Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis.

Percutaneous transluminal angioplasty (PTA) of carotid arteries has been rarely reported. Dilatation of internal carotid artery stenosis has so far been performed only for fibromuscular dysplasia. Because of the risk of cerebral embolization the technique has not been used for arteriosclerotic stenosis, particularly since endarterectomy is known as a safe procedure. Three cases are reported of successful dilatation of arteriosclerotic internal carotid artery stenosis. A neurologic complication occurred in one patient. The primary indication for performing PTA in such cases is limited operability for medical reasons.

Clinical experience with iopamidol for myelography.

Within 20 months 145 ascending thoracocervical myelographies and 155 lumbar myelographies with the nonionic water-soluble contrast medium iopamidol were performed. The iodine concentration given was 250 mg I/ml or 200 mg I/ml respectively. The total iodine never exceeded 2.5 g (8-10 ml). Image quality was assessed in terms of diagnostic value having experience of more than 1,000 myelographies using metrizamide. Picture quality was similar to metrizamide of equal iodine concentration. In 35 patients electroencephalography (EEG) was recorded before and after myelography with iopamidol 250. No changes that could be referred to the contrast medium were seen. There were no adverse reactions to lumbar myelography other than those following the lumbar puncture. In thoracocervical myelography mild and transient side effects occurred in 41 (28.3%). The most common were headache (41 cases), nausea (12), radicular pain (10), and dizziness (five). General seizures and psychopathologic symptoms were not observed.

MRI in cranial tuberculosis.

A case of multiple intracranial tuberculomas is presented. CT and MRI findings are discussed and compared. MRI showed multiple tuberculomas characterised by the same signal intensity as the surrounding brain parenchyma. Differentiation could be achieved only by the perifocal oedema of high signal intensity. Changes of the lesions during chemotherapy were monitored by CT and MRI and the results are presented.

[Technique and diagnostic value of functional myelography in lumbar discopathy (author's transl)]. / Technik und diagnostischer Wert der lumbalen Funktionsmyelographie beim Bandscheibenprolaps.

A standard myelogram using water soluble contrast with additional functional examination were carried out on 72 patients with suspected disc prolapse. Diagnostic accuracy can be significantly improved by the functional examination and, in some cases, the diagnosis can only be made in this way. There are no false positives. The advantages and limitations of the method are enumerated and its morphological significance is discussed.

[The angiographic demonstration of the arterial component of large meningiomas in the cerebral cortex and medulla (author's transl)]. / Arterielle Kern- und Schalenvaskularisation grosser Kalottenmeningeome im Karotisangiogramm

The arterial architecture of large meningiomas were studied in the cerebral cortex of medulla by selective arteriography of internal and external carotid arteries, or the common care in 12 patients. The findings were compared with operative observations (or in one case with the autopsy result), and were related to the histological and pathological findings. The origin of the supplying vessel was found to be significant in the differential diagnosis.

[Thin-layer NMR-imaging with a new T2-weighted 3-D-procedure]. / Dünnschicht-NMR-Imaging mit einem neuen T2-gewichteten 3-D-Verfahren.

Presentation of first experience with a new 3-dimensional data acquisition method. The new method yields sets of 120 continuous images of the head and brain in all 3 dimensions (slice thickness and spatial resolution both being 1.7 mm.) with a data acquisition time of 15 minutes. Depending on pulse sequences T1- or T2-images are available. Advantages and disadvantages are discussed.

[Radiological-densitographic examinations of the skull injuries of the pharoah Seqenenre (author's trasl)]. / Radiologish-äquidensitographische Untersuchungen der Kalottenverletzungen des Pharao Seqenenre.

Skull radiographs of the pharaoh Seqenenre-Ta'a II with special densitographic techniques have shown that he survived a perforating skull injury. The technique is described and its use in medical history and archaeology is discussed.

[Whole-body MRT studies--the results of the "Multicenter study on the evaluation of magnetic resonance tomography"]. / MRT-Untersuchungen im Ganzkörperbereich--Ergebnisse der "Multicenterstudie zur Evaluierung der Kernspintomographie".

In a nation-wide multicentre study, the use of MRI was examined in its clinical context and in relation to other imaging methods and as a routine examination. It was found that examinations of the brain and spine were predominant. MRI is accurate for certain problems affecting the extremities, the pelvis and the liver. The findings also show that there are still technical limitations. A high degree of accuracy can only be obtained if there is adequate information concerning individual problems. Technical limitations include the frequent appearance of artifacts. In its present state, MRI can only supply additional information, concerning the trunk only, in certain situations. The study also outlines the development of MRI and the role of other conventional diagnostic procedures.

[Neuroradiologic therapy of stroke]. / Zur neuroradiologischen Therapie des Schlaganfalls.

Cerebrovascular disease with consecutive stroke is the third leading cause of death, behind only heart disease and cancer. The cost to society, both directly in health care and indirectly in lost income, amounts to 15 billion Dollar in the USA. The leading cause of stroke is focal cerebral ischemia. The general approach to the acute stroke patient remains one of therapeutic nihilism, despite effective interventional neuroradiological methods such as local intraarterial fibrinolysis and percutaneous transluminal angioplasty. These methods can be applied in a narrow timeframe only. One case of successful treatment is presented. The effort should be the development of regionalized systems of early transfer to "stroke units" capable of providing the modern spectrum of acute care to stroke patients.

[Dilatation of the supra-aortic arteries--a catheter with blockade and rinsing potential]. / Dilatation supra-aortaler Gefässe--Katheter mit Blockade und Spülmöglichkeit.

Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries is not generally accepted, mainly because of the fear of brain embolism. The design of a new catheter offers four conduits and permits (1) guidewire conduct, (2) tip occlusion; (3) PTA; and (4) rinsing between occluded tip and dilational balloon. Thus, any particles that might otherwise cause brain embolism could be washed out after PTA and before opening of the tip occlusion. The prototype has already been manufactured. The catheter is easy to handle.

[Clinical aspects and diagnosis of acoustic neurinomas]. / Klinik und Diagnostik der Akustikusneurinome.

The application of microsurgical techniques for the removal of acoustic neuromas has evidenced greatly improved postoperative results. Therefore the early detection of an acoustic neuroma is a special need for every neurologist. The development of new electrophysiological and radiological procedures now allows a far better approach in the diagnosis of acoustic neuromas. Brain stem auditory evoked potentials as well as acoustic reflex testing have shown to be rather sensitive tools in the diagnosis of retrocochlear pathology. Other electrophysiological procedures have been widely replaced by these techniques. Gasmeatocisternography in combination with cranial computed tomography is the method of choice in the detection of small acoustic neuromas. The current status in the application of different techniques for the diagnosis of acoustic neuromas is reviewed.

The growth rate of acoustic neuromas: a report of three cases.

Until the present time, only a few CT air-cisternographic studies have been done to define the growth rate of acoustic neuromas. By using this method of study, we were able to observe a slow growth rate fo acoustic neuromas in a 41- and a 50-year-old woman over periods of 6-10 months. In contrast, we were unable to find any increase in tumor size during a period of 22 months in a 70-year-old woman.

Giant aneurysms of the posterior fossa suspected as neoplasms on computed tomography.

Giant intracranial aneurysms of the vertebral and basilar artery can be mistakenly diagnosed as neoplasms of the posterior fossa on the basis of their clinical presentation and CT findings. The following report of three cases of tumorous aneurysms emphasizes the complementary value of angiography and computed tomography for the localization and correct diagnosis of space-occupying lesions of the posterior fossa.

[Long-term follow-up study of the absorption of gas after encephalography in dilated intracranial cerebrospinal fluid spaces (author's transl)]. / Post-pneumencephalographraniellen Liquorräume.

The absorption of gas after encephalography in different groups of patients was investigated in a long-term follow-up study. Group I (11 patients) showed no pathological findings in the encephalogram. Group II (8 patients) had encephalographic signs of diffuse cerebral atrophy. Group III (7 patients) demonstrated in the encephalogram characteristics of normal pressure hydrocephalus with variously located blocks of air in the subarachnoid space. In group I the gas located in the subarachnoid space had usually disappeared after 24 h, in some cases after 72 h. In group II the pattern of resorption was basically similar, although in one case cortical air could be seen at 96 h. In group III the absorption of air from the subarachnoid space began after 72 h in radiological relevant amounts. In none of the cases of group III could similar short times of resorption be seen in comparison to group I. It is considered that these two groups can be clearly distinguished from each other in the duration of resorption of air from the subarachnoid space. The importance of encephalography as a pathophysiological tool for investigation of both the disturbed resorption and circulation of the cerebrospinal fluid in normal pressure hydrocephalus is stressed.

[Neuroradiologic and clinical correlations in asymmetric lateral ventricles and posterior cornua in pneumo-encephalograms (author's transl)]. / Neuroradiologische und klinische Korrelationen bei Asymmetrien der Seitenventrikel und Hinterhornanlagen im Pneumencephalogramm.

Retrospective study of 452 out of 4155 pneumoencephalograms continuously investigated by two independent observers over 20 years. Follow-up and statistics of frequency and sex-differences of asymmetries of lateral ventricles and posterior cornua. Criteria of selection: history and clinical findings in favor of a general cerebral cause and against circumscribed changes due to local damage. Technique standardized and equal bilateral filling in pneumoencaphalography. Results of the numerous findings: 1. Posterior cornua were symmetrical in 370 patients 81.9% (256 male, 114 female, 18.1%). Definite asymmetry of posterior horns in 72 males and 10 males. 2. These asymmetries showed variations from unilateral to bilateral, but clearly different sizes of posterior horns. 3. Unilateral posterior horn "anlagen" seen in 64 (14.1%) of all patients. Males predominated 8:1, left more common than right 3.5:1. 4. Bilateral "anlagen", with one posterior horn predominating, in 18 patients (3.9%). Once more males more common 8:1. Larger "anlagen" on left: 8:1. 5. Accompanying further asymmetries of lateral ventricles with equal bilateral posterior horns were of similar size in 73.7%. In 21.1% the lateral ventricle was larger on the right, in 5.1% on the left. The left side was more common 4.15:1. 6. Large ventricles were of equal size in 45.1 of patients with asymmetry of the posterior horns, 45.1% on left, 9.7% on right the ventricle was larger. Once more the left side predominated 4.6:1. 7. Trying to correlate clinical-neurologic, neurophthalmic, neurophysiologic and tachistocopic findings with pneumoencephalograms with or without asymmetry showed no regular relation with handedness, ocular dominance, limitations of visual fields or--neglect or shapes of ventricles. In all subgroups frequency and sex-distribution corresponded to the norm. 8. Numerical frequency of coupling of right-handedness and right predominant eye with left increased size of ventricle was within the statistically expected and was, therefore, not interpreted as a sign of functional dominance of the left cerebral hemisphere, as done by others. 9. When eliciting from the occiput visually evoked potentials 8 patients showed important findings, in spite of their small number. In 3 patients with symmetrical "anlagen" of the posterior horns, latency and amplitude of potentials were the same; in 5 patients, with asymmetry of posterior horns the side of the larger horn showed significant reduction of amplitude without exception. The investigations show, quantitative statistical findings of frequency and sex-distribution and their negative correlation with examined clinical parameters apart, the anatomic-morphologic variation of asymmetry of posterior horns corresponds to a correlate which can also be shown with a neurophysiologic technique.

[Clinical NMR tomography with sequential T2 images (Carr-Purcell spin-echo sequences)]. / Klinische NMR-Tomographie mit sequentiellen T2-Bildern (Carr-Purcell-Spin-Echosequenzen).

Advantages of the Carr-Purcell spin-echo sequence in NMR tomography are discussed. It is pointed out that this method generates complete information about relaxation time T2 with only one measurement per slice as compared with the classic spin-echo method.

[Can transcranial Doppler sonography replace cerebral angiography?]. / Kann die transkranielle Doppler-Sonographie die cerebrale Angiographie ersetzen?

Transcranial Doppler ultrasound is a noninvasive method of recording the flow velocity of larger intracranial vessels. The impact on diagnosis of cerebravascular occlusive disease is not yet evaluated. We present 15 patients, age range 39-73 years, who suffered from completed stroke. The findings of transcranial Doppler ultrasound and of cerebral angiography are presented. The value of both methods in treatment strategy is discussed.

[Deanol in tardive dyskinesia: a double-blind study (author's transl)]. / Zur Therapie mit Dimethylaminoäthanol (Deanol) bei neuroleptikainduzierten extrapyramidalen Hyperkinesen

Tardive dyskinesia following long-term application of neuroleptics is resistant to treatment. According to the hypothesis of a relative central nervous system acetylcholine lack as the underlying mechanism 20 patients were treated with dimethylaminoethanol (Deanol) in a double-blind study. Deanol is known to be a direct precursor of intracerebral acetylcholine. For several reasons (which are discussed) the data of but 11 patients were statistically evaluated. The results suggest some therapeutic effect in some of the patients only (significant improvement of oral hyperkinesia).