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Lost Opportunity in Otherwise Useful Contribution

Albert N. Martins, MC
JAMA. 1974;230(10):1386. doi:10.1001/jama.1974.03240100016008.
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To the Editor.—  In March 1973, Skinhøj and Strandgaard1 presented evidence that cerebral blood flow increases during hypertensive encephalopathy. Cerebral hyperperfusion that attends acutely elevated blood pressure was assumed to be secondary to a "breakthrough" of normal autoregulatory control of cerebral blood flow. Excessive cerebral blood flow may cause brain edema, which can explain the brain dysfunction of patients with acutely elevated blood pressure. An editorial in the following issue of The Lancet2 served to emphasize the importance of this information. It has been widely assumed that the cerebral symptoms of hypertensive encephalopathy are due to vasoconstriction and a subsequent reduction in cerebral blood flow. As the Lancet editorial noted, little convincing evidence supports this long-held assumption. Therefore, it was with surprise and disappointment that I read Dr. Frank Finnerty's commentary (229:1479, 1974) on the emergency management of hypertensive crises, in which he explained the signs of hypertensive


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