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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
Charles L. Wiseman, Charles Tiber, George R. Blumenschein. Treatment of Herniating Subdural Hematoma. JAMA. 1980;244(24):2728–2729. doi:10.1001/jama.1980.03310240020010