ABSTRACT
BACKGROUND: No prospective study of extracranial internal carotid artery aneurysms (EICAA) has been reported to date. The aim of this study was to evaluate central nervous system complications associated with surgical intervention for EICAA. PATIENTS AND METHODS: A total of seven patients, representing all cases observed at our institution from December 1997 to December 1998, were entered in this prospective study. Three patients had bilateral involvement. The aneurysms were both atherosclerotic and dysplastic. All patients were males, with mean age of 70 years (range 65 to 74). Internal or common carotid artery to EICAAs diameter ratios were calculated on the angiograms. The transverse diameter as well as the craniocaudal extension of the lesions were accurately measured intraoperatively. Follow-up evaluations were performed at three, six and twelve months postoperatively, and consisted of a clinical evaluation by both a neurologist and a vascular surgeon who were not part of the primary surgical team. RESULTS: Six patients presented with neurological symptoms ranging from non-hemispheric TIAs to hemispheric stroke. One patient was asymptomatic. The severity of symptoms was correlated with the size of the aneurysm. Preoperative symptoms were more severe in EICAAs of > or = 3 cm in transverse diameter. One case had a postoperative stroke, no perioperative deaths occurred. All the internal carotid arteries operated on were patent during follow-up evaluations. No new neurologic event was observed during follow-up. CONCLUSIONS: The severity of central neurologic symptoms seems to depend on the size of the aneurysmatic lesion. Prompt surgical management of small EICAAs may reduce the occurrence of severe CNS complications, both preoperatively and postoperatively, due to the lower risk of embolization associated with small aneurysms compared to larger lesions.
Subject(s)
Carotid Artery Diseases/surgery , Carotid Artery, Internal/surgery , Intracranial Aneurysm/surgery , Postoperative Complications/diagnosis , Aged , Carotid Artery Diseases/diagnosis , Cerebral Infarction/diagnosis , Follow-Up Studies , Humans , Intracranial Aneurysm/diagnosis , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/surgery , Male , Neurologic Examination , Prospective Studies , Risk Factors , Treatment OutcomeABSTRACT
We describe a southern Italian couple, married for 28 years, who developed amyotrophic lateral sclerosis (ALS) within 30 months of each other. They had drunk water taken from an artesian well for nearly thirty years. Samples of the water were investigated in the search for heavy metals and pesticides using high performances liquid chromatography, gas chromatography and absorption spectrometry. No heavy metals, pesticides or known environmental toxic substances were found in significant concentration. This would seem to support the view that conjugal ALS in Caucasians is due to mere coincidence.
Subject(s)
Amyotrophic Lateral Sclerosis/etiology , Environmental Exposure , Metals/toxicity , Pesticides/toxicity , Drinking , Female , Humans , Male , Middle AgedABSTRACT
The aim of this 3-month study was to assess the activity of dihydroergocristine (DHEC, CAS 17479-15-5) on organic brain syndrome. DHEC is an ergot alkaloid derivative with a dopaminergic activity on the central nervous system (CNS). It improves cerebral metabolism and increases the bioelectric potential in the cerebral cortex. The randomized double-blind trial versus placebo involved 240 outpatients (138 females and 102 males, mean age 68 years) recruited in 6 hospitals. Subjects with Hachinski Ischemic Score > 6 and Mini Mental State < 22 were excluded. Patients were randomly divided into 4 groups of 60 subjects each to receive either one 6-mg DHEC oral vial or placebo vial, or one 6-mg DHEC tablet or placebo tablet once daily for 3 months. Neuropsychological tests were performed at baseline, and then after 45 and 90 days of treatment. The statistical analysis of results showed a significant difference (p < 0.01) between DHEC and placebo groups with regard to the following tests: "Scale of Clinical Assessment for Geriatrics (SCAG), Digit Symbol, Digit Span, Toulouse-Pieron, Hamilton Depression Rating Scale and Rey's Words". The amelioration of clinical symptoms pointed out the equivalence of DHEC oral vials and tablets. The drug was well tolerated. It is concluded that DHEC is an effective and safe drug in the treatment or organic brain syndrome.
