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Millikan's article, which includes a critical review of the clinical literature on intracranial arterial vasospasm, is beneficial in that it points out the pitfalls in making scientific conclusions from incomplete clinical data. Unfortunately, Millikan's presentation of his own cases is equally inconclusive for the same reasons. He attempts to demonstrate that the presence or absence of angiographically demonstrated spasm has no bearing on the outcome of surgical cases, but in the majority of cases the only angiograms were performed preoperatively. Without postoperative angiograms performed at the time of onset of increasing neurologic deficit, it is impossible to know whether or not the patient's deterioration is related to spasm. Furthermore, the absence of spasm in the angiogram of a patient with focal neurologic deficit preoperatively does not exclude its occurrence as a transient phenomenon that causes infarction and then resolves.
Millikan also appears to have the bias that the finding of
J. F. Alksne, P. Levitt. To the Editor. Arch Neurol. 1976;33(4):309. doi:10.1001/archneur.1976.00500040093027