Intracranial arterial aneurysms / by Walter E. Dandy.

  • Dandy, Walter Edward, 1886-1946.
Date:
1944
Catalogue details

Licence: In copyright

Credit: Intracranial arterial aneurysms / by Walter E. Dandy. Source: Wellcome Collection.

    172/178 (page 162)
    l'AHLE G.—Aneurysms of the Vertebrae and Basilar Arteries TABLE G Xu mber, fame and Date Ago Sex Location of Aneurysm First Symptoms Duration of Symptoms Headache Convul¬ sions Convulsions Focal or General? Extra- ocular Palsies Ccrcbrul Hemorrhage Other Outstanding Symptoms Outstanding Signs Hotc Diagnosed Cause of A ncurysm Result Was Operation Performed? Remarks 1 Rudv +/3/3I- Fig. 25 18 F Left vertebral artery Left occipital pain; neck slightly stiff 8 months Pain No Bilateral VI partial; slight ptosis left lid (III N) No Vomiting, nervousness, numbness and tingling of fingers Bilateral VI, nystag¬ mus, Romberg to right, ptosis right; unsteady gait. No papillocdemn Ventricu¬ lography* operation, necropsy* Hydro- Congenital Dead Aneurysm re¬ moved; thought to be a tumor at the time. Weight 2G.9 gms. Patient died soon after operation. Cerebellar pressure was so great when dura opened that there was little chance of success. Aneurysm shelled out with finger and only slight bleeding. Aneurysm arose from left vertebral artery and presented at foramen of Magcndic casional); unsteady guit; diplo¬ pia ; dizziness on change of position 100 cc. air II Stoekdule 10/4/15 M Anterior part basilar artery. Localized pouch Headaches (1 year), dysphagia, dysarthria (4 mos.), stagger¬ ing, diplopia I year + Occipital No No No Weakness both legs and rigidity Bilateral Babinski; bi¬ lateral papilloedema Necropsy Congenital Dead Cerebellar ex¬ ploration nega¬ tive findings, hydrocephalus Sharply localized pouch involving entire circumference of basilar artery at pons and midbrain; size of hickory nut, deeply imbedded in brain stem, extends to sella turcica III Race 9/3/21 58 M Right side of basilar artery Headache and unconscious spell 2 weeks Severe suboecipi- tal No, but uncon¬ scious and de¬ lirium follow¬ ing No No Cause of death B.P. 120/90 Stiff neck, coma, brady¬ cardia. Bloody spinal fluid Necropsy Dead No Slit-like rupture of right wall of busilar artery which was not much sclerosed. A probe could be passed into a short narrow pouch (false sac) IV Johnson 9/23/31 45 F (C) Junction of basilar and posterior cerebral ar¬ teries. Sac 2 cm. in di¬ ameter Sudden blindness for 10 min. (10 days); convul¬ sion week later; coma followed 10 days + Severe Yes Not known Left VI Left III Cause of death Stiffness of neck B.P. 100/110 to 120/90. Bloody spinal fluid Necropsy Congenital (Wasser- munn neg¬ ative) Dead No 1 Aneurysmal sac, 3 cm., at junction of basilar and two posterior cerebral arteries ruptured. The sac had com¬ pressed the 3d and 6th nerves V Sutton 9/21/31 88 F (C) Junction of basilar mid posterior cerebral ar¬ teries Headache; blind right eye (few days), convul¬ sions and coma (I day) 2 weeks + Frontal Termi¬ nal General (?) No Cause of death Positive Babinski right. Bloody spinal fluid; 430 m.m. pressure: B.P. 226/154; stiff neck Necropsy Congenital (Wasser- mann neg¬ ative) Dead No 3-mm. sac (ruptured) at anterior tip of busilar artery. Patient was comatose when she entered hospital; lived 12 hours. VI Mncknll 9/20/3G 50 F Sac 5 mm. on inferior medial wall right ver¬ tebral artery opposite origin of posterior in¬ ferior cerebellar artery Sudden violent headache occipi¬ tal; coma in y> hour 4 days Violent occipital No No No Cause of death; 2 hem¬ orrhages (?) 3 days apart Regained conscious¬ ness follow¬ ing day. Died suddenly 3 days later. Neck rigid B.P. 110/70. Eye- grounds negative Necropsy Arterio¬ sclerosis Dead No Small broad-mouthed sac right vertebral artery, ruptured VII Lynch 5/10/42 52 F (1) Right post, inferior cerebellar (ruptured) (2) Ant. communicat¬ ing at right anterior cerebral (unruptured) VIII Stone 2/31/41 70 F Anterior tip of basilar None No No No No No Accidental finding at necropsy B.P. 170/100 Necropsy Congenital Dead No Patient had symmetrical (2) aneurysms on middle cere¬ bral arteries, and a third on the anterior communicatin; artery in addition to one on the basilar IX Bccrnft i/m/32 G7 M Basilar artery at left 5th nerve Trigeminal neu¬ ralgia left cor¬ ner mouth and tongue 3 years No No No No No No cere¬ bellar signs; no 7th nerve loss B.P. 210/120; head en¬ larged. Marked loss hearing left side Operation Arterio¬ sclerosis Living Trigeminal root sectioned Large bulging basilar aneurysm elevating auditor}* ar trigeminal nerves X ! Hanunond G/22/36 G8 F Anterior part basilar artery, left Rain in lower jaw, forehead, and eye 17 years No No No No No deafness B.P. 170/105 Operation 1 Arterio¬ sclerosis Living 4y, yrs. later Trigeminal root sectioned Bulging basilar artery compressing 5th nerve XI I Bcdenbaugh 10/2/40 55 F Anterior part of basi¬ lar artery,left Trigeminal neu¬ ralgia left chin and upper jaw 1 ¥> years No No No No B.P. 144/88 Operation Arterio¬ sclerosis Living 2 mos. Trigeminal root sectioned Bulge of anterior part of basilar artery at 5th nerve, was hoped that the ligation of one vertebral artery wou take the strain off the aneurysm XII Worthington G/26/33 M Basilar artery at left 5th nerve Trigeminal neu¬ ralgia left man¬ dible, cheek and tongue 2 months No No No No Mild dysp¬ noea B.P. 190/130; deafness both sides, more left. Cardiac enlargement At opera¬ tion fbr trigeminal neuralgia Arterio¬ sclerosis Died 3 mos. later Trigeminal root sectioned The lateral bulge of the basilar artery had corapresse the 5th nerve. Cause of death not known (3 months afte operation) XIII Lewellyn 11/22/27 Fig. 2G G3 F Basilar bulges to right, left vertebral artery greatly enlarged Dizzy attacks, nausea and vom¬ iting, bilateral tinnitus 5 weeks No No No No Bilateral deafness severe grade, bilat¬ eral tinnitus terrific B.P. 1G0/100;left cor¬ neal reflex diminished Operation and necropsy Arterio¬ sclerosis Dead Left VIII sec¬ tioned: later li¬ gation vertebral arteries. Huge S-shaped basilar artery at nec- ropsy Since tinnitus remained unbearable, and a basilar aneu¬ rysm had been found at operation, the left vertebral artery was ligated 2 weeks later. At same time the right vertebral was temporarily compressed with forceps; death followed immediately although compressed only for 2-3 seconds. Most rapid death I have ever seen XIV Croucli 4/17/32 Fig. 9 G4 F Basilar aneurysm right, also bilateral diffuse carotid aneurysms, ver¬ tebral arteries greatly dilated both sides Difficulty swal¬ lowing, vertigo 3 years No No No No Dysarthria and dyspha¬ gia B.P. 200/120 Necropsy Arterio¬ sclerosis Dead Patient had a large dural tu¬ mor, found at necropsy. The carotid aneu¬ rysms were ex¬ posed ut opera¬ tion; nothing done Large dural tumor found at necropsy. Died following ex¬ ploration of carotid aneurysm. Although basilar aneurysm compressed right 5th and 8th nerves there were no sub¬ jective or objective manifestations. The basilar aneurysm continued into both vertebral arteries XV Hanson 3/18/41 72 M Basilar artery right Trigeminal neuralgia 1 year No No No No No B.P. 224/110 Operation Arterio¬ sclerosis Living Aneurysm at operation for trigeminal neu¬ ralgia Fifth nerve entirely hidden by aneurysm. Nerve later sec¬ tioned by temporal route XVI Kelly 2/8/42 . 71 F Basilar artery right Trigeminal neuralgia 4 years No No No No No B.P. 240/140 Operation Arterio¬ sclerosis Living Aneurysm at operation for trigeminal neu¬ ralgia XVII Webster 2/2/42 73 M Basilar artery right Trigeminal neuralgia 5 years No No No No No B.P. 150/7G Operation Arterio¬ sclerosis Living Aneurysm at operation for trigeminal neu¬ ralgia Smith 3/17/42 58 F Basilar artery right Trigeminal neuralgia 4 years No No No No No B.P. 180/110 Operation Arterio¬ sclerosis Living Aneurysm at operation for trigeminal neu¬ ralgia Localized bulge of basilar artery just posterior to sensory root Kratz G/ll/39 G8 F (I) Basilur at left su¬ perior cerebellar ar¬ tery. (2) Bilateral internal carotid N one Wisher V8/41 65 M Right vertebral; un¬ ruptured None None Walker H/7/33 M Basilar artery right, 5th nerve Trigeminal ncu- ralgiu of left mandible and teeth 5 years No No No, but at¬ tacks of di¬ No Two attacks of diplopia B.P. 200/130 (several years) At opera¬ tion for trigeminal neuralgia Arterio¬ sclerosis Died 2 vrs. Trigeminal root sectioned The lateral bulge of the basilar artery had compressed the 5th nerve. Cause of death not known (2 years after op¬