Arteriographic Study of Cerebrovascular Disease

Abstract

Patient and Doctor-When a doctor supplies his patient with treatment and earns his fee, the transaction does not and never can possess the enviable simplicity of that between tradesman and customer, when in return for the appropriate price a pound of some commodity is handed across the counter. The attitude of the patient approaching his doctor must always be tingedfor the most part unconsciously-with distaste and dread; its deepest desire will tend to be comfort and relief rather than cure, and its faith and expectation will be directed towards some magical exhibition of these boons. Do not let yourselves believe that however smoothly concealed by education, by reason, and by confidential frankness these strong elements may be, they are ever in any circumstances altogether absent.The doctor on his part is perhaps dimly aware of the strange mixture of distrust and inordinate expectation that the patient unconsciously entertains ; he knows, moreover, how feeble are the resources against disease he commands, and he knows that for the reconciliation of these two incompatibles the responsibility will rest on him and his personal moral force.·-Emergency, The Collected Papers of Wilfred Trotter, Oxford and New York, Oxford Univ. Press, 1941, pp. 194.

Some Unsolved Problems of Cervical Spondylosis

“…It has been shown by several workers (Boldrey, Maass, and Miller, 1956;Hardesty, Roberts, Toole, and Royster, 1960;Bauer, Sheehan, and Meyer, 1961) that head rotation may lead to reduction of blood flow in the contralateral internal carotid artery by compression of this vessel against the lateral process of the atlas, deep to which it can be seen passing in Fig. 1, and it has also been shown that kinking and stenosis of the cervical portion of a tortuous internal carotid artery may be produced by head rotation on either the ipsilateral or the contralateral side.…”

“…Its importance lies in the fact that when one vertebral artery is very small compression of the other may cause disproportionately severe effects. The effects of head movement on the blood flow through the vertebral arteries have been studied by a number of workers both in the cadaver and by vertebral angiography (de Kleyn, 1939;Toole and Tucker, 1960;Tatlow and Bammer, 1957;Maslowski, 1960;Bauer, Sheehan, and Meyer, 1961 ;Bauer, Wechsler, and Meyer, 1961). To summarize their observations: (1) Even in normal individuals rotation of the head to one side may temporarily impair, or even abolish, the blood flow through the atlanto-axial segment of the contralateral vertebral artery.…”

Imaging and Clinical Findings in Patients with Aberrant Course of the Cervical Internal Carotid Arteries

“…In addition, on the right side the common carotid artery is relatively fixed at its origin from the innominate artery. With aging and other acquired factors such hypertension, the aortic arch elongates and the right common carotid artery is displaced cephalic [16-20]. As a consequence, the artery buckles to accommodate the decreased distance between its proximal and distal ends [19, 21].…”

Neurological manifestations associated with internal carotid loops and kinks in children.

“…This has been seen to happen during angiography. Bauer, Sheehan, and Meyer (1961) found that kinking of the tortuous internal carotid occurred when the neck was rotated during angiography. Toole and Tucker (1960) demonstrated the same phenomenon in cadavers when perfusion was made at a constant pressure in the aorta.…”