and biochemical correlations during oral and intravenous levodopa administration in parkinsonian paticnrs. Neurology (Minneap) 25:1144-1148, 1975 Progression of Carotid Disease After Endarterectomy William Gee, M D In the recent paper by Norrving and colleagues 141 regarding recurrent carotid stenosis, there is a transposition of numerals that results in an inaccuracy. These investigators indicated that Kremen and associates  reported a symptomatic recurrence rate of 1.7% and an asymptomatic recurrence rate of 1.8%. The numerals in the latter figure are transposed; Kremen and colleagues [ 3 ] reported an asymptomatic recurrence rate of 8.1%â. The instrument used by Kremen and colleagues [i) a was specific type of ocular pneumoplethysmograph, the O P G Gee. This was the same instrument used by Busuttil and coworkers [l], also cited by the authors. Busuttil and his coinvestigators evaluated a group of 2 15 patients over a period of five years. These patients were categorized into two subgroups, those with and those without carotid lesions of hemodynamic consequence (OPG-Gee positive or negative). In the former subgroup the risk of recurring transient ischemic attacks, stroke, and cerebrovascular death was high; in the latter, low. Although many investigators believe that emboli are the principal source of symptoms as a result of carotid atherosclerosis, it appears that emboli from carotid lesions that are not pressure significant (75V or more of crosssectional area) are uncommon. Several of the reports cited by the authors indicate that there is little potential for embolization from fibroproliferative recurrence. The authors expressed surprise at the high frequency of postoperative occlusion they encountered, which was silent in 4 of the 7 patients. Reports by Kremen  and Ortega [ 5 ] and their colleagues confirm these observations. The authors term as a direct test the ultrasound examination they performed, and they describe ocular pneumoplethysmography as an indirect test. The ultrasound examination is a direct anatomical test of a limited segment of the carotid arterial hemisystems. Spectral analysis contributes a limited qualitative physiological assessment to this direct examination. Ocular pneumoplethysmography, as described by Gee [2), is a direct examination of the quantitative physiology of the entirety of both carotid arterial hemisystems and the circle of Willis. With the advent of intravenous digital subtraction arteriography (IDSA), the anatomical limitation of ultrasound studies has been overcome. The OPG-Gee and IDSA are complementary in a quantitative physiological and anatomical assessment of the entirety of both carotid arterial hemisystems and the circle of Willis. Department of Neurology Unitlenity of Na?âarra Medical School Pamplona. Spain
Annals of Neurology – Wiley
Published: Aug 1, 1983
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