[The application of the endovascular prosthesis (stent)]

We report two cases of symptomatic internal carotid stenosis treated by vasoplasty and stent placement in two male patients aged 57 and 64 years, one who had been suffering from transient ischemic events and the other had had a recent cerebral infarction with hemiparesis. The treatment sessions took place without complications. We discuss the choice of simultaneous vasoplasty and stent placement, some of the current possible indications for the method and the importance of multidisciplinary planning for the patient's evaluation and treatment.

[The radiological pattern of cochlear otosclerosis. A CT study of 14 patients]

In this review of cochlear otosclerosis 14 cases were studied by CT scan aiming to establish a densitometric pattern of the capsular foci and relating it to the hearing and vestibule dysfunctions. Severe demineralization with characteristics of probable activity (increased lucency of 30-40%) was demonstrated in the capsular foci. These were mainly cochlear with endosteal involvement (93%): large (64%) or discrete (29%). Cochlear otosclerosis was widespread in 64% of the patients, with coexisting foci in the semicircular canals (38%), vestibule aqueduct (43%) and internal auditory canal (43%). The antefenestral component with stapes involvement was 85%, mostly of the anterior polar and crural varieties (64%) and signs of activity. In 2 patients there was a conductive hearing loss in the tonal audiometry, pure or combined; in 2 others there was only a pure perceptive hypoacusis of type IV. A direct relationship was noted (64% of cases) between the most serious hypoacusis (type III and IV) and the endosteal extension of the cochlear foci. Vertigo occurred in 36% of the patients and was attributed to the posterior labyrinth foci.

[CT study of 17 cases of congenital cochlear abnormality. Embryologic and anatomo-functional relationship]

In this review of cochlear malformations, 17 cases were studied by CT scan (high resolution-target program) including 10 males and 7 females. The anomaly was bilateral in 12 cases and unilateral in 7 (the latter included 2 Mondini type aplasias and one Michel). The cochlear malformation (whose most frequent expression was the cochlear hypoplasia with 1 or 1 1/2 spires-65% of the cases) was associated to semicircular canals and/or vestibular aqueduct anomaly in 82% of the patients; it was exclusively of the anterior labyrinth in 18% of the cases. A middle ear malformation coexisted in 29%: in 3 cases with malleoincudal dysmorphy only and with tympanic aplasia in 2 others. These cochlear anomalies with CT expression were discussed considering the embryology, in view of a possible gestational dating, moreover relating to the hipocusia type: perceptive or combined.

[Angiographic diagnosis of intracranial aneurysms: study of the experience of the neuroradiology service at the Egas Moniz Hospital]

In this work, 139 intra-cranial aneurysms diagnosed at the Egas Moniz Hospital were studied, from 1980 to the first quarter of 1992. The nature of this type of lesions was discussed, and aneurysms were defined as an abnormal and segmental dilatation of an intracranial artery wall. A statistical study was performed, including 67 cases after selection, corresponding to 71 aneurysms. Of these, 39% originated from the anterior cerebral artery, 37% from the carotid siphon, 18% from the middle cerebral artery and 6% were found in the vertebro-basilar system. The observed topographic incidence of the symptomatic aneurysms was compared with neuropathology data. The results obtained with the hypothesis test for a proportion are suggestive of an increased incidence of symptoms for the aneurysms of the anterior cerebral artery, with a significance level alpha = 0.05.

[Development of the embolization technique for cerebral and spinal marrow arteriovenous malformations, and its clinical basis]

The authors revised 4 cases of large AVM's--3 cerebral and 1 medullary--illustrating the evolution of their technique of endovascular occlusion. These embolizations always preceding the surgery have their interest discussed in terms of the clinical grounds, the easiest access to the nidus and the possibilities of preventing some of the surgical risks.

[Contribution of angiography in the pre-operative evaluation of 24 jugulo-tympanic paragangliomas with otoneurologic manifestations]

The contribution of carotid and vertebral angiography for surgical planning, particularly for the infratemporal approach, in 24 jugulotympanic paragangliomas with otoneurological symptoms is discussed. These symptoms included peripheral facial palsy, sensorineural hypoacusis, labyrinthine and nervous syndrome of the jugular foramen. Angiography was essential for the diagnosis of these tumors and, above all, for the rigorous evaluation of intrapetrous and apical invasion of the carotid artery, and also of extra and intradural posterior fossa extensions. Presurgical embolization, a relevant step in treatment, was based on the criterious evaluation of the angiotopographic pattern of the tumoral hypervascularization.

[Importance of magnetic resonance in Parkinson disease. An analytic study of the pars compacta]

The authors have studied by high field MR (Signa 1.5 T, GE) 11 patients with known Parkinson's disease and 19 normal controls. In all cases the widths of the pars compacta were measured by optical densitometry in T2-weighted images (gradient-echo TR 2600, TE 80). In Parkinson's patients the compactae of the nigra were found to be significantly thinned (p less than 0.01) which may be of importance for the discussion of the physicopathology and clinic of the extrapyramidal disease.

[A case of Wilson's disease studied using magnetic resonance: a new approach?]

Wilson's disease is a genetically determined disorder of copper metabolism with increased deposition in brain and liver. With current imaging techniques--CT scan and conventional Nuclear Magnetic Resonance (NMR)--it has been possible to demonstrate oedema, neuronal loss and reactive gliosis, but not copper deposition. In the present study we report the observations, done in one patient, using a new high magnetic field (1.5 Tesla) NMR device. In these circumstances, we are able to expand the CT scan analysis by showing not only the oedema and the brain cell death but also the probable existence of copper deposits. Will this be true, it is first instance in which it has been possible to demonstrate, by a non invasive method, increased copper deposition in Wilson's disease. This possibility may be important to monitor the therapeutic efficacy of chelating agents and also to distinguish asymptomatic homozygous patients from heterozygous healthy carriers.

Effect of treatment with bromocriptine on the size and activity of prolactin producing pituitary tumours

Eleven consecutive patients with large prolactinomas were treated for 6 months with bromocriptine, (7.5 mg/day). Nine had invasion of the sphenoidal sinus, one a visual field defect and one a secondary trigeminal neuralgia. At the end of the treatment period 8 of the first 9 patients showed radiographical signs of bone remodelling and/or actual reduction of the tumour size. The last 2 patients had complete disappearance of their symptoms. The remissions could be observed as early as 3 weeks after the start of the treatment. Two patients suffered acute, reversible (partial in one case) episodes of loss of vision during the study. During the treatment the prolactin values decreased in all patients to an average of 1.7% of the baseline levels. There was a steep rise in the serum prolactin concentrations after withdrawal of the drug. After one month there was a plateauing at a high level, although lower than basal level. Libido and potency were restored in all 3 males studied. Two of the females experienced orgasm for the first time in their lives after some years of primary frigidity. It is concluded that bromocriptine reproducibly reduces the size of prolactinomas. This effect can be observed shortly after the beginning of the treatment and is at least partially reversible. Episodes of pituitary apoplexy may occur during the treatment of large tumours despite an otherwise favourable response.