NEUROSURGICAL NAUSEA.

The article relates the author's experience as a neurosurgeon at Toronto Western Hospital, which is a regional referral centre that gets calls about cases at other hospitals. A 70-year-old man had been found by his family in the street near their home, apparently the victim of an assault. He had a deep cut on his head, was very drowsy and vomiting profusely. A CT scan showed bleeding inside the brain and in the space between the brain and skull. Life-saving surgery was needed. The leathery covering of the brain, the dura, was taut and discoloured blue from the blood bulging tensely beneath it. The patient's heartbeat became irregular. The patient had developed an uncommon blood-clotting disorder called disseminated intravascular coagulation. With the disorder, the blood loses its ability to clot so that thousands of tiny open veins and capillaries in skin and muscle leak blood. In this case, even his brain was oozing. The patient went on to make a good recovery. A few months later, as I recall the experience to write about it, I am still overcome with nausea.