Migrainous spasm simulating carotid dissection: a pitfall in MR arteriographic findings.

An MR arteriogram obtained in a patient with migraine headaches during prodrome showed features of carotid dissection. A repeated study conducted within minutes demonstrated complete patency. Vascular spasm was proposed to be the cause. Migraine occurs in more than 10% of the population. The possibility of misdiagnosing a vascular spasm as carotid dissection is real and should be guarded against since there are great prognostic and treatment implications.

Arterial lesions in severe lower limb ischaemia: a prospective study of 100 consecutive ischaemic limbs in a Hong Kong Chinese population.

BACKGROUND: The pattern and distribution of arterial lesions in a local Chinese population were studied to assess the feasibility of reconstruction and the possibility of avoiding major amputation of ischaemic limbs. METHOD: Between March 1995 and August 1997, 90 consecutive patients with 100 severely ischaemic lower limbs and their arteriograms were analysed. There were 48 female and 42 male patients with a mean age of 72 years. All the patients were in fair general health, did not have foot pulses and were willing to undergo major arterial reconstruction. Ten patients had bilateral limb ischaemia and 94 of the ischaemic limbs were affected by rest pain with or without ulcer and/or gangrene. The remaining six patients had debilitating claudication. These lesions were classified into low-grade (less than 50% stenosis), high-grade (50-90% stenosis) and critical (> 90% stenosis to occlusion). RESULTS: Critically stenotic or occlusive lesions were present in 16% of aorto-iliac segments; 76% of femoropopliteal arteries; and 82% of trifurcation and infrapopliteal segments. In at least 27 patients one of the two main foot arteries was also severely diseased. The present analysis suggested that 79 of these ischaemic limbs had reconstructable lesions. Sixteen were not suitable for intervention and in five patients the reconstructability was uncertain radiologically. CONCLUSION: Contrary to local belief, the majority of patients in the Chinese community with severe lower limb ischaemia without foot pulses would have technically reconstructable arterial lesions and could benefit from a revascularization procedure.

Clinical and radiological features of biliary papillomatosis.

Biliary papillomatosis is a rare disease with strong potential for malignant degeneration. Diagnosis is often not easy and most are made intraoperatively. In the present study, five patients with biliary papillomatosis admitted between 1990 and 1997 were reviewed. Their clinical presentation, radiological and biochemical findings were analysed. The aim of the study was to discern a set of characteristic features that would enable an early diagnosis. All of the five patients presented with recurrent episodes of acute cholangitis and epigastric pain with raised serum alkaline phosphatase. Imaging modalities including ultrasound, CT, endoscopic retrograde cholangio-pancreatogram, MRI and magnetic resonance cholangio-pancreatogram were reviewed. Salient imaging features included a dilated biliary tree with multiple ill-defined and fuzzy filling defects or endoluminal frond-like mass lesions. In conclusion, biliary papillomatosis is a rare but important cause of biliary obstruction with relapsing cholangitis and obstructive jaundice. With a healthy index of suspicion, the diagnosis can be reached when the above features are available.

The feasibility of three-dimensional guglielmi detachable coil for embolisation of wide neck cerebral aneurysms.

SUMMARY: The three-dimensional Guglielmi detachable coil is a modification of the conventional Guglielmi coil. It has a unique complex structure, with alternating small and large loops at 90 degrees angle to each other during deployment. The enhanced coil complexity optimizes coil purchase on the aneurysm wall, promoting coil stability within the aneurysm sac. It may be the solution of the single catheter technique in the embolisation of wide neck aneurysms.We report our early experience in the embolisation of wide neck aneurysms using these complex coils.