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JAMA. 1931;97(13):926-929. doi:10.1001/jama.1931.02730130030009.
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In 1920, dishing1 of Harvard University Medical School said "It is inconceivable that suppurative processes in the posterior paranasal sinuses can produce choked disk." He admitted that inflammatory processes may affect the optic nerve in such a way as to produce redness, injection and possibly such a degree of hyperemia and vascularity of the nerve head as to resemble the early hyperemic stage of choked disk, but said "It is unbelievable that an infection of the nasal sinuses in the absence of increased intracranial tension can produce an actual choked disk, a condition brought about by mechanical causes." From that time up to a quite recent date Cushing's opinion seems to have been accepted and reiterated not only by some leading neurosurgeons but also by a number of well trained and experienced ophthalmologists.

It is entirely possible, as Cushing says, that much confusion exists in the conception of choked


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