Abstract
Operation for a subdural haematoma in a 3½ month-old boy caused severe loss of blood, with cardiac arrest lasting for 30 min. By external heart massage a minimal residual circulation was secured. Survival was 11 months in a decerebrated state. Histological examination revealed widespread cortical necrosis due to severe hypotension and oligaemia, the cortex under the trephination hole remaining unaffected. Thus, that part of the brain which was not compressed could escape during the presumed concomitant brain swelling, remained intact, and its blood supply became relatively better. According to the authors this case supports the hypothesis that cerebral swelling may play an important role in the development of hypoxic-ischaemic states.
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