Pulmonary resuscitation in patients with ruptured intracranial aneurysms

193 Vesttbular examination suggested central pathology. Instruction O.K.N. was asymmetrical. possibly some dysfunction left hemisphere. .Y<~r’r,trhrr 1980. weight-loss since June: 1Skg. Amhlyopy left eye. in fundo no pathology. E.M.G. suggested hyperventilation syndrome. Transcient altered states of consciousness typical for hysteria w’ere considered. Prolactin: normal LH, FSH: sub-normal Cortirol: normal. .Ir/ntrar), 198 I: Ctcatrices ofchorioiditis in fundo 0.5. Bad.following period. Increasing metrorrhagia. Fits lasted days starting with diplopia - slurred speech. h~potonic muscles. poliuria - psychosis. Afterwards retrograde amnesia :I tcgirsi 198 1: H>\terectomie. improvement. no psychosis anymore. Etldi-ocrini\logif;II subnormal TSH - LH. FSH response, Possible relation between neur~~r~~di~?lo~i~al tindings and roxoplasmo~ix. f>c,c~r&~~~ 198 I : ‘T.S.C~)mputertomography: Hypophysis normal. asymmetrical ventriculi to the disadvantage of the left. &bin: 256. complement 2. .Itrrttctrr), 1982: Sabin: 5 I?. complement 4. L’h/~trrr,: chorioiditis cicatrices fundus o.d. 40 day\ antitout)plusmosis medication, Result\: No fits. She remained tired and without libido sexualis. :\ltrr,: Sahin: 12X. /llrgfrFI: tlndrocrinolopical supranormal gonadotroptne response. I%<: Verv active. libido sexualis normal.

PULMONARY RYSMS 4 HIJDRA. bl.

RESUSCITATION VkRMtl’Ltx

and

IN PATIENTS

I. VAN GUN

WITH

RLIPTURED

INTRACRANIAL

ANEU-

(Rotterdam)

Of 45 respiratory di\turbances in 39 patients (mostly respiratory arrest) associated with rupture of an intracranial aneurv\m I6 could be succesfullv treated with mechanical ventilation. In 40 episodes the duration of ventilation was less than 24 hours: the patient either died from the episode or survived. Four of tive patients who needed mechanical ventilation for a more extended period had spontaneous respiration but insufficient gas exchange caused bv a respiratory distress syndrome. Loss of brain stem reflexes (pupillarv light retlexes. extraocular motility. cornea1 reflexes) together with loss of respirntorq control did not predict pro,gno\ts because this occurred both m patients who survived and in those who died. We sugge’it that patients who suffer respiratory arrest associated with aneurvsm rupture should be vigorousI\ rcsuicitated.

PRE-OPERATIVE GERY

PSYCHOLOGICAL

TESTING

AND THE RESULTS

OF LUMBAR

DISK SUR-

To test the predictive value of pre-operative psychological testing in patients undergoing lumbar disk \urgcry. a prospective study was performed and the outcome of surgery after six months compared with a classification based on stepwise linear discriminant analysis of biographical data and scores of preoperatively administered psychological tests. In three groups of 48. 68 and 150 pattents respectively. the predictive value of such a classification was shown to be 80%. and under certain conditions over 90?. .4ssoctated with outcome were: level ofeducation. duration ofcomplaints. previous surgery. and scores on VOEG(a psychological test exploring psychosomatic habitus), the NPV-ZW scale and the Hs-scale of the MMPI. Our procedure might be valuable in the process ofclinical decision making in patients with proven herniated disk for whom surgery is considered. but when there is for any reason a need to get informed about the chances of a good. versus a fair or poor. result after surgery is performed.