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January 1975

Medical Treatment of Subdural Hematomas Challenged

Author Affiliations

Washington, DC

Arch Neurol. 1975;32(1):69. doi:10.1001/archneur.1975.00490430091024

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We are indebted to Drs. Bender and Christoff for their provocative contribution. It does "... seem a radical departure from convention..." to treat some subdural hematomas nonoperatively. Whether or not it "... actually represents progress..." cannot be determined from their study.

Given the observation that some subdural hematomas resolve without surgery, it does not necessarily follow that nonoperative intervention is the initial treatment of choice in all minimally symptomatic patients. It must also be shown that delaying surgery in favor of ineffective nonoperative treatment does not increase mortality and morbidity. Failing this, one must be able to identify at the outset those individuals who will not respond to medical management. The paper of Drs. Bender and Christoff does not provide this information.

Being advocates of an unorthodox treatment, Drs. Bender and Christoff must bear the burden of proving to us that nonoperative treatment for patients minimally ill with subdural hematoma is at

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