VARIETIES OF angiographic changes in occlusive basilar disease are described and the final outcome correlated with the site of occlusion and the type of collateral flow. MethodsFrom 1969 to 1973, 20 patients with basilar artery occlusion were studied radiologically. The examinations consisted of right and/or left brachial arteriograms in 18 patients and biplane aortic arch arteriograms in two. In addition, angiography of the right carotid was performed in two patients and of the left carotid in four.Each of the arteriograms was reviewed by one of us to establish the site and extent of the basilar artery occlusion and the type of collateral flow.The chart of each patient was then reviewed for the data in table 1. Follow-up information was obtained on 19 patients with the cooperation of the family physician or the relatives.During the same period, three patients with bilateral vertebral artery occlusion were studied in a similar way. A summary of their clinical information is found in table 2 (and their angiographic findings in table 6). ResultsTen of the 20 patients with basilar artery occlusion were men and ten women. Their ages ranged from 43 to 78 years, with one in the 40-49 year range, eight in the 50-59, six in the 60-69, and five in the 70-79.Hypertension was present in 14 patients and arteriolonephrosclerosis was found in the one patient who had a postmortem examination but who was clinically normotensivea total of 15 hypertensives.Two patients had rheumatic heart disease; both of them were normotensive but one had arteriolonephrosclerosis. Two normotensive patients had diabetes mellitus.A history of vertebro-vasilar disease was not obtained in any patients, but three had suffered a stroke in the past, presumably owing to disease in the carotid system.Only two autopsies were made but one was incomplete and the results of the second unobtainable.

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Eight normal subjects were examined in dark, light and color conditions. Mean cerebral blood flow velocity (MBFV) were recorded almost simultaneously from their posterior cerebral arteries (PCA) using transcranial Doppler (TCD) ultrasound. The side-to-side difference was significant during the dark (p = 0.0159) and color stimulation (p = 0.0001) but not in light condition. This side-to-side difference in MBFV was used to characterize lateralization of color perception. This showed that the right PCA was always greater than the left during the presentation of color stimuli. Primary psychological colors (blue, yellow, red and green) induced greater lateralization as compared with color resulting from a mixed blue-green wavelength. This suggests that the right visual cortex is selectively sensitive to wavelengths.

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Whipple's disease presenting as a neurological disease without gastrointestinal symptoms is an unusual occurrence. A 40 year old man suffered hypersomnia, memory loss and progressive ophthalmoplegia for 6 months prior to death. The nature of this disease was not established during life. Extensive granulomatous inflammation affecting the hypothalamus, hippocampus and periaqueductal gray matter of the brain was found to represent Whipple's disease by electron microscopy. Characteristic lesions were also present in spleen, mesenteric lymph nodes, small intestine and myocardium. Bacillary bodies and membranous inclusions similar to those seen in visceral lesions of Whipple's disease were present in macrophages. The findings supported the theory of direct involvement of the central nervous system by bacilli rather than a metabolic origin for the lesions.

Cerebral and cerebellar calcifications were discovered by computerized tomography (CT) in a man who presented with a dementing illness characterized by progressive memory loss, irritability, and dystonia. He had no known family. Magnetic resonance imaging showed areas of absent signal corresponding to the calcifications and areas of high-intensity signal on the T2-weighted images without counterpart on the CT. These are postulated to be static liquid pools secondary to endothelial membrane incompetence and leakage of plasma-derived fluid.

We performed Fourier analysis of the middle cerebral artery blood flow velocity waveform envelope in 14 normal subjects (group A) and 15 patients, of whom five had arteriovenous malformations (group B), five had cerebral vasospasm (group C), and five had arterial hypertension (group D). Measurements were obtained under conditions of normocapnia, hypercapnia, and hypocapnia. The Fourier coefficients measured in the first five harmonics of the Doppler waveforms of group A were used as the reference baseline and were compared with the coefficients found in the other three groups. Group B showed significantly lower Fourier coefficients, while groups C and D showed higher coefficients (p<0.05). The elevation of the Fourier coefficients occurred in an alternating pattern in group C and a decremental pattern in group D. This distinction was attributed to possible differences in the underlying pathophysiological processes. The degree of vascular distensibility of the cerebral arterioles, inferred from the shape of the Fourier analysis curves, was compared in all four groups. Vascular distensibility was characterized as abnormal in arteriovenous malformations, vasospasm, and arterial hypertension. Fourier coefficients may be better indicators of cerebrovascular abnormalities than mean blood flow velocity in hypertension and pulsatUity index in arteriovenous malformations, vasospasm, and hypertension. (Stroke 1991^2:721-726)

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