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Nihal T. Gurusinghe and Alan E. Richardson

✓ Of 256 patients with aneurysmal subarachnoid hemorrhage, 131 underwent computerized tomographic (CT) scanning within 7 days of the ictus. These scans were analyzed in order to assess the quantity of blood in the main subarachnoid cisterns and cerebral fissures. The method of quantification used recognized the horizontal and vertical components of the largest clot visible on the CT scan and expressed this as the “CT score.” Angiographic vasospasm was assessed and graded, based on reduction in the caliber of the major cerebral vessels. The CT score was then compared to 1) the incidence of angiographic vasospasm, 2) the clinical course, and 3) the eventual outcome. Of the patients who showed no blood on the initial CT scan, 87% were admitted in good clinical grades, whereas among patients with higher CT scores the number admitted in poor clinical grades increased. The degree of angiographic vasospasm did not relate as closely as the CT score to the clinical grade on admission or to the subsequent clinical course.

The final outcome was assessed on follow-up review, and those acquiring neurological deficits from ischemic neurological dysfunction (IND) were identified. Ninety percent of patients with no blood on the CT scan (CT score 0) had a good outcome, while 5% sustained the effects of IND. The incidence of IND gradually increased with a rise in the CT score until, with scores of 8 and above, 90% of patients suffered the ill effects of IND. The CT score proved to be a simple yet accurate prognostic indicator of the outcome of IND.

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Robert A. Beatty and Alan E. Richardson

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John Vassilouthis and Alan E. Richardson

✓ Ventricular dilatation following spontaneous subarachnoid hemorrhage (SAH) is a well recognized phenomenon. Its clinical significance, however, remains controversial. Two phases are distinguished, the acute or early, occurring soon after the ictus, and the chronic or late, developing after the second week. The authors studied the ventricular size in 210 patients with spontaneous SAH through the course of their illness and convalescence by means of serial computerized tomography (CT) scans. Their findings suggest that ventricular dilatation soon after SAH is not always clinically significant and does not necessarily require shunting before definitive surgery. Delayed symptomatic ventricular enlargement (communicating hydrocephalus) occurs in 7% of the patients and can be safely diagnosed on the basis of the clinical picture and CT scan appearances. Treatment with a ventricular shunting system is almost invariably rewarding.

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Robert R. Richardson, Yoon Sun Hahn and Edir B. Siqueira

✓ A case of an encapsulated organizing hematoma of the sciatic nerve is reported. Hemorrhage-induced neuropathy as a complication of anticoagulant therapy, leukemia, hemophilia, and other bleeding diatheses has been frequently reported. While trauma is the most common etiology of a hemorrhagic neuropathy, actual hematoma formation beneath the epineurium is very rare.

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Robert A. Beatty and Alan E. Richardson

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Aneel N. Patel and Alan E. Richardson

✓ An analysis of 3000 ruptured intracranial aneurysms revealed 58 cases in patients under the age of 19 years. There was a striking incidence of aneurysms of the carotid termination and anterior cerebral complex, accounting for 43 of 58 cases, and of these 20 involved the terminal portion of the carotid artery. Vasospasm occurred slightly less often than in adults and infarction was only seen in one postmortem examination. The surgical mortality in alert patients was 7% whereas in a comparable bedrest group it was 38%. This good tolerance to surgery was evident whether intracranial operation or carotid ligation was used, but the surgical method was not randomly allocated.

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Alan E. Richardson, John A. Jane and Peter M. Payne

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Peter M. Richardson and Peter K. Thomas

✓ Weights were dropped on rat sciatic nerves. Teased fibers and light and electron micrographs of nerves removed between 10 minutes and 2 weeks later were examined. Axonal alterations were seen 10 minutes after injury, and subsequently interruption of axonal continuity with preservation of the basal lamina was apparent. Dissolution of myelin began within 30 minutes and progressed. At 4 days, a segment of some large fibers was devoid of myelin and, by 2 weeks, remyelination had commenced. Demyelination of a significant number of fibers was always accompanied by Wallerian degeneration of other fibers of the same nerve. Percussive injury of nerves caused a mixed lesion in which the early and late pathological features were clearly distinguishable from those following crush or compression by a cuff. Any explanation of the transient interruption of function that has been described following such an injury is at present speculative.

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H. Richard Winn, Alan E. Richardson and John A. Jane

✓ The long-term evaluation of 60 patients who suffered a subarachnoid hemorrhage and survived 6 months is reported. By bilateral carotid arteriography, all patients were shown to have a single aneurysm at the vicinity of the posterior communicating artery at its junction with the internal carotid artery. The patients had previously been randomly assigned to treatment either by bed rest or by common carotid ligation. Average duration of survival among those followed is 8 years. Late rebleeding episodes were found to occur at a similar rate, irrespective of mode of treatment in the studied populations, but morbidity following operation continued to remain somewhat less over the ensuing years of follow-up study compared with the patients treated conservatively. On final assessment many years after the original hemorrhage, there is little improvement in degree of morbidity in either treatment group, and hypertension is noted to develop in the patients undergoing carotid ligation. A larger number of cases will be required to validate these findings.