In Islamic Legal Thought: A Compendium of Muslim Jurists, twenty-three scholars each contribute a chapter containing the biography of a distinguished Muslim jurist and a translated sample of his ...work. Jurists of the formative, classical and modern periods are represented.
Fifteen patients with ruptured dissecting vertebral aneurysm were treated by intravascular neurosurgery. Twelve of them were treated in the acute stage (within 80 hours after the last rupture) and ...three were in the chronic stage. They were divided into 3 types according to location of the posterior inferior cerebellar artery (PICA) and the aneurysm: Type A, the PICA originated distal to the aneurysm; Type B, the PICA originated proximal to the aneurysm; Type C, the PICA was absent or uncertain. A parent vertebral artery was occluded as proximal to the aneurysm as possible in Types A and C. A vertebral artery was occluded between the PICA and the aneurysm, if possible, in Type B (Type B-1). Because that procedure is, in practice, difficult, especially if a detachable balloon is used, a parent vertebral artery was occluded at C4 or C5 level, proximal to the segmental arteries, in most Type Bs (Type B-2). The parent vertebral artery was occluded with detachable balloons in 14 patients. In all the patients treated with detachable balloon, parent arterial occlusion followed 15 minutes after test occlusion. If the patient's neurological symptoms or conscious conditions were not changed, the balloon was detached just as it was. The most recent case was treated with electrically detachable coils. Three patients developed cranial nerve palsies and three patients developed hemiparesis or sensory disturbance. Those symptoms were thought to be caused by gradual thrombotic formation, since the symptoms appeared not immediately after arterial occlusion but in the next day. Cranial nerve palsies disappeared in a few months in all the patients. Minimal hemiparesis or sensory disturebance remained. Seven patients suffered from symptomatic vasospasm. Transluminal angioplasty was performed on four of them, and one of them soon recovered. The remaining three and another one died of severe vasospasm in spite of angioplasty. In conclusion, intravascular neurosugery is an effective and less invasive way to treat a ruptured dissecting vertebral aneurysm. Several kinds of platinum coils, including electrically detachable coils are a useful alternative. Attention should be paid to delayed neurological deficits caused by gradual thrombotic formation. Transluminal angioplasty is also an effective way to treat severe vasospasm.
During 2.5 years after introduction of MRI, we have experienced 9 cases of vertebral dissecting aneurysm (VDA) that initially appeared with the signs and symptoms of subarachnoid hemorrhage. The ...patients' age ranged from 40 to 70 years (average: 51.8 years), and 6 male and 3 female patients were included in this series. Five of the 9 patients were hypertensive and 1 had an episode of CVA (internal carotid occlusive disease). It was particularly noteworthy that abducens palsy was observed in varying degrees in 8 cases immediately after the SAH symptoms. Lower cranial nerve palsy was also observed in 2 elderly cases. On MRI, VDA consistently showed high signal intensity around eccentric signal void. However, the intimal flap and double lumen could not be confirmed. Angiography demonstrated a fusiform dilatation of the vertebral artery with irregular surface on it and either narrowing or tapering in vascular diameter was found adjacent to the dilated portion. VDA with the onset of SAH was characterized by these MRI and angiographic findings. In 4 cases, VA was surgically ligated following balloon occlusion test. Coating of VDA was performed in 2 cases while conservative treatment was chosen for 2 cases. The outcome in the 9 month to 2 year follow-up study was good or excellent except for 1 case that resulted in death with a complication of early recurrent hemorrhage within 5 days after its onset. Based on our results in this series, it was considered that vertebral dissection tends to extend to the basilar artery particularly in aged patients with atherosclerosis, and so conservative treatment seems to be preferred for these elderly cases. For relatively younger cases, proximal ligation should be chosen in stable chronic stage, for spontaneous occlusion is not rare in these cases.