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.

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    of the left common carotid. There was complete anosmia, no perception of light, the condition of the optic discs as described above, both pupils fixed to light. On the right side the external ocular movements were all grossly impaired, except for outward movement, which was about half its normal range; on the left side movements of the eyeball were normal. There was ptosis of the right upper eyelid and very slight proptosis of both eyeballs. (The precise time of onset of the oculomotor nerve palsies on the right side is uncertain, but as the man had gone back to work before his first epistaxis occurred it is likely that they were not present at that time. And observations during the days preceding January 14 suggested that they were at that time progressive in character.) First operation. On January 14 the right common carotid artery was tied under local anaesthesia and the bruit ceased immediately. A further transfusion was given on the same day, and another on January 20. He remained well, but without any recovery of eyesight, until January 22, when his nose bled again, and further epistaxis took place on January 26 and January 28. Seaond operation. January 30. The right common carotid was found to be pulsating above the ligature and was accordingly tied again. Third operation. As bleeding continued the neck was explored again on February 2. No pulsation was found in the common carotid above the ligature. The right external carotid was tied. Subsequent Course. February 20. Some oozing of blood from the right nostril. Bruit audible again. External ocular movements were now com¬ pletely normal, but there was no recovery of sight, and the left optic disc was now, like the right, pale. February 21. After slight headache for several hours, severe epistaxis of 1 V2 pints. The patient became pulseless and unconscious, but rallied and was given 1,500 c. c. of blood by slow drip. February 25. A further severe epistaxis. Given 900 c. c. of blood. February 27. On this day the patient came under my care. In spite of a good blood count he had a waxy, pale appearance. X-rays showed almost complete destruction of the anterior part of the floor of the sella turcica. At times a faint murmur was heard over the right orbit and it was not influenced by compression of the right common carotid artery below the site of ligation. No pulsation could be felt in the right facial artery, whereas on the left side there was good pulsation. These signs were taken, wrongly as later events showed, to indicate that the carotid ligations on the right side of the neck were complete. In the following weeks a series of arterial ligations, intracranial and extracranial, were undertaken to stop the bleeding, but the relief after each was only temporary, and the patient died of epistaxis. Post mortem showed a saccular aneurysm 2 cms. diameter in the sphenoidal air sinus (Fig. 11). In the right internal carotid in the bend alongside the anterior clinoid process and just proximal to the level of the ophthalmic artery was a hole 0.2 c. m. diameter which led into the aneurysm. The greater part of the floor of the sella turcica was eroded. Apart from presumptive evidence of fracture in this region no other
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