiographical analysis of the first 25 patients until 30 months after radiotherapy gave complete obliterations and reduction of volume in more than 50% with minor AVM's. The result are not detrimental compared with a group after photon irradiation.

[Normal pressure hydrocephalus in geriatric patients--a treatable form of dementia]. / Normaldruckhydrozephalus bei geriatrischen Patienten--eine behandelbare Form der Demenz.

Six geriatric patients are presented who were treated because of normal pressure hydrocephalus. A tentative diagnosis was made if dementia, gait disturbance, and incontinence together with a typical CAT-scan were present. In these cases an operation was carried out. After ventriculo-peritoneal shunting clinical improvements were seen in four patients. Postoperative complications were hygromas in three patients and a shunt-dislocation in another patient. A chronic subdural bleeding was recorded also in one of these patients with only a temporary success in this case. Two patients showed no clinical improvement at any time. However, in these cases additional neurologic symptoms together with typical CAT-scan changes were present. Before making a decision for an operation vascular processes and Alzheimer's disease should be ruled out.