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H. J. Roberts, M.D.
JAMA. 1960;173(13):1507. doi:10.1001/jama.1960.03020310095031.
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To the Editor:—  The review of therapy for cerebral vascular accidents by Dr. George A. Wolf Jr. in The Journal (172:562 [Feb. 6] 1960) is a fair statement of the indications, contraindications, and limiting factors of currently accepted regimens. I take issue, however, with the statement that treatment during the acute phase of a cerebral vascular accident is limited to the supportive measures listed in this article. I should like to call attention to another valuable approach to the management of selected patients with acute and subacute cerebrovascular accidents, particularly those with significant brain stem involvement: the use of the adrenocortical steroids. My observations in such patients for the past four years (J. Am. Geriatrics Soc. 6:686 [Sept.] 1958) may be summarized here by stating that dramatic improvement has been observed repeatedly in critically ill patients with clinically progressive cerebral infarction in whom it appeared that remissions either


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