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To the Editor.—
The question of diagnosis of chronic subdural hematomas (220:1370,1972) was well answered by Drs. McLaurin and Shapiro, but I believe warrants further amplification.Progressive signs of intracranial deterioration should always prompt the carrying out of definitive diagnostic procedures that are available. Needless to say, these should be carried out as soon as possible in order to rule out a surgically remediable lesion. Consideration must be given to the safety of such diagnostic tests and the potential morbidity.A chronic subdural hematoma exerts its effect by slowly expanding, causing compression of adjacent brain and later, more remote areas are involved, as enlargement proceeds. Symptoms are related to the speed of the expansion and the ability of the brain to compensate. In this respect, the subdural hematoma acts as a noninvasive neoplasm and must be considered in a similar light.In my opinion, lumbar puncture, besides being notoriously misleading,
Lyons AE. Diagnosis of Subdural Hematoma. JAMA. 1972;221(8):916. doi:10.1001/jama.1972.03200210060022