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September 8, 1923


JAMA. 1923;81(10):849. doi:10.1001/jama.1923.02650100057035

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To the Editor:  —Recent articles by Dr. C. P. Symonds and Dr. Harvey Cushing in Guy's Hospital Reports for April, 1923, pp. 140-163, not only present an unusually interesting series of cases, but demonstrate the possibility and means of making a diagnosis during life of this fairly common, yet too often overlooked condition. Intracranial aneurysms, which are most often at the bifurcation of the internal carotid artery, seldom become large enough to make a diagnosis possible before rupture. With rupture of the aneurysm, the patient is likely to complain of "something snapping," of occipitofrontal pain, and especially of pain in the back of the neck. Unilateral ophthalmoplegia, ptosis, immobile pupil, and disturbances of vision point to pressure in the parachiasmal region. Following the intracranial hemorrhage is the picture of increased intracranial pressure, blood in the spinal fluid, and later, xanthochromia, and often subretinal hemorrhages. A rise in temperature, and signs

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