Hernias cerebrais intracranianas

Guidugli Neto, João

doi:10.1590/S0004-282X1975000400001

Resumos

O autor estuda as diferentes manifestações macroscópicas de deslocamento intracraniano de massa encefálica em 420 encéfalos. Em 23 destes havia lesão secundária do tronco cerebral. A hérnia temporal uni ou bilateral foi a alteração mais frequente no material, sendo a anóxia terminal provavelmente um dos fatores importantes no seu estabelecimento. Foi verificado decréscimo acentuado das lesões secundárias do tronco cerebral após os 60 anos de idade.

Intracranial cerebral herniations occurring in 420 brains from consecutive necropsies are studied. They were present in 65 brains; in 23 there was secondary lesions in the upper brainstem. Temporal herniations in one or both sides, was the most frequent finding. Terminal anoxia is believed to be one of the most important factors. There was decrease of the secondary lesions of the brainstem after 60 years of age.

Hernias cerebrais intracranianas

Intracranial cerebral herniations

João Guidugli Neto

Serviço de Anatomia Patológica (Diretor: Dr. L. C. Mattosinho França); do Hospital do Servidor Público Estadual Francisco Morato de Oliveira (HSPE-FMO); Médico Assistente

RESUMO

O autor estuda as diferentes manifestações macroscópicas de deslocamento intracraniano de massa encefálica em 420 encéfalos. Em 23 destes havia lesão secundária do tronco cerebral. A hérnia temporal uni ou bilateral foi a alteração mais frequente no material, sendo a anóxia terminal provavelmente um dos fatores importantes no seu estabelecimento. Foi verificado decréscimo acentuado das lesões secundárias do tronco cerebral após os 60 anos de idade.

SUMMARY

Intracranial cerebral herniations occurring in 420 brains from consecutive necropsies are studied. They were present in 65 brains; in 23 there was secondary lesions in the upper brainstem. Temporal herniations in one or both sides, was the most frequent finding. Terminal anoxia is believed to be one of the most important factors. There was decrease of the secondary lesions of the brainstem after 60 years of age.

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REFERENCIAS

1. ATTWATER, N. L. Pontine haemorrhages. Guy's Hospital Rep. 65:339, 1911.

2. BALCKWOOD, W. Vascular diseases of the central nervous system. In BLACKWOOD, W.; McMENEMEY, W. H.; MEYER, A.; NORMAN, R. M. & RUSSEL, D. S. Greenfield's Neuropathology. 2^nd ed. Edward Arnold Ltd., London, 1963, p. 71-137.

3. BOGOSSIAN, L. Consequências do choque nos diferentes órgãos e tecidos. In Choque, 2.ª edição. Rio de Janeiro, Livraria Atheneu, 1972, p. 21-36.

4. CABIESES MOLINA, F. & JERI, R. Transtentorial temporal lobe herniation. Acta neurol. latinoamer. 1:167, 1955.

5. CANNON, B. W. Acute vascular lesions of the brain stem. Arch. Neurol. Psychiat. (Chicago) 66:687, 1951.

6. CARREA, R. M. E. El edema agudo cerebral y las hemorragias mesencefálicas como causa de muerte em los tumores metastáticos. Arch. Neurocirugia (Buenos Aires) 1:228, 1944.

7. CARRILLO, R. Hérnias cisternales. Arch. Neurocirugia (Buenos Aires) 7: 498, 1950.

8. CATELAND, E. Les Hernies Cérébrales Internes. Imprimerie Commerciale du Nouvelliste, Lyon, 1944.

9. COCHRAN, W. G. Some methods for strengthening the common x² test. Biometrics 10:417, 1954.

10. COHEN, S. I. & ARONSON, S. M. Secondary brain stem hemorrhages. Arch. Neurol. (Chicago) 19:257, 1968.

11. CROMPTON, M. R. Brainstem lesion due to closed head injury. Lancet 1:669, 1971.

12. ECKER, A. Upward transtentorial hernation of the brain stem and cerebellum due to tumor of the posterior fossa with a special note on tumors of the acoustic nerve. J. Neurosurg. 5:51, 1948.

13. FEIGIN, I. Intracranial tension and cerebral edema. In MINCKLER, J., ed. Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1938, Vol. 1, p. 242-433.

14. FREYTAG, E. Autopsy findings in head injuries from blunt forces. Arch. Path. 75:402, 1963.

15. GARCIA AUST, E.; VILLAR, J. I.; AZAMBUJA, N. & ROIG, J. A. Experimental study of intracranial pressure: IV Brain displacements. Acta neurol. latinoamer. 12:164, 1966.

16. HASSLER, O. Arterial pattern of the human brainstem. Normal appearence and deformation in expanding supratentorial conditions. Neurology (Minneapolis) 17:368, 1967.

17. HASSLER, O. Brainstem haemmorrhages secondary to expanding supratentorial conditions. Acta path, microbiol. scand. 72:448, 1968.

18. HICKS, S. P. Vascular pathophysiology and acute and chronic oxygen deprivation. In MINCKLER, J., ed. Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1S68, vol. 1, p. 341-350.

19. HOWELL, D. A. Upper brains-stem compression and foraminal impaction with intracranial space-occupyng lesions and brain swelling. Brain 82:525, 1959.

20. JEFFERSON, G. The tentorial pressure cone. Arch. Neurol. Psychiat. (Chicago) 40:857, 1938.

21. JEFFERSON, G. & SHELDON, P. Transtentorial herniation of the brain as revealed by the displacement of arteries. Acta radiol. (Stockholm) 46:480, 1956.

22. JOHNSON, R. T. & YATES, O. Brains stem hemorrhages in expanding supratentorial conditions. Acta radiol. (Stockholm) 46:250, 1956.

23. KLINTWORTH, G. K. Evaluation of the role of neurosurgical procedures in the pathogenesis of secondary brains-stem haemorrhages. J. Neurol. Neurosurg. Psychiat. 29:423, 1966.

24. KLINTWORTH, G. K. Grooving of the uncus in the absence of overt intracranial disease. J. forens. Med. 9:137, 1962.

25. KLINTWORTH, G. K. Paratentorial grooving of human brains with particular reference of secondary brain-stem hemorrhages. Amer. J. Path. 53:391, 1968.

26. KLINTWORTH, G. K. The pathogenesis of secondary brainstem hemorrhages as studied in an experimental model. Amer. J. Path. 47:525, 1965.

27. LINDENBERG, R. Compression of the brain arteries as pathogenetic factor for tissue necroses and their areas of predilection. J. Neuropath. exp. Neurol. 14:223, 1955.

28. LINDENBERG, R. & FREYTAG, E. Brainstem lesions characteristic of traumatic hyperestension of the head. Arch. Path. 90:509, 1970.

29. MATSUOKA, K.; SAKAKI, S. & OKAMOTO, E. A clinico-pathological study on the cause of hemorrhagic lesions in the brain stem with head injury. Med. J. Osaka Univ. 17:257, 1967.

30. MOORE, M. T. & STERN, K. Vascular lesions in the brain-stem and occipital lobe occuring in association with brain tumours. Brain 61:70, 1938.

31. MUNRO, D. & SISSON, W. R. Hernia through the incisura of the tentorium cerebelli in connection with craniocerebral trauma. New England J. Med. 247: 699, 1952.

32. PIERRE MARIE, M. De l'engagement des amygdales cérébelleuses à l'interieur du trou occipital dans les cas oú la pression intracranienne se trouve augmentée. Rev. neurol. (Paris) 8:252, 1900.

33. POPPEN, J. L.; KENDRICK, J. F. & HICKS, S. F. Brain stem hemorrhages secondary to supratentorial space-taking lesions. J. Neuropath. exp. Neurol. 11:267, 1952.

34. SATO, K. Transtentorial herniation and brainstem hemorrhages in connection with acute head injuries. Arch. jap. Chir. 37:94, 1968.

35. SCHEINKER, I. M. Transtentorial herniation of the brain stem. A characteristic clinico-pathological syndrome: pathogenesis of the hemorrhages in the brain stem. Arch. Neurol. Psychiat. (Chicago) 53:289, 1945.

36. SCHWARZ, G. A. & ROESNER, A. A. Displacement and herniation of hippocampal gyrus through the incisura tentorii: a clinico-pathological study. Arch. Neurol. Psychiat. (Chicago) 46:297, 1941.

37. SHIMOURA, N. On the pontine hemorrhages in the fatal cases of head injury. Jap. J. leg. Med. 21:397, 1967.

38. STEEGMANN, A. T. The neuropathology of cardiac arrest. In MINCKLER, J., ed. Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1968, Vol. 1, p. 1005-1029.

39. SUNDERLAND, S. The tentorial notch and complications produced by herniations of the brain through that aperture. Brit. J. Surg. 45:422-437, 1958.

40. VINCENT, C; DAVID, M. & THIÉBAUT, F. Le cóne de pression temporal dans les tumeurs des hémisphères cérébraux: sa symptomatologie; sa gravité; les traitements qu'il convient de lui opposer. Rev. neurol. (Paris) 65:536, 1936.

41. VOGEL, F. S. The anatomy of head trauma. In SOMMERS, S. C., ed. Pathology Anual. Appleton-Century-Crofts, Educational Division Meredith Corporation, New York, 1971, Vol. 6, p. 321-336.

42. WEINTRAUB, C. M. Bruising of the third cranial nerve and the pathogenesis of midbrain haemorrhages. Brit. J. Surg. 48:62, 1960.

Serviço de Anatomia Patológica Hospital do Servidor Público Estadual Caixa Postal 8570 01000 São Paulo, SP Brasil.

Agradecimentos O autor agradece aos Drs. Neil Ferreira Novo e Elias de Paiva, da Disciplina de Estatística Médica, do Departamento de Medicina Preventiva da Escola Paulista de Medicina, o tratamento estatístico dos resultados; ao Dr. A. Spina-França, da Disciplina de Neurologia da Faculdade de Medicina da Universidade de São Paulo, a orientação recebida na feitura desta investigação.

1. ATTWATER, N. L. Pontine haemorrhages. Guy's Hospital Rep. 65:339, 1911.
2. BALCKWOOD, W. Vascular diseases of the central nervous system. In BLACKWOOD, W.; McMENEMEY, W. H.; MEYER, A.; NORMAN, R. M. & RUSSEL, D. S. Greenfield's Neuropathology. 2^nd ed. Edward Arnold Ltd., London, 1963, p. 71-137.
3. BOGOSSIAN, L. Consequências do choque nos diferentes órgãos e tecidos. In Choque, 2.Ş edição. Rio de Janeiro, Livraria Atheneu, 1972, p. 21-36.
4. CABIESES MOLINA, F. & JERI, R. Transtentorial temporal lobe herniation. Acta neurol. latinoamer. 1:167, 1955.
5. CANNON, B. W. Acute vascular lesions of the brain stem. Arch. Neurol. Psychiat. (Chicago) 66:687, 1951.
6. CARREA, R. M. E. El edema agudo cerebral y las hemorragias mesencefálicas como causa de muerte em los tumores metastáticos. Arch. Neurocirugia (Buenos Aires) 1:228, 1944.
7. CARRILLO, R. Hérnias cisternales. Arch. Neurocirugia (Buenos Aires) 7: 498, 1950.
8. CATELAND, E. Les Hernies Cérébrales Internes. Imprimerie Commerciale du Nouvelliste, Lyon, 1944.
9. COCHRAN, W. G. Some methods for strengthening the common x² test. Biometrics 10:417, 1954.
10. COHEN, S. I. & ARONSON, S. M. Secondary brain stem hemorrhages. Arch. Neurol. (Chicago) 19:257, 1968.
11. CROMPTON, M. R. Brainstem lesion due to closed head injury. Lancet 1:669, 1971.
12. ECKER, A. Upward transtentorial hernation of the brain stem and cerebellum due to tumor of the posterior fossa with a special note on tumors of the acoustic nerve. J. Neurosurg. 5:51, 1948.
13. FEIGIN, I. Intracranial tension and cerebral edema. In MINCKLER, J., ed. Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1938, Vol. 1, p. 242-433.
14. FREYTAG, E. Autopsy findings in head injuries from blunt forces. Arch. Path. 75:402, 1963.
15. GARCIA AUST, E.; VILLAR, J. I.; AZAMBUJA, N. & ROIG, J. A. Experimental study of intracranial pressure: IV Brain displacements. Acta neurol. latinoamer. 12:164, 1966.
16. HASSLER, O. Arterial pattern of the human brainstem. Normal appearence and deformation in expanding supratentorial conditions. Neurology (Minneapolis) 17:368, 1967.
17. HASSLER, O. Brainstem haemmorrhages secondary to expanding supratentorial conditions. Acta path, microbiol. scand. 72:448, 1968.
19. HOWELL, D. A. Upper brains-stem compression and foraminal impaction with intracranial space-occupyng lesions and brain swelling. Brain 82:525, 1959.
20. JEFFERSON, G. The tentorial pressure cone. Arch. Neurol. Psychiat. (Chicago) 40:857, 1938.
21. JEFFERSON, G. & SHELDON, P. Transtentorial herniation of the brain as revealed by the displacement of arteries. Acta radiol. (Stockholm) 46:480, 1956.
22. JOHNSON, R. T. & YATES, O. Brains stem hemorrhages in expanding supratentorial conditions. Acta radiol. (Stockholm) 46:250, 1956.
23. KLINTWORTH, G. K. Evaluation of the role of neurosurgical procedures in the pathogenesis of secondary brains-stem haemorrhages. J. Neurol. Neurosurg. Psychiat. 29:423, 1966.
24. KLINTWORTH, G. K. Grooving of the uncus in the absence of overt intracranial disease. J. forens. Med. 9:137, 1962.
25. KLINTWORTH, G. K. Paratentorial grooving of human brains with particular reference of secondary brain-stem hemorrhages. Amer. J. Path. 53:391, 1968.
26. KLINTWORTH, G. K. The pathogenesis of secondary brainstem hemorrhages as studied in an experimental model. Amer. J. Path. 47:525, 1965.
27. LINDENBERG, R. Compression of the brain arteries as pathogenetic factor for tissue necroses and their areas of predilection. J. Neuropath. exp. Neurol. 14:223, 1955.
28. LINDENBERG, R. & FREYTAG, E. Brainstem lesions characteristic of traumatic hyperestension of the head. Arch. Path. 90:509, 1970.
29. MATSUOKA, K.; SAKAKI, S. & OKAMOTO, E. A clinico-pathological study on the cause of hemorrhagic lesions in the brain stem with head injury. Med. J. Osaka Univ. 17:257, 1967.
30. MOORE, M. T. & STERN, K. Vascular lesions in the brain-stem and occipital lobe occuring in association with brain tumours. Brain 61:70, 1938.
31. MUNRO, D. & SISSON, W. R. Hernia through the incisura of the tentorium cerebelli in connection with craniocerebral trauma. New England J. Med. 247: 699, 1952.
32. PIERRE MARIE, M. De l'engagement des amygdales cérébelleuses à l'interieur du trou occipital dans les cas oú la pression intracranienne se trouve augmentée. Rev. neurol. (Paris) 8:252, 1900.
33. POPPEN, J. L.; KENDRICK, J. F. & HICKS, S. F. Brain stem hemorrhages secondary to supratentorial space-taking lesions. J. Neuropath. exp. Neurol. 11:267, 1952.
34. SATO, K. Transtentorial herniation and brainstem hemorrhages in connection with acute head injuries. Arch. jap. Chir. 37:94, 1968.
35. SCHEINKER, I. M. Transtentorial herniation of the brain stem. A characteristic clinico-pathological syndrome: pathogenesis of the hemorrhages in the brain stem. Arch. Neurol. Psychiat. (Chicago) 53:289, 1945.
36. SCHWARZ, G. A. & ROESNER, A. A. Displacement and herniation of hippocampal gyrus through the incisura tentorii: a clinico-pathological study. Arch. Neurol. Psychiat. (Chicago) 46:297, 1941.
37. SHIMOURA, N. On the pontine hemorrhages in the fatal cases of head injury. Jap. J. leg. Med. 21:397, 1967.
38. STEEGMANN, A. T. The neuropathology of cardiac arrest. In MINCKLER, J., ed. Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1968, Vol. 1, p. 1005-1029.
39. SUNDERLAND, S. The tentorial notch and complications produced by herniations of the brain through that aperture. Brit. J. Surg. 45:422-437, 1958.
40. VINCENT, C; DAVID, M. & THIÉBAUT, F. Le cóne de pression temporal dans les tumeurs des hémisphères cérébraux: sa symptomatologie; sa gravité; les traitements qu'il convient de lui opposer. Rev. neurol. (Paris) 65:536, 1936.
41. VOGEL, F. S. The anatomy of head trauma. In SOMMERS, S. C., ed. Pathology Anual. Appleton-Century-Crofts, Educational Division Meredith Corporation, New York, 1971, Vol. 6, p. 321-336.
42. WEINTRAUB, C. M. Bruising of the third cranial nerve and the pathogenesis of midbrain haemorrhages. Brit. J. Surg. 48:62, 1960.

Datas de Publicação

Publicação nesta coleção
04 Abr 2013
Data do Fascículo
Dez 1975

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ATTWATER, N. L. Pontine haemorrhages. Guy's Hospital Rep. 65:339, 1911.

[2] 2. BALCKWOOD, W. Vascular diseases of the central nervous system. In BLACKWOOD, W.; McMENEMEY, W. H.; MEYER, A.; NORMAN, R. M. & RUSSEL, D. S. Greenfield's Neuropathology. 2^nd ed. Edward Arnold Ltd., London, 1963, p. 71-137.

[3] 3. BOGOSSIAN, L. Consequências do choque nos diferentes órgãos e tecidos. In Choque, 2.Ş edição. Rio de Janeiro, Livraria Atheneu, 1972, p. 21-36.

[4] 4. CABIESES MOLINA, F. & JERI, R. Transtentorial temporal lobe herniation. Acta neurol. latinoamer. 1:167, 1955.

[5] 5. CANNON, B. W. Acute vascular lesions of the brain stem. Arch. Neurol. Psychiat. (Chicago) 66:687, 1951.

[6] 6. CARREA, R. M. E. El edema agudo cerebral y las hemorragias mesencefálicas como causa de muerte em los tumores metastáticos. Arch. Neurocirugia (Buenos Aires) 1:228, 1944.

[7] 7. CARRILLO, R. Hérnias cisternales. Arch. Neurocirugia (Buenos Aires) 7: 498, 1950.

[8] 8. CATELAND, E. Les Hernies Cérébrales Internes. Imprimerie Commerciale du Nouvelliste, Lyon, 1944.

[9] 9. COCHRAN, W. G. Some methods for strengthening the common x² test. Biometrics 10:417, 1954.

[10] 10. COHEN, S. I. & ARONSON, S. M. Secondary brain stem hemorrhages. Arch. Neurol. (Chicago) 19:257, 1968.

[11] 11. CROMPTON, M. R. Brainstem lesion due to closed head injury. Lancet 1:669, 1971.

[12] 12. ECKER, A. Upward transtentorial hernation of the brain stem and cerebellum due to tumor of the posterior fossa with a special note on tumors of the acoustic nerve. J. Neurosurg. 5:51, 1948.

[13] 13. FEIGIN, I. Intracranial tension and cerebral edema. In MINCKLER, J., ed. Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1938, Vol. 1, p. 242-433.

[14] 14. FREYTAG, E. Autopsy findings in head injuries from blunt forces. Arch. Path. 75:402, 1963.

[15] 15. GARCIA AUST, E.; VILLAR, J. I.; AZAMBUJA, N. & ROIG, J. A. Experimental study of intracranial pressure: IV Brain displacements. Acta neurol. latinoamer. 12:164, 1966.

[16] 16. HASSLER, O. Arterial pattern of the human brainstem. Normal appearence and deformation in expanding supratentorial conditions. Neurology (Minneapolis) 17:368, 1967.

[17] 17. HASSLER, O. Brainstem haemmorrhages secondary to expanding supratentorial conditions. Acta path, microbiol. scand. 72:448, 1968.

[19] 19. HOWELL, D. A. Upper brains-stem compression and foraminal impaction with intracranial space-occupyng lesions and brain swelling. Brain 82:525, 1959.

[20] 20. JEFFERSON, G. The tentorial pressure cone. Arch. Neurol. Psychiat. (Chicago) 40:857, 1938.

[21] 21. JEFFERSON, G. & SHELDON, P. Transtentorial herniation of the brain as revealed by the displacement of arteries. Acta radiol. (Stockholm) 46:480, 1956.

[22] 22. JOHNSON, R. T. & YATES, O. Brains stem hemorrhages in expanding supratentorial conditions. Acta radiol. (Stockholm) 46:250, 1956.

[23] 23. KLINTWORTH, G. K. Evaluation of the role of neurosurgical procedures in the pathogenesis of secondary brains-stem haemorrhages. J. Neurol. Neurosurg. Psychiat. 29:423, 1966.

[24] 24. KLINTWORTH, G. K. Grooving of the uncus in the absence of overt intracranial disease. J. forens. Med. 9:137, 1962.

[25] 25. KLINTWORTH, G. K. Paratentorial grooving of human brains with particular reference of secondary brain-stem hemorrhages. Amer. J. Path. 53:391, 1968.

[26] 26. KLINTWORTH, G. K. The pathogenesis of secondary brainstem hemorrhages as studied in an experimental model. Amer. J. Path. 47:525, 1965.

[27] 27. LINDENBERG, R. Compression of the brain arteries as pathogenetic factor for tissue necroses and their areas of predilection. J. Neuropath. exp. Neurol. 14:223, 1955.

[28] 28. LINDENBERG, R. & FREYTAG, E. Brainstem lesions characteristic of traumatic hyperestension of the head. Arch. Path. 90:509, 1970.

[29] 29. MATSUOKA, K.; SAKAKI, S. & OKAMOTO, E. A clinico-pathological study on the cause of hemorrhagic lesions in the brain stem with head injury. Med. J. Osaka Univ. 17:257, 1967.

[30] 30. MOORE, M. T. & STERN, K. Vascular lesions in the brain-stem and occipital lobe occuring in association with brain tumours. Brain 61:70, 1938.

[31] 31. MUNRO, D. & SISSON, W. R. Hernia through the incisura of the tentorium cerebelli in connection with craniocerebral trauma. New England J. Med. 247: 699, 1952.

[32] 32. PIERRE MARIE, M. De l'engagement des amygdales cérébelleuses à l'interieur du trou occipital dans les cas oú la pression intracranienne se trouve augmentée. Rev. neurol. (Paris) 8:252, 1900.

[33] 33. POPPEN, J. L.; KENDRICK, J. F. & HICKS, S. F. Brain stem hemorrhages secondary to supratentorial space-taking lesions. J. Neuropath. exp. Neurol. 11:267, 1952.

[34] 34. SATO, K. Transtentorial herniation and brainstem hemorrhages in connection with acute head injuries. Arch. jap. Chir. 37:94, 1968.

[35] 35. SCHEINKER, I. M. Transtentorial herniation of the brain stem. A characteristic clinico-pathological syndrome: pathogenesis of the hemorrhages in the brain stem. Arch. Neurol. Psychiat. (Chicago) 53:289, 1945.

[36] 36. SCHWARZ, G. A. & ROESNER, A. A. Displacement and herniation of hippocampal gyrus through the incisura tentorii: a clinico-pathological study. Arch. Neurol. Psychiat. (Chicago) 46:297, 1941.

[37] 37. SHIMOURA, N. On the pontine hemorrhages in the fatal cases of head injury. Jap. J. leg. Med. 21:397, 1967.

[38] 38. STEEGMANN, A. T. The neuropathology of cardiac arrest. In MINCKLER, J., ed. Pathology of the Nervous System. McGraw-Hill Book Co., New York, 1968, Vol. 1, p. 1005-1029.

[39] 39. SUNDERLAND, S. The tentorial notch and complications produced by herniations of the brain through that aperture. Brit. J. Surg. 45:422-437, 1958.

[40] 40. VINCENT, C; DAVID, M. & THIÉBAUT, F. Le cóne de pression temporal dans les tumeurs des hémisphères cérébraux: sa symptomatologie; sa gravité; les traitements qu'il convient de lui opposer. Rev. neurol. (Paris) 65:536, 1936.

[41] 41. VOGEL, F. S. The anatomy of head trauma. In SOMMERS, S. C., ed. Pathology Anual. Appleton-Century-Crofts, Educational Division Meredith Corporation, New York, 1971, Vol. 6, p. 321-336.

[42] 42. WEINTRAUB, C. M. Bruising of the third cranial nerve and the pathogenesis of midbrain haemorrhages. Brit. J. Surg. 48:62, 1960.