Pineal cavernous angioma presenting with Parkinsonism.

Cavernous angioma of the pineal region is rare, as is brain tumour coincident with Parkinsonism. The authors describe the case of a 55 year old woman with a pineal region cavernous angioma, who subsequently developed Parkinsonism after her increased intracranial pressure was relieved. The cause of Parkinsonian syndrome is unclear, but compression of the posterior thalamus and upper mid-brain with congestion of the deep venous system may have caused vascular disturbance of the nigro-striate-pallidal system. Her symptoms gradually improved after total excision of the lesion.

The usefulness of magnetic resonance angiography in surgery for intracranial aneurysms that have bled.

BACKGROUND: Once it was confirmed that magnetic resonance imaging (MRI) including angiography (MRA) could demonstrate intracranial aneurysms, a study was set up to establish whether satisfactory images could be obtained to plan and execute early surgery on ruptured intracranial aneurysms without recourse to intra-arterial digital subtraction angiography (IA.DSA) in the acute phase of the illness. METHODS: All patients presenting with a subarachnoid haemorrhage (SAH) were considered for MR studies. The patient selection was based on whether they were considered fit enough to tolerate scanning and did not have a known contraindication. A standard protocol was used--a three-dimensional time-of-flight with T1 and T2-weighted sagittal and axial images. If an aneurysm was demonstrated and early surgery was undertaken they were entered into the study. RESULTS: Over a 25-month period, 122 patients were submitted for MR studies, these being selected from over 200 patients presenting with an SAH. Aneurysms were believed to be present in 55 patients who were clinically suitable for early surgery. There were 21 males and 34 females, with an age range of 23-79 years, a mean of 50.5 years. Sixty-three aneurysms in all were demonstrated and 55 of these were surgically dealt with. There were two false positives. CONCLUSION: MRI is the investigation of choice to plan surgery in those patients presenting with an SAH who, on clinical grounds, would be considered suitable for early surgery. The imaging is easily obtained, non-invasive, avoids radiation, and in view of the multiple images obtained is often superior to conventional DSA.

Carotid body tumour: microvascular Doppler flowmeter for shunt placement.

During the span of five years from October, 1987 to December, 1992, we have operated on six cases of carotid body tumours. Total excision was performed in five patients; one patient had 90% of the tumour excised. All patients had pre-operative balloon occlusion test; only one patient showed electroencephalographic changes. Three patients required intra-operative intraluminal shunts for various reasons. Microvascular Doppler flowmetery confirmed patency and correct placement of the shunt. Elective use of the intraluminal shunt is very useful for safe excision of carotid body tumours. Microneurosurgical techniques were used for all patients. There were no cerebrovascular sequelae and 25% of patients experienced cranial nerve injury. Average follow up was three years and none of the total excision patients have had recurrence of the tumours.

Functional 5-HT receptor subtypes in the isolated canine common carotid artery.

The vascular responses to 5-hydroxytrypamine (5-HT), 5-carboxamidotryptamine (5-CT, a selective 5-HT1-like receptor agonist), alpha-methyl-5-HT (alpha-M-5-HT, a relatively selective 5-HT2 receptor agonist), noradrenaline (NA), and KCl were examined in isolated, cannulated, and perfused canine common carotid arterial preparations. They caused strong vasoconstrictions. The rank order of vasoconstrictive potency was 5-HT > alpha-M-5-HT > or = NA > 5-CT >> KCl. The 5-HT-induced vasoconstriction was significantly depressed by methysergide (a 5-HT1 and 5-HT2 receptor antagonist), ketanserin (a selective 5-HT2 receptor antagonist), and spiperone (a selective 5-HT2 receptor antagonist). The 5-CT- and alpha-M-5-HT-induced vasoconstrictions were also significantly inhibited by methysergide, spiperone, and ketanserin. The NA-induced vasoconstriction was readily inhibited by bunazosin (an alpha-adrenoceptor antagonist) and ketanserin but not significantly inhibited by spiperone and methysergide. KCl has a weak potency for producing a vasoconstriction of the canine common carotid artery. A relatively large dose of diltiazem (a calcium channel-blocker) did not modify 5-HT-induced vasoconstrictions.(ABSTRACT TRUNCATED AT 250 WORDS)