T HE percutaneous method of puncturing the carotid artery allows cerebral angiography to be performed on repeated occasions in the same patient. The cerebral arteries thus visualized with the same technic on different occasions generally are identical but sometimes differ strikingly in caliber. When the artery has the smaller caliber it is said to be in arterial spasm. It is the purpose of this paper to present our observations of such spasm and to indicate its possible significance. MATERIALS AND METHODSFor this study there were available about 400 groups of angiograms made on 350 patients. The patients were mostly adults and suffered from a variety of medical and surgical neurologic disorders. We have found only 12 instances, among 10 of these cases, which have met our criteria of arteriographically demonstrated spasm. This study is devoted to the intracranial portion of the internal carotid artery, its subdivisions, the anterior and middle cerebral arteries and their main branches. It is concerned only with vessels of at least 1.5 mm. in internal diameter.Arterial spasm can be definitely recognized arteriographically when a vessel is of larger caliber in a subsequent angiogram than was demonstrated at a previous study made under identical conditions. This study is concerned with spasm of only moderate degree, rather than with maximal spasm or total occlusion of the vessel, which obviously cannot be recognized arteriographically. Minimal spasm, with alterations of caliber of less than 0.5 ram., will not be considered because of the difficulties involved in precise measurement.Marked spasm slows the blood stream. In such cases arteriograms with routine timing show filling of only the proximal portion of the intracranial arteries. Repeating the arteriogram with delayed timing of the exposure (by 89 to 5 seconds) will show full arterial filling. When spasm is relieved the velocity of blood flow becomes normal as demonstrated by full arterial filling with routine timing.
Vibrotactile thresholds were determined at 7 frequencies between 25 and 300 Hz at the medial edge of the cheek in 11 patients who had been or were currently being treated for major trigeminal neuralgia, tic douloureux. A control group, comparable in age but without neural pathology, was also tested. Results indicate essentially no difference between normal and affected sides of the face prior to surgery. The drug carbamazepine (Tegretol), commonly used to control pain of trigeminal neuralgia, did not affect vibrotactile thresholds. Infraorbital neurectomy resulted in an initial loss of sensitivity at all frequencies, followed by a gradual return of sensation which reached preoperative levels at approximately one year. The return of sensitivity was followed by the return of neuralgia. Following alcoholic gasserian rhizolysis, low-frequency thresholds were elevated considerably as after neurectomy, but sensation above 100 Hz was lost completely. A return of high-frequency sensitivity accompanied the recurrence of pain in some patients who had been injected up to 13 years prior to testing. The results are discussed in terms of recent anatomical, electrophysiological, and clinical findings.
The purpose of this paper is to draw attention to sciatica caused by tumoral calcinosis. It is a rare condition of obscure etiology marked by benign, lobulated, fluctuating, calcified cystic masses in the region of gliding surfaces or bursae. These masses are usually not accompanied by pain, tenderness or limitation of *notion. However, in the patient reported the mass of tumoral calcinosis pressed on spinal nerve roots and was the apparent cause of sciatic pain. Removal of the mass was followed by relief of pain. CASE REPORTA 59-year-old woman, referred by Dr. Charles Lloyd, complained of pain for ~ years in the ]eft buttock and down the back of the left lower limb to the ankle. One year before we saw her, x-ray studies had revealed a calcified cauliflower-like mass in the left ]umbosacral region which measured about 5)<3 cm. (Fig. 1). Similar smaller masses were present over the right greater trochanter and in the region of the left subdeltoid bursa. She had never taken vitamin D before these films were made. Subsequently the patient took 2000 units of vitamin D daily for 6 months. The ]eft sciatic pain became progressively more severe several months before admission. It was unaffected by coughing or sneezing. There was neither parcsthesia nor difficulty with sphiuctcric control.
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