Ephraim Roseman

Serial electroencephalography in vascular lesions of the brain.

THE early years of clinical electroencephalography were devoted to the accumulation of statistical data in such conditions as the epilepsies, brain tumors, head injuries, vascular lesions of the brain, as well as data on normal subjects. This material, although basic and important diagnostically, gave but little hint as to the underlying pathophysiologic changes which the brain undergoes following cerebral damage. A single electroencephalogram merely indicates the electrical activity of the brain at that particular time. Since all disease is a moving process, it would seem desirable to attempt to correlate the dynamic clinical alterations with serial variations in the electroencephalogram. This correlation of the electroencephalographic changes in disease or trauma with the altering clinical picture is defined as dynamic electroencephalography. Elsewhere it has been shown that the electroencephalograph can be used serially (dynamically) in the accumulation of diagnostic and prognostic data in trauma to the brain,l encephalopathies,2 and in such vascular diseases of the brain as aneury~rns.~ But dynamic electroencephalography need not be so confining. It can be used to understand better many conditions involving the brain directly or indirectly, whether they be of a vascular, neoplastic, degenerative, traumatic or congenital nature. Frequently the lack of change in the electroencephalogram is of as great importance as its serial alterations.

Electroencephalographic studies of the encephalopathies:: II. Serial studies in tuberculous meningitis

Abstract Serial clinical and electroencephalographic correlations were made in 57 proven cases of tuberculous meningitis. Thirty-six children and 21 adults were included. The number of EEGs per patient varied from one to 33 and included observation periods from 3 days to 4 years. The records of adults and children differ markedly. In untreated adults the initial EEG is at most only midly slow. Terminally, the adult record shows only moderate slowing. Untreated children show very slow EEGs initially. Diagnostically, the EEG would seem to be of value in children. In an untreated lymphotic meningitis, tuberculous meningitis can be suspected or excluded on the basis of the initial EEG, since the record is invariably very slow if tuberculosis is present. Prognostically, EEG changes usually parallel or precede the clinical alterations. With improvement in the patients condition the EEG becomes faster. Serial records enable one to suspect the development of seizures, hydrocephalus or relapse. The prognosis for recovery is poor in any patient who shows a very slow record with an amplitude reduction on one side for a two week period. The large number of patients with seizure discharges in the EEG seems to correlate with the high incidence (over 80 per cent) of clinical seizures observed in the present series.

The Electroencephalogram in Intracranial Aneurysms

INTEREST in vascular lesions of the intracranial contents has greatly increased in recent years. Pathologic and angiographic studies have shown that most spontaneous intracranial hemorrhages are secondary to rupture of congenital aneurysms. Although there is great variance in the statistics cited by many authors, the fact remains that the mortality from ruptured aneurysms is high. Furthermore, with repeated ruptures, mortality and morbidity increase. Only within the past few years has any rational surgical approach been made to these lesions. Evacuation of intracerebral hematomas and ligation of the carotid arteries in the neck are, for the most part, palliative procedures. Studies of the arterial blood flow of the circle of Willis have shown that ligation of the carotid arteries may be effectual only when the aneurysm is located on the internal carotid artery. When the aneurysm is situated elsewhere in the circle, carotid ligation may even be detrimental. Thus, hemiplegia is a not infrequent complication of this procedure, irrespective of preliminary prophylactic progressive compression of the carotid arteries in the neck. The hemiplegias may occur immediately or be delayed days to weeks, and may be temporary or permanent. Thus it would seem desirable to develop a procedure aimed a t cure of the defect in the vascular system, e.g., trapping of the aneurysm and excluding i t from the cerebral circulation. However, a major problem from the surgical standpoint is the difficulty frequently encountered not only in localization but also lateralization of the aneurysm. Even after rupture many aneurysms demonstrate no focal clinical symptoms or signs. Furthermore, some fail to be demonstrated by arteriography. Injection of an opaque medium into the internal carotid vessels demonstrates, a t best, the anterior and middle cerebral