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Marcus Welby, M.D.: Silken Threads and Silver Hooks

Nadine Cabot, actress, suffers a stroke on set, and another during a procedure called cerebral angiography, to assess the nature of the injury. That forces doctors to rush her into surgery, where they are only partially able to repair the damage. She awakens, a miracle in itself, with deficits and must work hard to recover from them. And her husband and business manager pushes her hard to make that recovery. But is he pushing her too hard?

Episode Info

Episode number: 1x4
Production Number: 30808
Airdate: Tuesday October 14th, 1969

Director: John Erman
Writer: John W. Bloch

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Guest Stars
Shirley O'Hara
As 1st Nurse
Alexander Scourby
As Lucas Coleman
Barbara Rush
As Nadine Cabot
Dorothy Dells
As 2nd Nurse
Fred Sadoff
As Jerry Ainsworth
Hanna Landy
As Renee
Peter Brandon
As Dr. Hoving
Main Cast
Robert Young
As Dr. Marcus Welby
James Brolin
As Dr. Steven Kiley
Episode Notes
Nadine Cabot suffered a ruptured aneurysm, which caused a cerebral hemorrhage. This is properly called a cerebrovascular accident, or a hemorrhagic stroke (the other sort of stroke is called ischemic, and occurs when a clot or other foreign body blocks a blood vessel). Blood irritates neurons (brain cells), which causes them to swell. The damaged artery does not conduct blood where it needs to go properly, further imperiling cells by depriving them of oxygen. These hazards can, if severe enough, kill regions of the brain, resulting in deficits. If the damage is not too severe and the patient works hard to rehabilitate, some or all of the loss can be recovered as the brain, a remarkably plastic organ, can recruit new neurons to do the jobs of the destroyed cells, rewiring itself in essence. It is not known why certain people develop what are called berry aneurysms (their names comes from their general shape). Genetics probably plays a role. Uncontrolled hypertension is a risk factor, as is diabetes, especially if refractory or poorly controlled.

Cerebral angiography involves routing a catheter through the arteries and into the brain. A contrast agent is injected via this catheter and X-ray images made. The contrast agent is designed to show up well on an X-ray, enabling doctors to see the basic structure of the cerebral vasculature. With this information, they can identify the source of the problem and plan their surgical intervention properly. Sometimes, they can correct an aneurysm without surgery, by inserting a coil of platinum wire through the catheter; this coil promotes the growth of connective tissue which patches the defect. (This procedure did not exist at the time this show was produced.) In a modern clinical setting doctors would probably use computer-aided tomography - a CAT scan - to identify the problem first, since this procedure is much less invasive.

Warning: Marcus Welby, M.D. season 1 episode 4 guide may contain spoilers
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