Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Sep 1982
Case Reports[Idiopathic medial necrosis of intracranial and cervical arteries. A report of 3 cases].
Two cases of stroke and one of subarachnoid haemorrhage are reported in women of child-bearing age, in which histological examination of the cervical and intracranial arteries revealed idiopathic medial necrosis. In the first case there was a dissecting aneurysm of a vertebral artery in the neck, caused by medial necrosis of this vessels. Two further dissecting aneurysms were found of the cervical arteries and partial rupture of the posterior cerebral artery, as well as focal medial degeneration of the aortic arch. ⋯ In the third case a massive subarachnoid haemorrhage occurred after several years of severe migraine. Histological examination of an "aneurysm" of a vertebral artery revealed complete rupture and focal medial necrosis. The scanty literature on this subject is reviewed and the significance of idiopathic medial necrosis in stroke and unexplained subarachnoid haemorrhage is emphasized.
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In peripheral vascular surgery a patient not infrequently becomes a high-risk case on account of local causes (morphological, haemodynamic), especially during long operations. Hence, low-risk procedures like partial or palliative operations, including extraanatomical procedures, and appropriate anaesthesiological methods are very important. ⋯ The distribution of extraanatomical procedures in a high-risk and a local or angiological-morphological situation showed that after one year only 50% of high-risk patients were still alive compared with 85% of the latter group. Local anaesthesia was very suitable for embolectomies, whilst for other indications we prefer spinal and peridural or combined regional and general anaesthesia, with the proviso that the patient is in the hands of a skilled anaesthesiologist.