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Maurice L. Silver, M.D.
JAMA. 1957;163(13):1097-1102. doi:10.1001/jama.1957.02970480001001.
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•The genera/ practitioner and specialist may be called for advice after the catastrophic collapse of an apparently healthy individual. The sudden onset of profound neurological signs and symptoms in such a patient always suggests intracranial hemorrhage. All patients suspected of having intracranial bleeding should be subjected to prompt cerebral angiography to determine the pathological nature of the lesion. In analyzing 100 cases of this type with cerebral angiography, a definite vascular malformation was demonstrated in 69%. A positive diagnosis as to cause or associated manifestation was made in 85% of the cases. While there are certain inherent risks in angiography, no additional complications appear to have been introduced into the treatment of intracranial bleeding by having performed the procedure, even as early as two hours after the presumed onset of the bleeding. Such risks as may exist seem minor in comparison with the existing risk of the lesion itself. In cases of ruptured aneurysm of the circle of Willis, the survival rate following neurosurgical intervention is 75%. In a smaller but comparable group, those treated by conservative means had a survival rate of 18%. Indicated surgical intervention is actually the conservative therapy for intracranial bleeding.


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