ACUTE NEUROGENIC ACTIVATION OF CHRONIC DUODENAL ULCERS: HEMORRHAGE OR PERFORATION FOLLOWING ACUTE CEREBROVASCULAR ACCIDENTS.

THE ASSOCIATION of acute gastrointestinal lesions with brain pathology has been known for many years.1It is only more recently, since the clinical observations of Cushing2and with the elucidation of the central control of gastrointestinal functions,3,4that this association has assumed a greater clinical importance. Acute neurogenic gastrointestinal ulceration and hemorrhage have been described as complications of a variety of traumatic, inflammatory, and neoplastic lesions of the central nervous system, as well as following intracranial operations and acute cerebrovascular accidents.5-11These complications are usually of grave clinical significance, in view of the associated neurological disorder, the nature and multiplicity of the gastrointestinal lesions, and the possible presence of gastromalacia. Every effort, therefore, is made to treat the patients conservatively, and surgery is usually only undertaken as a last resort. This is by itself a dangerous procedure under such circumstances and usually fails to change the