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The treatment for severe traumatic injuries of the brain may be divided into two large classes: The first class is surgical and is applied to extensive hemorrhages that can be localized. In this group are included such lesions as hematomas, extradural or subdural, and certain subarachnoidal hemorrhages, the situation of which, in the neighborhood of the motor area, for example, provokes localizing convulsions.
The second is the class of conservative treatment, the principal weapons of which are watching and waiting, and lumbar punctures. The latter is the treatment par excellence for pure concussion, that is, for a state of paralytic cerebral vasodilatation that follows traumatisms that are not severe enough to provoke anatomic or histologic cerebral lesions. In such cases, lumbar punctures permit alleviation of the hypertension that results from hypersecretion of cerebrospinal fluid caused by cerebral and pial congestion (the plexus is but pia invaginated in the proportion of
ODY F. ATLANTO-OCCIPITAL EVACUATIVE TREPANATION IN CONTUSIONS OF THE BRAIN. Arch NeurPsych. 1932;28(1):112–119. doi:10.1001/archneurpsyc.1932.02240010120007
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