In a prospective study 76 children were divided into three groups on the basis of severity of head injury as defined by the Glasgow Coma Scale and duration of increased intracranial pressure. The children were administered a neuropsychological test battery and behavioural ratings were made by parents and teachers at three intervals: time of hospital discharge and 3 and 9 months post-initial testing. There were cognitive deficits related to severity of injury with the greatest difference in abilities observed between the severe and the other two groups. The greatest differences in skills were on the Performance IQ and timed tests of visual-motor speed and co-ordination. The greatest improvement in skills occurred in the first 3 months post-injury. Several children in coma for up to 4 weeks were able to obtain normal IQ scores. In the mild and moderate injury groups very few had behavioural change while in the severe group approximately 90% had one learning or adjustment difficulty and 40% had three or more problems.

No abstract

The epidural and cisternal pressure was recorded simultaneously in eight dogs. Epidural pressure was monitored with a Ladd fiberoptic sensor, and the cisternal pressure via a Statham transducer and a Grass polygraphy. Various pressure levels were compared when mock cerebrospinal fluid was injected into the cisterna magna. The results were analyzed statistically and, within a range of 0 to 70 mm Hg, a high degree of correlation was found between the pressures of the two compartments (r = 0.96 to 1.0).

Spontaneous spinal epidural hematoma was confirmed by myelography in an 8-year-old boy. The hematoma was removed more than 21 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The patient made a complete recovery.

In this address I shall discuss head trauma from an angle which may be unusual for neuroscientists. Our preoccupations are diagnostic challenges and management problems, but that which we experience at the bedside is only a narrow segment of a continuum which started with trauma somewhere in a war, on the road, at home, on the football field, in the boxing ring, and in many other distinct locations. When our role is over, there are only three places where head trauma victims can be found; in cemeteries, where every year, 5,000 new graves are made to accommodate fatal head injuries in Canada; in chronic hospitals, which are already overloaded with victims of various insults to the brain, and, of course, within society, which accepts the fully recovered or tolerates the subtle and not so subtle consequences of so-called ‘minor’ head injuries.