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Biomedical subjects

C G Drake

Publications and source records attributed to C G Drake.

121 records · Page 7Linked to original sources
PubMedDate not supplied

Intracranial saccular aneurysm and moyamoya disease.

Moyamoya disease is a rare but well described entity which has been found in the angiographic investigation of subarachnoid hemorrhage, its most common symptom in adults. We present 4 patients in whom moyamoya disease and an intracranial saccular aneurysm were discovered. In 2 of the 3 patients suffering a hemorrhage, the aneurysm was the source of bleeding. Three of the aneurysms were located at the basilar artery bifurcation. We recommend a careful search for a concomitant aneurysm in all patients with subarachnoid hemorrhage in whom moyamoya disease is found. We believe these patients should be treated as though the aneurysm were the source of bleeding.

Adult↗
PubMedDate not supplied

Progress in cerebrovascular disease. Management of cerebral aneurysm.

The primary effort of neurosurgery over the past two or three decades has been to deal effectively with cerebral aneurysms surgically. Concomitantly with aggressive medical treatment, considerable progress has occurred in the prevention of early rebleeding and the treatment of the ischemic syndrome, the most serious features of the natural history of a ruptured aneurysm. The major problem now becoming evident is that in spite of this progress, the majority of patients are not seen by physicians and there has been only a small impact on the overall morbidity. It is dismaying to realize that many patients go unrecognized, at least until a massive brain-destroying hemorrhage has occurred. Only a small fraction of the patients are seen after the initial bleed when the greatest therapeutic reward would occur. The challenge for the future, then, will be the early recognition of the initial bleeding, the warning bleeding. It will require public education about the problem in a continuing fashion, as well as continuing emphasis on it for students and physicians. The potential for prevention of death or dreadful disability is large for thousands in the prime of life each year. While delayed surgery is safe, a significant amount of rebleeding and ischemia with vasospasm still occur, resulting in an unsatisfactory overall morbidity. A collaborative study is desirable to determine with sufficient patients whether very early modern operation in many hands will reduce this morbidity.

Aging↗
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Amaurosis fugax as the presenting manifestation of dural arteriovenous malformation.

A 46-year-old woman under investigation for three episodes of amaurosis fugax in the left eye proved to have a left anterior-middle fossa dural arteriovenous malformation with pial venous drainage. The malformation received its main supply from the left middle meningeal artery, but its anterior part was fed by the recurrent meningeal branch of the left ophthalmic artery. Transient episodic lowering of retinal arterial pressure due to shunting of blood from the ophthalmic artery to the malformation is the most likely explanation for the occurrence of amaurosis fugax, indicating that this symptom occurs in some patients on a hemodynamic basis.

Blindness↗
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Major cerebral arterial and venous disease in osteopetrosis.

Two patients with osteopetrosis were studied in whom severe stenosis of one or both internal carotid arteries was demonstrated. One patient had autosomal dominant osteopetrosis and the other patient had the autosomal recessive form of the disease. In one patient, probable occlusion of one internal jugular vein and retrograde thrombosis of the contributing dural venous sinuses was present. Venous drainage of parts of the brain occurred through dilated emissary and scalp veins. It appears that major extracranial vessels may be impinged upon by dysplastic bone in osteopetrosis, although this is the first report of such an occurrence. A posterior fossa aneurysm was present in one case, and may have been related to abnormal intracranial hemodynamics.

Bone and Bones↗
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How old people tolerate intracranial surgery for aneurysm.

The purpose of this paper is to examine how well (or poorly) patients past the age of 60 tolerate intracranial surgery for aneurysms in all locations. The records of 93 consecutive good risk patients (Botterell Grades 1 and 2) have been reviewed. Co-existing chronic medical conditions, e.g., hypertension, were ignored in patient grading. The results indicate that, for treatment of aneurysms on the anterior circulation, older patients tolerate intracranial procedures as well as younger patients. This is not true for operations upon posterior circulation aneurysms. Some possible reasons for this discrepancy are suggested.

Age Factors↗
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Saccular aneurysms in basilar artery fenestration.

Of 59 cases of vertebrobasilar junction aneurysms diagnosed and treated from January 1977 to April 1986, 21 (35.5%) saccular aneurysms arose in a fenestration of the proximal basilar artery. Defects of the media at the junctures of the fenestrated segments, as well as the possible presence of turbulent flow at the vertebrobasilar junction, may explain the high incidence of vertebrobasilar aneurysms associated with proximal basilar artery fenestration.

Adult↗
PubMedDate not supplied

Rolandic arteriovenous malformations: improvement in limb function by IBC embolization.

Three patients with arteriovenous malformations in the rolandic region and significant limb deficit showed virtually complete functional recovery after awake operative embolization of most of the malformations using isobutyl-2 cyanoacrylate. Two of these patients, with functionally useless hands, had sustained the deficits months earlier as the result of a specific brain-damaging event: one as a result of surgery and the other as a result of a hemorrhage. Both of these showed significant return of function during the awake operative embolization procedure. The other patient had had progressive leg weakness over a 2 year period. The theory of steal phenomenon as an explanation for progressive neurologic deficits in association with large arteriovenous malformations must be extended to explain apparently stable deficits after some brain trauma (surgery or hemorrhage). These results suggest that some patients with arteriovenous malformations and without clinical deficits who are near a critical level of "near ischemia" may be thrown out of balance by an acute interceding event.

Adolescent↗
PubMedDate not supplied

Extensive organization in a thrombosed giant intracranial aneurysm: case report.

A 58-year-old man presented with a 4-month history of personality changes and transient episodes of right lower extremity weakness, as well as transient episodes of aphasia. Computerized tomography revealed a large basal frontotemporal mass with extensive surrounding edema which was confirmed on angiography to be a partially thrombosed giant aneurysm. Pathologically, the lesion was extraordinary, demonstrating extensive organization, with the entire cavity of the aneurysm occupied by vascular channels of different sizes, some of which were thrombosed. These findings were substantiated by scanning electron microscopy which also illustrated areas of active platelet-fibrin interaction on the remaining luminal surface.

Humans↗
PubMedDate not supplied

Progressive thrombosis of brain arteriovenous malformations after embolization with isobutyl 2-cyanoacrylate.

Embolization of brain arteriovenous malformations (AVMs) with isobutyl 2-cyanoacrylate (IBCA) is an alternative to surgical treatment when dealing with large AVMs with multiple arterial feeders. The deposition of IBCA in the nidus of the AVM may produce an active and progressive thrombosis that may lead to complete occlusion of the nidus and/or to progressive thrombosis of the draining veins. Four clinical examples of progressive thrombosis after IBCA embolization are demonstrated, including two cases in which late follow-up angiography showed complete obliteration of a partly embolized AVM.

Adult↗