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In cases of completed middle cerebral artery territory stroke, prognosis is very poor and the clinical course is characterised by a rapid decline in consciousness and signs of herniation 2-4 days after the onset of symptoms due to a space-occupying mass. Failure of conservative therapy is the rule, and herniation is the usual cause of death, occurring in almost 80 per cent of cases. Recently published results have suggested that hemicraniectomy may improve survival in patients with massive hemisphericstroke, decreasing mortality to less than 35 per cent. The article presents what is probably the first case to be reported in Sweden, where hemicraniectomy was performed on a 45-year-old woman with right hemispheric completed middle cerebral artery infarction.

Angiography is carried out as a basic part of the sodium amobarbital procedure in most institutions in order to predict the distribution of the amobarbital before the procedure itself is performed. This paper presents details of cerebral circulation to provide a framework that will help investigators who are not radiologists to interpret angiography results. The application of angiography specifically to the amobarbital procedure and the implications of different patterns of arterial filling for interpretation of speech and memory test results are discussed.