Sayre, George P.

Ligation of various combinations of arteries in the neck in 21 dogs demonstrated that there is little clinical effect following ligation of three or less of the major arteries to the brain and that most dogs survive after all the major arteries to the brain are ligated in the neck. A procedure is described in which the collateral circulation is determined by injection of liquid vinyl acetate into the arterial tree in dogs immediately after death subsequent to one-stage ligation of all the major arteries to the brain. The main anastomotic channels are branches of the costocervical and omocervical arteries that join muscular branches of the vertebral arteries beyond the ligated points. No anastomotic channels were detected in the carotid systems.

Cerebral infarction is attended by extravasation of blood in varying degrees. The present study was undertaken to learn whether anticoagulant therapy increases the extravasation and thereby diminishes or negates possibly favorable therapeutic effects. A series of experiments on dogs is described and the clinical implications are discussed.

Cerebral infaretion currently is the third leading cause of death in the United States. Since atherosclerosis of the cerebral arteries is the basis for the majority of strokes, the authors undertook to define more accurately the distribution of such atherosclerosis, its relation to coronary atherosclerosis, and its relation to such other factors as hypertension, obesity, and cerebral infarction. The results of their study are presented here.

Dialysis and transplantation are now standard treatments for end-stage renal failure. Often, neurologists are consulted regarding the neurological complications of these therapeutic procedures. In addition to previously reported complications, neurovascular disease is being recognized as a cause of mortality and morbidity in these patients. We report two cases of apparent thromboembolic stroke in young patients with renal failure -- one treated by dialysis and the other by renal transplantation. The risk factors of both dialysis and transplant are identified and data from the American College of Surgeons/National Institutes of Health Transplant Registry are reviewed.

The records of the Mayo Clinic have been used as the primary basis for the study of stroke in the population of Rochester, Minnesota, from 1945 through 1954. The incidence rate for first stroke of all types was 1947/100,000/year. The rates increased with age, and at age 65 to 74 years, about 1% of the population was affected annually. No significant differences were noted between men and women. The rate for cerebral thrombosis was 146/l00,000/year for all ages. Cerebral hemorrhage represented less than 10% of all strokes and occurred in less than 15% of those who died; this is contrary to what is published in the U.S. Mortality Statistics . The prevalence rate was 547/100,000 on January 1, 1955. Twenty-one percent of these persons who had previously had a stroke were functioning with no incapacity on the date of prevalence determination and only 3% were bedridden. Death certificates were reviewed for all those who died after a stroke. Among those who died within a month after a stroke, some type of stroke was noted as the underlying or an associated cause of death in 91%. However, among those who died more than a month after a stroke, only 54% had such a diagnosis recorded. Probability of surviving after each type of stroke was determined and compared with survival in a normal population. The curve showing probability of surviving from cerebral thrombosis diverges throughout its course from that of the expected survival but diverges more sharply in the first several months. Among those patients with stroke who died, 41% died of causes related to the acute stroke and 10% died of a subsequent stroke. Heart disease was the cause of nearly twice as many deaths as was a subsequent stroke among those who survived the initial stroke. Autopsies were performed on approximately 50% of those persons who died following a stroke, and information from these studies confirmed the high degree of accuracy of the clinical appraisals.