[Cerebral function disorders caused by ischemia and hypoxia].
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Biomedical subjects
Publications and source records attributed to E Zderkiewicz.
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A case of aneurysm associated with the anterior cerebral artery is described. The authors stress diagnostic difficulties in such cases and discuss the coexistence of vascular anomalies and cerebral aneurysms.
On the basis of literature data and own material of 18 cases of cerebral abscesses of unknown origin the authors discuss their incidence, most frequent locations, diagnostic difficulties and results of surgical treatment in relation to remaining groups of cerebral abscesses of known aetiology.
In 20 patients with expanding intracranial lesions the intracranial pressure, cerebral blood flow, mean arterial blood pressure were determined and the cerebral perfusing pressure and cerebral vascular resistance were calculated before the operation and after removal of the expanding lesion. In 7 cases rises of the intracranial pressure occurred after the operation. In 5 of them they were associated with increased cerebral blood flow and decreased vascular cerebral resistance which was an evidence of their vasogenous mechanism. In 2 cases increased intracranial pressure was associated with raised cerebral vascular resistance suggesting oedema as the cause. The value of the investigations is discussed which give the results on which the choice of a proper management can be based in cases of increased intracranial pressure.
In 20 patients with expanding intracranial lesions the cerebral blood flow was determined by the method of Kety-Schmidt in an own modification with an original device--N2O-meter, with simultaneous continuous measurement of the intraventricular pressure and arterial blood pressure. This made possible determination of the cerebral perfusion pressure and of the effect of its fluctuations on the cerebral blood flow. Lowering of the cerebral blood flow below the normal value occurred when the perfusion pressure fell below 60 mm Hg, but its further fall, even to 20 mm Hg, caused no proportional decrease of the cerebral blood flow.
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In the light of own experience with 50 patients with brain abscesses and a survey of the literature the authors discuss the values of the surgical methods of treatment in this disease. When the radical methods are used the mortality is lowest and the incidence of recurrent abscesses is lowest, but of this treatment is likely to produce considerable neurological deficit it is better to apply conservative methods, such as puncture and drainage of the abscess. The sparing operation as a method of choice may be the first stage of treatment before radical operation in acute abscess and in patients in serious clinical condition.
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