ABSTRACT
The authors describe a patient with an unruptured posterior communicating artery aneurysm presenting with enhancement of the third cranial nerve on magnetic resonance (MR) imaging and cerebrospinal fluid (CSF) pleocytosis. Pathological entities associated with enhancement of the third cranial nerve on MR imaging are discussed and the authors speculate about the possible explanation for the CSF pleocytosis.
Subject(s)
Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnosis , Leukocytosis/cerebrospinal fluid , Leukocytosis/complications , Oculomotor Nerve/pathology , Ophthalmoplegia/etiology , Ophthalmoplegia/pathology , Brain/diagnostic imaging , Brain/pathology , Cerebral Angiography , Female , Humans , Intracranial Aneurysm/surgery , Magnetic Resonance Imaging , Middle Aged , Neurosurgical Procedures/methods , Oculomotor Nerve/surgeryABSTRACT
Temporary occlusion of large vessels (the Matas test) to test the adequacy of collateral circulation is part of daily clinical practice. Nevertheless, only a few clinicians are aware of Rudolph Matas and his pioneering work in different fields of medicine. A legendary New Orleans surgeon, Rudolph Matas (1860-1957) lived nearly a century. During that time he witnessed enormous progress in medicine and greatly contributed to its evolution. He is unanimously recognized as the father of modem vascular surgery for his creation and popularization of aneurysmorrhaphy, a technique for the definitive treatment of aortic and peripheral aneurysms. He also made significant contributions to the then burgeoning fields of anesthesia, critical care, and infectious disease (yellow fever in particular). In 1911, he wrote a landmark article in which he described a challenge test to assess the degree and efficacy of the collateral circulation in patients under consideration for permanent occlusion of a major vessel. Matas studied the feasibility of such a test by temporarily occluding the carotid and femoral arteries in dogs for variable periods of time. In the introduction to his seminal article on the subject, he stated that "the chief object of this inquiry has been to determine whether the large arteries can be occluded long enough to make it possible to observe the effect of the arrested circulation in the territory supplied by the occluded vessel, without irreparably damaging the artery during the period of observation." He definitively achieved his stated goal: the Matas test, although greatly modified by contemporary endovascular techniques to be safer and more reliable, is in essence still routinely performed worldwide 90 years after its initial description.
