SPECT findings in an unusual case of visual hallucinosis.

A 64-year-old right-handed man acutely developed elementary visual hallucinations (monochromatic, moving geometrical figures), visual illusions (distortion of the right side of faces) with achromatopsia and blurred vision restricted to the left visual hemi-field. CT of the brain before and after administration of contrast medium and a repeat examination 2 months later showed no abnormalities, while brain mapping (power analysis of EEG) demonstrated theta wave slowing of the curve over the posterior part of the right hemisphere. 99mTC HMPAO SPECT of the brain, however, demonstrated an area of definite focal hypoperfusion in the right occipito-temporal region. Echo-Doppler-duplex and continuous wave examination of the cervical arterial blood vessels disclosed bilateral discrete atheromatous plaques that did not affect the blood flow. Transoesophageal echocardiography demonstrated slight mitral valve insufficiency. Cerebral angiography showed an occlusion of the right posterior cerebral artery. After the visual hallucinations had subsided, SPECT showed partial normalization of the right occipito-temporal perfusion. In the absence of CT evidence for a structural lesion in the clinically suspected areas, only functional imaging revealed an obviously significant lesion. This case furthermore demonstrates that SPECT can contribute to the identification of the pathophysiology underlying visual hallucinosis.

[Imaging of aortic dissection: a retrospective study of 27 patients]. / Beeldvorming van aortadissektie: een retrospektieve studie van 27 patiënten.

Aortic dissection can be a life threatening condition which requires an early diagnosis. As initial signs and symptoms may be nonspecific and confusing, reliable imaging techniques are requested for immediate and accurate diagnosis. This retrospective study of 27 patients with proven aortic dissection assesses the relative value of angiography, CT, and MR imaging. Contribution of these imaging modalities is discussed and illustrated. Aortic dissection was correctly identified by angiography and CT respectively in 100% and 83% of the cases. MRI was diagnostic in all six examined cases. Both angiography and CT proved to be reliable imaging modalities; in addition, they can be easily performed in the critically ill patient. We consider MRI useful in the evaluation of suspected dissection in stable patients and follow-up of medical or surgical therapy.

Effects of intra-arterial ketanserin in Raynaud's phenomenon assessed by 99MTc-pertechnetate scintigraphy.

The severity of the peripheral vasopastic condition in 10 patients with Raynaud's phenomenon was investigated using scintigraphy of both hands. 99MTc-pertechnetate was used as a diffusable tracer and scintigrams were recorded with normal hand skin temperature and following immersion of the hands in ice-cold water. Cold provocation resulted in a marked reduction of the rate of blood inflow and tissue perfusion in affected hands. The selective peripheral S2-antagonist ketanserin and placebo were administered intra-arterially according to a double-blind cross-over design. As compared to placebo, ketanserin significantly improved the rate of inflow following cold provocation, and it increased tissue perfusion in the hands of the patients to values normally observed in healthy individuals. The results support the use of ketanserin in the treatment of Raynaud's phenomenon.

[Role of arteriography in the assessment and treatment of hemorrhagic diseases of the small intestines]. / Place de l'artériographie dans la mise au point et le traitement de la pathologie hémorragique de l'intestin grêle.

We present the indications and usefulness of visceral angiography for diagnostic and therapy in patients with gastrointestinal haemorrhage. This is based on the results of a retrospective study of 265 angiographies for gastrointestinal bleeding. In fifty one cases an extravasation was seen and in one hundred and four patients a possible etiology for the gastrointestinal hemorrhage was suspected from indirect signs. In 19 cases, an embolization was performed with good result in 16 (84%).

Transcatheter embolization of a bronchial side branch of the internal mammary artery for the treatment of a coronary steal phenomenon.

We present a 58-yr-old woman with unstable angina due to a coronary steal phenomenon down a bronchial side branch draining into the pulmonary circulation, 1 yr after coronary bypass grafting. The patient was cured of angina pectoris after microcoil embolization of the bronchial side branch.

Headache as only symptom in multiple cervical artery dissection.

We describe a patient with atypical headache as the only presenting symptom of spontaneous triple cervical artery dissection. As the patient suffered from arterial hypertension, a causative relation between headache and arterial hypertension was initially taken into consideration. However, four-vessel arteriography disclosed a dissection of both internal carotid arteries and the right vertebral artery. This unique case highlights the value of conventional arteriography for diagnosing cervical artery dissection. Since multiple cervical artery dissections are not rare, all cervical arteries should be examined by means of conventional arteriography when a dissection is suspected.

Postpartum dissecting aneurysm of the basilar artery.

BACKGROUND AND PURPOSE: Dissecting aneurysms arising from the vertebrobasilar complex are rare and difficult to manage. More of their natural history needs to be known before treatment can be optimized. CASE DESCRIPTION: We report a postpartum dissecting aneurysm of the right vertebrobasilar artery in a 31-year-old woman that was confirmed by angiographic identification of a double lumen. The intracranial segment of the right vertebral artery was thrombosed proximal to the aneurysm. The patient, managed conservatively, recovered well and, when reexamined 2 months later, was found to be neurologically intact. A repeat angiographic study at that time demonstrated that the aneurysm had resolved. CONCLUSIONS: Proximal occlusion may have protected the aneurysm from rupture and further dissection, thereby making surgery unnecessary.

Role of hepatic arterial embolisation in the treatment for metastatic insulinoma. Report of two cases and review of the literature.

Malignant insulinomas are very rare. They have typical clinical and biochemical characteristics that allow an early detection and distinction from other sorts of islet cell carcinoma. As a result a curative resection can occasionally be managed. Nevertheless, for more advanced stages the same treatment options as for other metastatic neuroendocrine tumours must be considered: palliative surgery, medical treatment, chemotherapy and hepatic arterial (chemo-) embolisation. Especially the last kind of treatment has recently gained interest. We report two cases of metastatic insulinoma treated in this way. In the first case we are able to record an unusually long survival through the single use of sequential embolisation, following palliative resection of the primary tumour. In the second case we describe the current way to use this technique, i.e. in combination with chemotherapy. We argue that it might be more important in the treatment of metastatic insulinoma to combine hepatic arterial embolisation with other types of local or systemic therapy, rather than the choice of this most efficient technique on its own.

Posterior epistaxis: our experience with transantral ligation and embolisation.

Transantral ligation of the arteria maxillares internae (AMI) (with or without ligation of the arteria ethmoidalis) and percutaneous embolisation of AMI in cases of intractable epistaxis (i.e. epistaxis not responding to classical posterior packing) are compared. Except when ethmoidal bleeding is suspected, we recommend embolisation for epistaxis not responding to classical measures as it leads to fewer complications and recurrences, to shorter hospital stay and to improved postoperative comfort.