The Stroke Council of the American Heart Association. The early years.

An account of the origin, within the American Heart Association, of a council devoted to vascular disease of the central nervous system, with particular attention to the context in which that occurred, is presented in this article. The forces of a service-charitable organization, political action, medical practice in general, and interested, strong-witted citizens provided the stimuli for the development of the Stroke Council.

Neurological manifestations of infective endocarditis. Review of clinical and therapeutic challenges.

The nervous system is frequently involved in patients with infective endocarditis. When a careful review of presenting complaints is undertaken, neurological symptoms have been found in as high as 29% of patients. Because these manifestations may be so protean in nature, for example, stroke or transient ischaemic attack (the most common), toxic encephalopathy, meningitis, brain abscess, visual loss, seizures, headache, backache, or acute mononeuropathy, the neurologist needs to consider infective endocarditis as a possible diagnosis in many patients. During the past two decades, infective endocarditis has occurred in an ever widening clinical setting. It may often be found in persons unknown to have predisposing cardiac disease. This is particularly true in certain subsets of the population, including the elderly, patients subjected to various invasive procedures leading to nosocomial infection, and drug abusers. New diagnostic studies, including refined bacteriological culture techniques, echocardiography, computed tomography, magnetic resonance imaging, and greater availability of skillful cerebral angiography, make earlier diagnosis of infective endocarditis possible. Despite this, patients with neurological complications continue to have an uncertain prognosis.

The ocular aspects of bypass surgery of the carotid artery.

A new neurosurgical procedure, anastomosis of the superficial temporal artery to the middle cerebral artery, is being performed with increasing frequency. Over a 7-year period (1971 through 1977), 121 patients have undergone this operation in our institution. Ophthalmodynamometry may be of great help in identifying occlusion of an internal carotid artery. Progressing venous stasis retinopathy and ischemic orbital pain are believed to be indications for bypass surgery of the carotid artery.

Dietary restriction and the development of atherosclerosis.

1. White Carneau pigeons develop genetic atherosclerosis. The aorta shows intimal cushions at birth, cholesterol accumulation at 9 months of age and definite atherosclerotic lesions by 3 years of age. To determine whether these age-related arterial changes can be prevented by dietary restriction started early in life, 3-month-old pigeons were subjected to dietary restriction (40% of ad lib. diet). 2. Plasma cholesterol levels, cholesterol excretion and aortic cholesterol concentrations were compared with those of pigeons on the ad lib. diet. The pigeons on dietary restriction showed a decrease of 30% in weight. The plasma cholesterol levels of these pigeons decreased 20% when compared with those of ad lib. group. In the dietary-restricted group, both the faecal excretion of bile acids (P less than 0.01) and the aortic cholesterol level (P less than 0.02) were significantly reduced, with changes in the free and in the esterified sterol fraction. 3. This study shows, for the first time, that age-related accumulation of aortic cholesterol can be prevented or at least delayed by dietary restriction started early in life.

Atypical lymphoid leukemia in ataxia telangiectasia.

We observed two sisters with ataxia telangiectasia, one of whom developed an atypical subacute lymphocytic leukemia characterized by atypical lymphocytes and absence of palpable lymphadenopathy or hepatosplenomegaly. The lack of organomegaly in this patient may have been due to the underlying ataxia telangiectasia, which was associated with lymphoid hypoplasia. Cytogenetic studies showed a marker chromosome 14 [t(14q11:14q34)] in both patients. The sister with leukemia had other complex chromosomal aberrations in addition to the marker chromosome 14 that were stable for more than 14 mo before the patient's death from complicating infection. The development of atypical T cell leukemia has not been previously described in ataxia telangiectasia. This case further illustrates the interesting interrelationships amoung immunosuppressed states, development of lymphoid malignancy, and an emerging pattern of a propensity to chromosome 14 abnormalities in various lymphoid malignancies.

The ocular aspects of carotid artery bypass surgery.

A new neurosurgical procedure, anastomosis of the superficial temporal artery to the middle cerebral artery, is being performed with increasing frequency. Over a 7-year period (1971 through 1977), 121 patients have undergone this operation in our institution. Ophthalmodynamometry may be of great help in identifying occlusion of an internal carotid artery. Progressing venous stasis retinopathy and ischemic orbital pain are believed to be indications for bypass surgery of the carotid artery.

Bypass surgery for vascular disease of the carotid system.

A series of 58 operations on 56 patients, in whom a branch of the superficial temporal artery was anastomosed to a branch of the middle cerebral artery (STA-MCA bypass or Yasargil procedure), is reviewed. These operations were performed chiefly for occlussions or for inaccessible stenotic lesions of the internal carotid or middle cerebral arteries. Patency in eight patients operated on from April 1971 through November 1973 was low (25%). Patency in patients operated on since July 1974 has been high (95%). There have been no deaths and no major ischemic strokes attributable to the surgery. The rationale for this procedure is considered in relationship to the anatomy and physiology of the cerebral circulation and the pathogenesis of syndromes of cerebral ischemia. The operation appears to have a low morbidity in good-risk patients. The role of this operation in managing common manifestations of cerebral vascular disease such as focal transient cerebral ischemic attacks (TIAs) and amaurosis fugax, although not fully established, appears encouraging. The procedure seems useful for orthostatic cerebral ischemia caused by multiple occlusions of major extracranial (and intracranial) vessels and, occasionally, for progressing strokes related to internal carotid artery occlusion, both of which are relatively uncommon manifestations of cerebral vascular occlusive disease. It may have application in the rare "slow stroke." The procedure is probably of limited value, if any, in the management of large completed infarcts but may be indicated in selected patients with small infarctions who have preserved most of their cerebral function and who have had evidence of subsequent focal ischemic events. The procedure is useful for bypassing giant aneurysms or basofrontal tumors invading major vessels. It may have a role in the management of fibromuscular disease of the internal carotid artery.

Cholesterol balance in atherosclerosis-susceptible atherosclerosis-resistant pigeons.

On cholesterol-free diets, the total fecal steroid excretion was significantly lower in atherosclerosis-susceptible Whit Carneau pigeons than in atherosclerosis-resistant Show Racer pigeons, with major differences in the neutral sterol fraction.