[Dissection of the internal carotid artery. Personal case reports and a review of the literature]. / Dissecazione dell'arteria carotide interna. Casistica personale e revisione della letteratura.

The clinical and angiographic features of 20 patients affected by internal carotid artery dissection are reported. In one patient the neurological signs were related to a traumatic event, in two cases the symptoms presented after hyperextension of the neck during athletic events, while their onset was apparently spontaneous in the remaining 17 patients. Plain CT was normal in 14 cases and positive for ischemic necrosis in 6 patients. Angiography demonstrated extensive/segmental stenosis of the internal carotid lumen in 12 cases (60%), pseudoaneurysmal dilatation in 3 cases (15%), and complete carotid occlusion in 5 patients (25%). The "double lumen" feature was seen in 3 cases at the origin of the dissection. One patient died, surgical ligature of the internal carotid artery was performed in two cases, while the other patients received medical treatment with platelet inhibitors, except for the young patient affected by post-traumatic artery dissection. Complete recovery was observed in 82% of the patients. Follow-up angiograms demonstrated normal recanalization of the internal carotid artery in 4 out of 6 patients; one of them had two false aneurysms which following angiograms demonstrated to be completely resolved. Regression of stenosis was observed in 6 of the remaining patients by Doppler US. On the whole, the recanalization of the internal carotid artery was observed in 59% of cases. Angiographic findings seemed not to play a decisive role in the prognosis of carotid dissections, which largely depends on the overall patient's condition and on the presence/absence of ischemic cerebral damages.

[Preoperative embolization of angiomas of the face. Remote angiographic results]. / Embolizzazione prechirurgica di angiomi del viso. Risultati angiografici a distanza.

Preoperative embolization was performed on 27 patients with facial angiomas supplied by the external carotid branches. Sixteen were males and 11 females; 13 of these angiomas were high-flow arteriovenous (A-V), 14 were low-flow capillary malformations. Fourteen patients underwent surgical removal after preoperative embolization; in this group embolization was carried out with Spongel in 3 cases and with Lyodura in 11 cases. In 12 of these patients the last angiographic examination was performed 3-6 years later: angiography evidenced no recurrence in 8 cases (67%), while in 3 cases (25%) there was capillary residual angioma of negligible size. Treatment was unsuccessful in one patient only, due to the large recurrent A-V angioma. Thirteen patients underwent embolization only, which was carried out with Lyodura in 10 cases, and with Ivalon in 3 cases. On 12 of these patients the last angiographic study was performed 2-14 months later: there was recurrent A-V angioma in 5 patients (42%), who underwent a subsequent embolization; angiography evidenced no recurrence in the other 7 patients (58%). In both series, the best results were obtained in the patients with low-flow capillary angiomas. Embolization and subsequent surgical removal are the treatment of choice for facial angiomas; embolization alone is useful in the management of surgically inaccessible vascular malformations, and it can be the only treatment in patients with small low-flow angiomas when distal occlusion of the feeding vessels with Lyodura or Ivalon particles is performed.

Age and duration of illness as predictors of ventricular brain ratio (VBR) size in chronic schizophrenic patients. A stepwise regression analysis study.

The CT scans of 18 chronic schizophrenic patients and 17 controls were evaluated for Ventricular Brain Ratio (VBR) size. A trend for the patient group to have larger VBR than controls was present but did not reach statistical significance at the 5% level. Age was found to be an important correlate of VBR within the patient group but not among controls. In a stepwise multiple-regression model age, among other independent variables, can account for 47% of VBR variance in schizophrenic patients. Linear regression analysis did not reveal significant association between VBR and age in control subjects.

A computerised tomographic study in DSM-III affective disorders.

The relationship between ventricular brain ratio (VBR) and clinical variables was investigated in 21 DSM-III depressed patients. None of the following dichotomies--major depression vs. dysthymic disorder, suicidal vs. non-suicidal patients, male vs. female patients--showed any statistically significant differences. An association was identified between VBR and age at onset of depression but when current age was controlled such an association failed to reach a statistically significant level except in the group with major depression. When patients were matched with a control group no differences in VBR were seen with age controlled by decade.

[Post-traumatic arteriovenous fistulae and pseudoaneurysms of the superficial temporal artery: presentation of 4 cases]. / Fistole artero-venose e pseudoaneurismi post-traumatici dell'arteria temporale superficiale: presentazione di 4 casi.

Three cases of traumatic arteriovenous fistula of the superficial temporal artery and one of pseudoaneurysm seen over a recent two-year period are presented and the literature is reviewed. Because of the course of the superficial temporal artery over the temporal bone, it is vulnerable to injury. The differential diagnosis includes hematoma, cysts, inflammatory lesions, vascular tumors and aneurysms of the middle meningeal artery. If there is doubt as to the diagnosis, angiography could confirm it, although it is seldom necessary. The treatment is simple and consists of proximal and sital ligation of the artery before aneurysmal sac or fistula removal.

Cerebral atrophy and neuropsychological correlates in schizophrenia.

Twenty-three patients with DSM III chronic schizophrenia, were given the Wechsler Adult Intelligence Scale and had CT brain scans performed in order to measure the size of the 3rd and 4th ventricles and ventricular brain ratio (VBR). CT-scans showed an evident enlargement of the 3rd ventricle and a VBR overall significantly above that found in normal sample. No significant correlation between ventricular size and cognitive impairment was found. Possible meanings of these findings will be discussed in this paper.

[Transient ischemic attacks in the carotid system: main angiographic findings]. / Gli attacchi ischemici transitori del territorio carotideo: principali quadri angiografici.

The clinical material of this report includes 100 cases of TIAs, studied with angiographic investigations in the past four years: lesions in the carotid system were more common (78%) than in the vertebro-basilar system (22%). Ulcerative and stenotic atheromatous plaques of the carotid artery were the more frequent alterations in our cases of TIAs in the carotid system. Thrombosis of the internal carotid artery was fairly frequent. Angiographic investigations used in our patients are presented.

[Treatment of large tumors of the cerebellopontile angle using a combined transtentorial and translabyrinthine approach to the middle cranial fossa]. / Trattamento dei grossi tumori dell'angolo ponto-cerebellare attraverso la via combinata della fossa cranica media transtentoriale e translabirintica.

The Authors have reported on 7 patients with large tumors (larger than 4 cm) of the cerebello-pontine angle operated-on utilizing a subtemporal-transtentorial-translabyrinthine-trans-occipital approach. The technique, the results and complications of this approach to the cerebello-pontine angle are discussed. The advantages are the delineation of the cranial nerves and of the ventrolateral brainstem with its blood supply. This approach has been associated with a low morbidity and no operative mortality in 5 cases of acoustic nerve tumor and 2 meningiomas.

[Clinical and angiographic aspects of medullary angiomas]. / Aspetti clinici e angiografici degli angiomi midollari. Casistica personale.

The authors present six personal cases of medullary angiomas: three cases of retromedullary, one of intramedullary and two of intra-retromedullary vascular malformations. One of two last cases was associated with a paravertebral arteriovenous malformation. The neuroradiologic investigations include a water-soluble myelography, with hypocicloidal tomography, and spinal cord selective angiography. The latter present many advantages of the aortography, for feeding arteries visualization, but the site of the shunt inside the intervertebral foramen can be localized only by angiotomography. In our cases neurological complications or clinical worsening were not found.

[Computerized axial tomography in the study of orbital pathology]. / La tomografia assiale computerizzata nello studio della patologia orbitaria.

In recent years, C.A.T. has revolutionized the diagnostic iter in the field of orbitary pathology. Although echotomography has reached very good results in this field, C.A.T. still remains, according to the Authors the most reliable diagnostic approach, because of its excellent insight of normal and pathological orbital material. the analysis of personal casistics of 120 orbital tomodensitometric examinations has proved this event, especially as retrobulbar expansive pathology is concerned.

[Hyperselective angiography in the study of spinal diseases (author's transl)]. / Sulla validità dell'arteriografia superselettiva nella patologia midollare e del canale vertebrale.

We report about a new angiographic technique, spinal angiography, its indications and complication. Spinal angiography is clearly essential for the diagnosis in retro or intramedullary arterio-venous malformations and for metameric angiomatosis with neurological involvement.