The vascular aspects of head injuries / Hugh Cairns.

  • Hugh Cairns
Date:
1942
Catalogue details

Licence: Public Domain Mark

Credit: The vascular aspects of head injuries / Hugh Cairns. Source: Wellcome Collection.

    25/40 page 397
    immediately in contact with the bony roof of the sphenoidal air sinus. The difficulty that arose in Case III was to decide from which .internal carotid artery, the bleeding came, and though the balance of evidence favoured the right side, from the fact that the cranial nerves (including the optic nerve) were severely involved on that side and almost unaffected on the other side, yet there was no absolute certainty. In the absence of a murmur the only clinical test that could be made was to compress each common carotid separately while severe epistaxis was in progress, and this, as was shown, turned out to be an unsatisfactory test. In such cases as this, then, it is clear that arteriography should wherever possible be employed, as affor¬ ding a satisfactory and precise method of diagnosis. In the following case the train of events was similar to those of Case III, but the treatment through a misunderstanding had a most unfortunate outcome. CASE VII. Traumatic aneurysm of the right internal carotid artery. Severe epistaxis. Multiple arterial ligations on both sides of the neck. Death. History. N. S., an airman aged 19, (R. I. 914) was involved in a motor-cycle accident on July 10, 1938. He was severely concussed, and his total amnesia was about a week. He had a haematoma of the right eye, a lacerated wound in the right temples, and he was suspected of having a fracture of the base of the skull. On recovering consciousness he was found to be almost blind in the right eye, vision being limited to appre¬ ciation of hand movements. He was discharged from hospital on August 19. On October 4, twelve weeks after the accident, he had copious bleeding from the nose which was controlled by plugging the right nostril. He was readmitted to hospital. Further epistaxis occurred on November 2, No¬ vember 5, December 2, and December 18. On December 21 his red cell count was down to 3,500,000 and haemoglobin content was 60 per cent., and at this time he complained that he could not see anything with his hitherto sound left eye. Examination of the eyes at this time showed total blindness, optic atrophy, on the right side and a normal disc on the left. On January 6, 1939, he had two sharp attacks of epistaxis, and the nose was plugged again. By this time he had become so anaemic that blood transfusion was given. On January 10 lumbar puncture showed noimal cerebrospinal fluid. There were on this day several small, brisk haemor¬ rhages from the right nostril; on January 14 a very severe haemorrhage of 1 14 to 2 pints poured out of the nose and mouth, and his pulse rate rose to 140. Auscultation on this day revealed a sharp, high-pitched systolic murmur over the front of the head and face, and this was stopped by compression of the right common carotid and intensified by compression
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