Carotid endarterectomy was performed in 25 patients with symptomatic cerebrovascular disease. All patients underwent detailed neuropsychological investigations immediately before surgery, immediately after surgery, and again after a follow-up period of 14 months. Immediately after surgery the flicker fusion frequency was temporarily reduced, indicating an impairment of global cognitive functioning. Postoperatively, verbal attention was found to be improved, particularly in younger patients, in patients with TIA, and in patients with left-sided operation. Finally, visual retention (Benton) was improved at the end of the observation period, especially in older patients and in patients with left-sided operation. Considering the complexity of pathologic brain perfusion, the effects of carotid endarterectomy can only be explained if a multidimensional approach is adopted.

Carotid endarterectomy was performed in 25 patients with symptomatic cerebrovascular disease. All patients underwent detailed neuropsychological investigations immediately before surgery, immediately after surgery, and again after a follow-up period of 14 months. Immediately after surgery the flicker fusion frequency was temporarily reduced, indicating an impairment of global cognitive functioning. Postoperatively, verbal attention was found to be improved, particularly in younger patients, in patients with TIA, and in patients with left-sided operation. Finally, visual retention (Benton) was improved at the end of the observation period, especially in older patients and in patients with left-sided operation. Considering the complexity of pathologic brain perfusion, the effects of carotid endarterectomy can only be explained if a multidimensional approach is adopted.

An 25 Patienten mit zerebrovaskulären Erkrankungen auf ischämischer Basis wurde eine Karotisendarterektomie durchgeführt. Um die Auswirkungen auf die Hirnleistung zu beurteilen, wurden im Rahmen dieser prospektiven Studie alle Patienten insgesamt 3mal (unmittelbar präoperativ, unmittelbar postoperativ und nach einem Beobachtungszeitraum von 14 Monaten) einer neuropsychologischen Testuntersuchung unterzogen. Unmittelbar postoperativ war eine Beeinträchtigung der globalen Hirnfunktion, gemessen mit der Flimmerverschmelzungsfrequenzanalyse, festzustellen, die sich im weiteren Verlauf wieder weitgehend rückbildete. Ebenfalls unmittelbar postoperativ war eine Verbesserung der verbalen Merkfähigkeit zu beobachten, von der primär jüngere Patienten, solche mit TIA und linksseitig Operierte profitierten. Schließlich kam es langfristig auch zu einer Besserung der visuellen Merkfähigkeit, in erster Linie bei älteren Patienten und ebenfalls bei linksseitig Operierten. Die widersprüchlichen Ergebnisse in der Literatur werden diskutiert. Die Auswirkungen der Karotisendarterektomie auf einzelne Hirnleistungsparameter sind in Anbetracht der Komplexität der Pathophysiologie der Hirndurchblutung nur über einen mehrdimensionalen Ansatz erklärbar.

The aim of this study was to explore whether magnetic resonance angiography (MRA) could serve as a substitute for invasive, selective catheter angiography in stenotic disease of craniocervical arteries. MRA was done with the Siemens 1.5T Magnetom. Intra-arterial digital subtraction angiography (IADSA) was performed with the Siemens Angiotron. Thirty-six patients with cerebrovascular accidents or brain tumours were included; up to two regions of interest (ROIs) per side per patient were studied. MR image quality and sensitivity were most affected by patient motion. Spearman’s rank correlation (R) reveals a highly significant correlation (R = 0.9 for internal carotid artery ROIs and R = 0.6 for common carotid artery ROIs) of degrees of stenosis in both MRA and IADSA of 132 ROIs of the internal and common carotid arteries. Twelve MRA-ROIs were unusable for various reasons. In spite of good correlation of IADSA grades of stenosis (at an interobserver correlation of 100%), MRA has several pitfalls limiting its use as a preoperative diagnostic tool.

Seventy-one patients (ages: 15–58 years) suffering from complicated migraine were investigated by means of cerebral angiography which was not performed during an attack. Angiography was carried out to exclude stenoses or occlusions of the cranio-cervical vessels and above all vascular malformations (arterial aneurysms, arteriovenous angiomas). In 18 cases (25.4%) organic lesions were found, including three vessel malformations (4.2%). Thirty-one patients (43.7%) suffered from headache reactions or other complications during or within 24 h following angiography. In 15 cases (21.1%) attacks of complicated migraine were observed, three patients (4.2%) suffered from headache and bilateral flickering visual disturbances, another 11 patients (15.5%) developed headache and vegetative symptoms requiring therapeutic management. One patient (1.4%) got an epileptic seizure, another patient (1.4%) developed a generalized urticaria exanthema. There were more headache reactions in women than in men. However, the highest percentage of reactions was observed in patients in whom migraine headache had occurredclearly set off from the transient cerebral functional disturbances. Neurological complications (transient functional disturbances) occurred in 16 of 71 patients (22.5%). The neurological complication rate was significantly (P < 0.001) higher than that in an unselected group of patients (3.0%). However, apart from one case with an acute organic psychosis and permanent amnesia during the angiographic investigation and the postangiographic period, only transient functional disturbances without permanent deficits were seen. In view of the benign course of the complications, it is our opinion that in spite of the high rate of headache reactions angiography should be performed in patients with complicated migraine. Cerebral angiography is the only method of reliably diagnosing intracranial arterial stenoses, occlusions and vascular malformations. Without angiography and thus without diagnosis patients would be considerably endangered (possible rupture of the malformation with fatal consequences).

Seventy-one patients (ages: 15-58 years) suffering from complicated migraine were investigated by means of cerebral angiography which was not performed during an attack. Angiography was carried out to exclude stenoses or occlusions of the cranio-cervical vessels and above all vascular malformations (arterial aneurysms, arteriovenous angiomas). In 18 cases (25.4%) organic lesions were found, including three vessel malformations (4.2%). Thirty-one patients (43.7%) suffered from headache reactions or other complications during or within 24 h following angiography. In 15 cases (21.1%) attacks of complicated migraine were observed, three patients (4.2%) suffered from headache and bilateral flickering visual disturbances, another 11 patients (15.5%) developed headache and vegetative symptoms requiring therapeutic management. One patient (1.4%) got an epileptic seizure, another patient (1.4%) developed a generalized urticaria exanthema. There were more headache reactions in women than in men. However, the highest percentage of reactions was observed in patients in whom migraine headache had occurred clearly set off from the transient cerebral functional disturbances. Neurological complications (transient functional disturbances) occurred in 16 of 71 patients (22.5%). The neurological complication rate was significantly (P less than 0.001) higher than that in an unselected group of patients (3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Among 234 haemophiliacs (A and B) treated between 1948 and 1975 at the First Medical Clinic of the University of Vienna, 25 (10.8%) with 36 peripheral nerve lesions have been observed. This amounts to 15.3% or 2.4 lesions within 100 observation years. The average age of the patients at the time of development of lesion was 26.4 years.

The etiology, frequency and prognosis of recurrent Bell's palsy were studied in patients with peripheral paresis of n. facialis of various etiology.