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Summary. Cerebral blood flow and metabolism were measured by the iodoantipyrine-4-131I method in nine patients and by the nitrous oxide method in three patients with the Wernicke-Korsakoff syndrome.Cerebral blood flow and cerebral oxygen and glucose consumption were strikingly reduced from the normal, whereas cerebral vascular resistance was increased.Total cerebral metabolism and blood flow may be greatly reduced even though the cerebral metabolic defect is confined to circumscribed anatomical areas. Profound reduction in brain metabolism is not necessarily reflected in alterations of consciousness or awareness as has been previously suggested, or in electroencephalographic abnormalities. This appears to provide cogent support for the neurophysiological principle that disturbance of consciousness is a function of the location of the lesion, not the over-all degree of metabolic defect.The absence of improvement of cerebral metabolic functions in two patients who were restudied after an additional 2 to 3 weeks of treatment confirms the clinical impression of incomplete recovery in many such patients.

Schmidt (1945Schmidt ( , 1948, Shenkin, Harmel, and Kety (1948), Scheinberg (1950a, b), and Munck and Lassen (1957) suggest that blood in each internal jugular vein is probably representative of all histological regions of the homolateral cerebral hemisphere and not necessarily of the entire brain. In normal subjects or patients without occlusive vascular disease, unilateral cerebral blood flow and metabolism measurements are probably representative of whole brain values. The purpose of this presentation is to demonstrate that this is not necessarily true in patients with unilateral brain infarction and, further, that prediction of cerebral metabolic data from clinical evaluation is impossible without arteriographic correlation, because of the enormous variability of circulatory patterns in the human brain. METHODSThis study included 12 patients admitted to the neurology service at Jackson Memorial Hospital with acute vascular lesions of one cerebral hemisphere. The patients were carefully examined and followed in an effort to obtain as much clinical information as possible for correlative purposes. Arteriography was done to visualize the entire extracranial and intracranial arterial circulation. Ordinarily transbrachial catheterization arteriography was done but in certain cases it was necessary to resort to direct needle puncture of one or both carotid arteries in order to obtain an adequate study. A rapid cassette changer was utilized and usually six exposures made after each dye injection at the rate of one exposure per second in order to visualize the various stages of arterial and venous filling. Particular emphasis was placed on attempting to visualize sources and distribution of collateral circulation in subjects with demonstrated arterial stenosis or occlu-