To the Editor.
—The description of the natural history of intracranial aneurysm1 is most welcome. The difficulties in defining groups of patients and controls of such studies is well known. In defining such groups, heuristic categories may be created. In these studies two such populations have been defined—(1) "conservative" (ie, "left untreated surgically" with six weeks of bed rest and lowering of any essential hypertension) and (2) "surgical." Such a dichotomy runs the risk of implying that these are the only two methods of therapy.I would like to draw attention to a third method of therapy—prolonged or chronic medically induced hypotension.2 In Slosberg's2 series, this therapy is clearly effective for controlling rebleeding and in rendering life expectancy normal.The role of hypertension in rebleeding is stated in part 3 of the articles under consideration. I would stress the preventive role of chronically induced hypotension, particularly in
Krieger HP. Therapy for Cranial Aneurysm. Arch Neurol. 1986;43(1):7–8. doi:10.1001/archneur.1986.00520010007003
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