Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
This consideration of the relationship of neuro-transmitters not only to cerebral infarction but also to subarachnoid hemorrhage is, to my mind, the most promising area of investigation over the next decade. There is also a quantity of evidence that neurotransmitters play a large part in spasm following subarachnoid hemorrhage and in the disturbance of neurological function in that situation. Following subarachnoid hemorrhage, some remediable medical problems arise. Apart from clipping of the aneurysm, which the neurosurgeons are able to do, there is the problem of communicating hydrocephalus, which is extremely common in about 40% of patients. It can be discerned by the method of determining regional CBF and doing a spinal tap. If you note an increase in cerebral blood flow with removal of 25 cc of spinal fluid, you know you have a problem with communicating hydrocephalus. This is because autoregulation is disturbed. This increase will not occur when a spinal tap is done on a normal person who does not have communicating hydrocephalus. Finally, one can give glycerol and reduce the brain edema in patients with subarachnoid hemorrhage and brain swelling.
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