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January 1975

Medical Treatment of Subdural Hematomas Challenged-Reply

Arch Neurol. 1975;32(1):69-70. doi:10.1001/archneur.1975.00490430091026

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To the Editor.—  Our purpose was to show that medical therapy was an acceptable alternative to surgery in certain cases. We do not believe that all cases as yet should be treated medically. A controlled prospective study of medical vs surgical therapy for subdural hematoma would be of interest but not feasible nor pertinent.Dr. Geissinger is concerned about what is happening to the brain while the hematoma is being absorbed during medical therapy. The same may be asked as to what happens after surgical therapy. This question has been answered in two publications (Cook et al: J Neurosurg 19:419, 1962, and McLaurin: Neurology, 15:866, 1965). Both showed that after surgical treatment there was persistence of fluid collections, midline shifts, and cerebral edema for up to two months. They also noted that these roentgenographic findings did not correlate with the clinical picture. It could be argued that since medical therapy

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