To the Editor.—
Two letters (242:2844, 1979;241:2783,1979) appearing in The Journal discussed successful neurosurgical intervention for acute subdural hematoma associated with transtentorial herniation. We describe a case in which noninvasive medical measures alone were successfully employed.
Report of a Case.—
A 33-year-old woman under treatment for metastatic breast cancer had been hospitalized for evaluation of frontal headache and thrombocytopenia (<15,000/cu mm). No neurological findings were detected and a computerized tomographic (CT) brain scan was normal. On the 12th hospital day, the patient complained of a severe headache and abrupt loss of vision in the left eye. Previously normotensive, the blood pressure (BP) had acutely risen to 190/110 mm Hg. The patient was treated with diazoxide, and the BP fell to 160/75 mm Hg. Recurrent symptoms and hypertension required another dose of diazoxide 30 minutes later. The patient remained in satisfactory condition for approximately one hour, but the symptoms and