Nicholas Christoff

Electroencephalographic changes with intracarotid megimide and amytal in man.

Abstract 1. 1. An introductory study of the EEG and behavioral effects of intracarotid Amytal and Megimide was carried out in 16 patients, one studied bilaterally. 2. 2. The effects of the drugs were strikingly independent of the underlying pathology. The behavioral responses were predominantly unilateral while the EEG changes were mostly bilateral. 3. 3. Amytal produced EEG high voltage slowing, bilaterally and diffusely. The behavioral changes were contralateral motor, sensory and visual defects without aphasia. 4. 4. Megimide produced motor seizures most marked contralaterally; with universally contralateral onset. The EEG showed diffuse, bilateral spike and spike-wave patterns. 5. 5. The implications of the findings with regard to site of drug action and speculations concerning the value of this method of study are discussed. It is felt that carotid drug studies may help elucidate problems in brain physiology and pharmacology. 6. 6. Judicious use of intracarotid drugs in man is apparently a safe procedure.

Some unusual manifestations of cerebral aneurysms

Abstract Six cases of cerebral aneurysms which were diagnostic problems are presented and discussed. Bizarre symptom complexes and unusual background situations contributed to the diagnostic difficulties. Some patients exhibited backgrounds of cardiac and vascular disease and blood coagulation defects. Two separate episodes with different symptoms were present in other cases. Unusual symptoms were dependent on unusual size and location of the aneurysms. Acute psychotic episodes without meningeal signs were present in two patients with subarachnoid bleeding. Incomplete arteriography was another diagnostic pitfall. The diagnosis of aneurysm should be considered prominently in all instances of subarachnoid hemorrhage and in cases suggesting a mass at the base of the brain.

Medical Treatment of Subdural Hematomas Challenged-Reply

To the Editor.— Our purpose was to show that medical therapy was an acceptable alternative to surgery in certain cases. We do not believe that all cases as yet should be treated medically. A controlled prospective study of medical vs surgical therapy for subdural hematoma would be of interest but not feasible nor pertinent. Dr. Geissinger is concerned about what is happening to the brain while the hematoma is being absorbed during medical therapy. The same may be asked as to what happens after surgical therapy. This question has been answered in two publications (Cook et al: J Neurosurg 19:419, 1962, and McLaurin: Neurology , 15:866, 1965). Both showed that after surgical treatment there was persistence of fluid collections, midline shifts, and cerebral edema for up to two months. They also noted that these roentgenographic findings did not correlate with the clinical picture. It could be argued that since medical therapy