The cases of 109 patients with a transcranial or transorbital stab wound are presented. Angiography in 74 patients revealed 26 vascular lesions: 11 aneurysms, five carotid-cavernous fistulas, three other arteriovenous fistulas, three occlusions, two transections, and two instances of severe vascular spasm. The following important points and pitfalls are stressed: the 30% incidence of vascular lesions, the delayed onset of these lesions and neurological signs from 1 week to several months after trauma, and the incidence of delayed intracranial hemorrhage in four of 11 cases with traumatic aneurysms. The basal location of the lesions is described, and the authors warn against the misleading clinical picture of a trivial scalp wound in the absence of a "slot" fracture, with life-threatening neural and vascular damage on the opposite side. Aggressive investigation and treatment of these lesions are advocated because of the associated high morbidity and mortality rates, especially in patients with aneurysms.
The authors performed a controlled study of induced hypertension therapy for treatment of experimental stroke in unanesthetized monkeys. Ten control and 10 treated animals were subjected to a 4-hour occlusion of the middle cerebral artery (MCA) by an implanted tourniquet. Neurological status and local cerebral blood flow (CBF) were monitored serially. Local CBF was determined by hydrogen clearance in and around the elevated 20% to 40% by intravenous infusion of phenylephrine hydrochloride. Neuropathological evaluation was performed after about 2 weeks. A 4-hour occlusion of the MCA in control animals caused moderate stable neurological deficits, moderate stable decreases in local CBF, and medium-sized infarcts. With induced hypertension, five of 10 treated animals showed neurological improvement, and eight exhibited increased CBF in the ischemic zone. Average infarct size tended to be smaller in the treated group, although the difference did not reach statistical significance. Hemorrhagic infarcts were not observed. In four animals, phenylephrine caused cardiac dysrhythmias and hypotension which were reversed by appropriate measures. In this unanesthetized primate model of moderate experimental stroke, induced hypertension had beneficial effects on neurological status, local CBF, and infarct size without causing hemorrhagic infarction. Induced hypertension may be beneficial for some clinical cases of focal cerebral ischemia.
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